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Past ORCS Research Grants

The objective of this fund is to promote research regarding any field of acute or chronic lung disease. Research may include investigation of any phenomenon pertinent to illness assessment, management, or responses of the individual with a respiratory condition. Research may also be aimed at health promotion, education and prevention issues. Studies may use quantitative or qualitative methodologies. Applicants for funding must be ORCS members.

Research Funded (1991-Present)

2018-2019
2017-2018
2016-2017
2015-2016
2014-2015
2013-2014
2012-2013
2011-2012
2010-2011
2009-2010
2008-2009
2007-2008
2006-2007
2005-2006
2004-2005
2003-2004
2002-2003
2001-2002
2000-2001
1999-2000
1998-1999
1997-1998
1996-1997
1995-1996
1994-1995
1993-1994
1992-1993
1991-1992

2018-2019

Measuring Participation in Life Roles in People with COPD
Marla Beauchamp, PT, PhD

COPD is a lung condition that makes it hard for people to breathe. Treatment usually helps them walk for longer and manage their breathing problems. Patients’ ability to participate in life roles such as visiting with friends and taking care of loved ones is an important part of health that is often overlooked. In order to increase participation in people with COPD we need to find an accurate and reliable tool to measure it. This will be the first study to show the measurement abilities of a participation questionnaire in people with COPD. One hundred people will complete a few questionnaires and physical tests. Some of those people will complete the questionnaire again within one week. This will tell us if the participation questionnaire measures what it should and if the scores stay the same over time. Participation in life roles is important to patients and this study will improve our ability to measure and treat this important aspect of health.

Use of computed tomography to assess muscle mass in patients with interstitial lung disease at diagnosis and through disease progression:  a retrospective pilot study
Sylvia Rinaldi, MScFN, RD

Interstitial lung disease (ILD) is a group of disorders that involve irritation and swelling of the tissue lining the lungs. Little information is known about nutritional concerns of this patient population from diagnosis through disease progression. This study aims to address the question, can the amount of muscle mass at diagnosis and through disease progression predict survival in ILD? The research team will review 59 patient files from a previous pilot study. Previously completed CT-scans will be used to measure the amount of muscle mass at various stages of ILD beginning at diagnosis. In select cases, muscle mass determined using CT-scans will be used to validate previously completed body composition measures from the original pilot study. As minimal information is known about the nutritional status of ILD patients, it is hoped that the knowledge gained from the study will help health professionals provide best care to their patients with ILD.

The contribution of prefrontal neural activity to dyspnea and task failure during inspiratory and limb muscle exercise
Darlene Reid, BMR (PT), PhD

Dyspnea is a very threatening experience for many people who live with chronic lung disease.  Experiencing breathlessness day in and day out can be very exhausting for many of these individuals, regardless of the type of lung disease. One underlying cause of feeling fatigued might be the central processing of the brain required for planning physical activities of daily living and the emotional cost of being short of breath. This study will examine the brain activity that processes these emotional cues while people with lung disease perform exercises of the breathing muscles, the arms or the legs.   Examining the brain activity that provokes breathlessness will provide a stronger basis for targeting better treatments that could include medications, exercise, meditation or some combination of these.

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2017-2018

Is dual tasking compromised in people with COPD?
Darlene Reid, BMR (PT), PhD

Multitasking, such as walking across the street while looking at a cell phone, often results in doing one or both things poorly. People with cognitive impairment have more limitations when multitasking because they do not have the “brain-power” to devote to more than one activity at a time. For decades, people with chronic obstructive pulmonary disease (COPD) are known to have cognitive impairment and research has focused on how cognitive impairment affects mental functions such as memory or attention. To date, no one has looked at how brain activity affects balance and the ability to walk in people with COPD. In this study, brain activity during walking, standing on one leg and spelling words backwards will be compared in people with COPD, and older and young adults. Participants will then be asked to do two things at once: walking plus spelling backwards and standing on one leg plus spelling backwards. Mistakes made while doing two activities and brain activity will be compared to better understand how brain function affects balance and walking in COPD.

It has long been known that people with COPD often have cognitive impairment. Research into this has always focused on how mental functions such as memory or attention are impacted – functions that involve one mental task at a time. In contrast, this new research will look at how this cognitive impairment may impact people with COPD with regards to multi-tasking, specifically how focussing on other mental tasks may impact balance and walking

Patient and family centered performance measures focused on actionable processes of care for persistent or chronic critical illness
Louise Rose, RN, PhD

Some people admitted to an intensive care unit (ICU) end up staying for a long time because they are just not getting better and may develop other problems. Family members also experience a lot of emotional distress. There are ways to improve quality of care in the ICU, like daily checklists, but they work best for acute (or urgent) illness.  They don’t necessarily apply to patients who have been in the ICU for a long time with persistent or chronic illness.  Our research will find out what is most important to patients and their families, as well as the doctors, nurses and others who care for them. Our goal is to make hospital stays better for patients, so that they can get well. We will interview patients, their families, and doctors, nurses and others, to find out what is most important to them all. We will then develop tools that help us measure and improve the ICU experience for other patients.

High intensity interval versus moderate intensity continuous exercise in individuals with advanced interstitial lung disease.
Sunita Mathur, BScPT, MSc, PhD & Lisa Wickerson, BScPT, MSc, PhD

Exercise is a key component of pulmonary rehabilitation for people with interstitial lung disease.  Individuals with advanced interstitial lung disease can experience significant symptoms of shortness of breath and drop their levels of oxygen to very low levels which can limit exercise training and functional benefit.  Alternative methods of exercise training may allow individuals to exercise at a level that can lead to important improvements in functional ability, leading to better rehabilitation outcomes.  This study will compare the responses and preference of a traditional type of endurance exercise to a higher intensity exercise in order to investigate optimal strategies and modifications for exercise training in interstitial lung disease.

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2016-2017

Does Pulmonary Rehabilitation aggravate or relieve pain in individuals with Chronic Obstructive Pulmonary Disease?
Dina Brooks, PhD, MSc, BScPT, West Park Healthcare Centre, Toronto, Annemarie Lee, B.Physio, M.Physio, PhD, West Park Healthcare Centre, Toronto, Roger Goldstein, MD, FRCPC, West Park Healthcare Centre, Toronto

Recently, it has emerged that pain in the upper and lower back and neck region is the common problem for people with chronic obstructive pulmonary disease (COPD). However, it is not clear whether pain worsens or improves following pulmonary rehabilitation. This study will examine the effects of pulmonary rehabilitation on pain intensity, the ability to cope with pain, avoidance of activity due to pain and depression levels in a group of people with COPD who present with chronic pain upon enrolment to pulmonary rehabilitation. The effects of pulmonary rehabilitation on exercise tolerance and quality of life will be compared between those with pain and those without pain. With this intervention critical for COPD management, it is important to identify the impact of pain on exercise training and to know whether equal benefits are achieved in those with pain compared to those without pain. This information will inform the need for modification to a pulmonary rehabilitation program to ensure pain is adequately addressed.

Deoxygenation of Limb Muscles during Incremental Exercise in Persons with Interstitial Lung Diseas
Darlene Reid, BMR, PhD, Department of Physical Therapy, University of Toronto, Lisa Wickerson, PT, Toronto General Hospital, Toronto, Lianne Singer, MD, FRCPC, University Health Network, Toronto, Sunita Mathur, PhD, PT, University of Toronto

Exercise is an essential part of pulmonary rehabilitation for people with interstitial lung disease, yet we do not know if exercise can cause oxygen in the muscle to drop to damaging levels or if supplemental oxygen levels drop precipitously in arm or leg muscles during exercise in persons with interstitial lung disease by monitoring oxygen levels using a near infrared spectroscope (NIRS that rests on the skin overlying the muscle. Using this technology, changes in the amount of oxygen in muscle capillaries will be measured absolutely for the first time during progressive exercise to determine if oxygen levels are dangerously low in muscle and if some muscles preferentially get oxygen delivered to them at the expense of the others in interstitial lung disease. This study will inform considerations for optimal exercise prescription in people with interstitial lung disease to improve physical function and quality of life.

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2015-2016

Exploring the Effect of Mindfulness in Individuals with Respiratory Compromise: A Systematic Review
Tania Januadis-Ferreira, PhD, ScPT, West Park Healthcare Centre, Toronto; Dina Brooks, PhD, MSc, BScPT, West Park Healthcare Centre, Toronto; Roger Goldstein,MD, FRCPC, West Park Healthcare Centre, Toronto; Samantha Harrison, PT, West Park Healthcare Centre, Toronto

Individuals with respiratory compromise experience symptoms of intense breathlessness which can be very distressing. Psychological approaches such as Cognitive Behavioural Therapy (CBT) and mindfulness, aim to reduce feelings of distress. The function of CBT is to change thoughts potentially undermining legitimate feelings of anxiety surrounding breathlessness. Mindfulness-Based Stress Reduction has been found to be successful in reducing feelings of stress, anxiety, and depression in individuals with mental health issues and/or a diagnosis of a chronic condition. The technique of mindfulness, which uses breathing as a focus of concentration to re-direct thoughts and prevent rumination, may have uniquely supportive features for those with respiratory symptoms. The researchers of this study are proposing to conduct a systematic review of the current literature exploring the effect of mindfulness for adults with respiratory compromise. The results are intended to guide clinical practice and/or the development of a mindfulness intervention for individuals suffering from breathlessness. Such an intervention may be effective at improving health-related quality of life, psychological morbidity, and self-management.

The Diagnostic Accuracy of an Ambulatory Level III Sleep Study for the Screening of Sleep Disordered Breathing in Children with Neuromuscular Disease
Colin Massicotte, RPSGT,  Hospital for Sick Children, Toronto; Suhail Al-Saleh, M.B.B.S, MSc, FRCPC, RPSGT,Hospital for Sick Children, Toronto; Reshma Amin, MD, MSc, FRCPC, Hospital for Sick Children, Toronto; Laura McAdam, MSc, MD, Bloorview Research Institute, Toronto; Indra Narang,BMedSci, MBBCH, FRCPCH, MD,Hospital for Sick Children, Toronto

Children with neuromuscular disease (NMD) are at a high risk of sleep disordered breathing (SDB). A polysomnogram (PSG) is the gold standard test for its diagnosis. However, pediatric sleep facilities in Canada are limited, resulting in long wait times. Our objective is to evaluate the diagnostic accuracy of an ambulatory level III device in children with NMD. Children with NMD whom are referred for sleep evaluation will undergo an in-laboratory PSG while wearing a level III sleep device. Participants will also undergo an ambulatory level III study for one night at home. The PSG and the ambulatory level III studies will be conducted in random order within 14 days of each other. We will determine the sensitivity of the ambulatory level III study as compared to the PSG. Our study can improve future health outcomes through the implementation of a screening strategy using level III devices to facilitate early diagnosis and treatment of SDB, thus preventing unnecessary morbidity for children with NMD.

A Novel Method for Evaluating Sarcopenia Using Computed Tomography in Patients with Advanced Lung Disease
Sunita Mathur, PT, PhD, University of Toronto, Toronto; Heidi Roberts, MD, FRCPC, Women’s College Hospital, Toronto; Dmitry Rozenberg, MD, FRCPC, University Health Network, Toronto; Lianne Singer, MD, FRCPC, University Health Network, Toronto

There have been many medical and surgical advances in the field of lung transplantation, and as a result this life-saving surgery is being offered to older patients with more complex medical histories. Although this is promising, these individuals may be at higher risk for complications. A factor that has been linked to poor outcomes in older adults and liver and kidney transplant recipients is sarcopenia, a condition primarily defined by low muscle mass. However, there are no studies to date examining sarcopenia and its relevance to clinical outcomes in lung transplant recipients. To perform this type of research, a simple and accurate measure of sarcopenia for people with advanced lung disease is needed. The objective of our study is to develop a new method of evaluating muscle mass in people with advanced lung disease from the computed tomography (CT) scan of the chest that they undergo routinely as part of their clinical care. The overall goal of this work is to find a simple and accurate measure of sarcopenia that can be applied in all patients being evaluated for lung transplantation that can help identify those individuals who are at risk for poor outcomes and may need interventions to improve muscle health prior to transplant.

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2014-2015

Exploring the Immediate and Short-Term Effects of an Acute Exacerbation on Balance Control in Patients with Chronic Obstructive Pulmonary Disease   
Dina Brooks, PhD, MSc, BScPT, West Park Healthcare Centre, Toronto; Roger Goldstein,MD, FRCPC, West Park Healthcare Centre, Toronto; Samantha Harrison, PT, West Park Healthcare Centre, Toronto

Chronic Obstructive Pulmonary Disease (COPD) is punctuated by acute exacerbations (flare-ups) affecting leg muscle strength. Individuals with COPD have poorer balance than “healthy” people. Leg muscle strength plays a major role in balance and a reduction in strength, associated with an acute exacerbation, may further decrease balance and increase patients’ risk of falling. Therefore the objective of this study is to assess the immediate and short term effects of an acute exacerbation of COPD on balance. Following Pulmonary Rehabilitation (PR), patients with COPD will complete a balance assessment. If patients experience an acute exacerbation of COPD within 12 months of finishing PR, the balance assessment will be repeated within 10 days of experiencing symptoms and again after one month. The proposed study will allow for comparison of an individual’s balance before and after an acute exacerbation. A simple balance training program can improve balance among stable patients with COPD and as PR is now recommended following an acute exacerbation, the effect of an exacerbation and the future impact of balance training will be highly relevant.

Prevalence of COPD among Individuals Participating in Non-Pulmonary Rehabilitation Programs
Tania Janaudis-Ferreira, PhD, MScPT, West Park Healthcare Centre; Dina Brooks, PhD, MSc, BScPT, West Park Healthcare Centre, Toronto; Roger Goldstein,MD, FRCPC, West Park Healthcare Centre, Toronto

The main objective of this study is to find out the prevalence of chronic obstructive pulmonary disease (COPD) among individuals who are participating in non-pulmonary rehabilitation programs. We also want to find out whether COPD is associated with the length of time the patients stay at the rehabilitation hospital, their functional status and the location to which they are discharged. The study will include in- and out-patients from the rehab programs at the St. John’s Rehab site of Sunnybrook Health Sciences Centre, Toronto, Canada. We will approach patients aged 40 years or more with a smoking history of at least 20 pack-years and invite them to attend one assessment session. Patients will perform a spirometry test, which shows how well the lungs are working. This will help us with a definite diagnosis of COPD. We will collect information about their health (symptoms and presence of other diseases), functional status, length of time they stayed at the hospital and discharge destination.

Systematic Review of Rehabilitation in the Management of Patients with Acute Cardiorespiratory Conditions 
Deborah Lucy, PhD, MSc, MClSc, BScMR(PT), School of Physical Therapy, The University of Western Ontario, London; Dina Brooks, PhD, MSc, BScPT, West Park Healthcare Centre, Toronto; Tania Larsen, PT, London Health Sciences Centre, London; Erin Miller, PT, Wingham and District Hospital, Wingham; Monique Prendergast, PT, London Health Sciences Centre, London; Karen Kin-Yue Koo, MD, FRCPC, London Health Sciences Centre, London

Physiotherapists are routinely involved in the rehabilitation of patients with a variety of acute cardiorespiratory conditions such as pneumonia, rib fractures and collapsed lungs. Despite being considered part of standard medical care for these conditions, there is still much controversy surrounding the effectiveness and indications of the specialized techniques used by physiotherapists to treat these conditions. The researchers of this study are proposing to conduct a systematic review of the current literature on interventions used in the rehabilitation of individuals with acute cardiorespiratory conditions in order to determine their effect on cardiorespiratory and physical function. The results of this study are intended to inform the development of evidence-based practice guidelines to guide best practice and future research in the management of individuals with acute cardiorespiratory conditions.

Nutritional Status of Patients with Interstitial Lung Disease: A Cross-Sectional Pilot Study
Janet Madill, PhD, RD, Brescia University College, Western University, London; Marco Mura, MD, PhD, Western University

Interstitial lung disease (ILD) is a group of disorders that involve irritation and swelling of the tissue lining of the lungs. The goal of the study is to determine the nutrition profile of ILD patients and to determine the percentage of patients who have higher or lower than normal energy needs at two time points: pre- and post-lung transplantation. It is planned to recruit all 59 current patients of the ILD clinic at Victoria Hospital in London, Ontario. Project investigators will collect food, beverage and supplement intake data using a 24-hour food recall and a 3-day food intake record. A review of blood work history will be compared against these analyses. Additional values including but not limited to energy needs, percent body fat and body water will be measured using a BodyStat© Analyzer machine. As minimal information is available on the nutritional status of ILD patients, the knowledge gained from the study will provide guidance to health professionals, including Registered Dietitians, to provide best care through evidence-based nutrition care plans to their patients with ILD.

The Transition of Teenagers Receiving Long-Term Domiciliary Mechanical Ventilation to Adult Care: The TTEEN VENT STUDY
Louise Rose, RN, PhD, University of Toronto; Reshma Amin,MD, MSc, FRCPC, The Hospital for Sick Children, Toronto; Craig Dale, RN, University of Toronto; Robert Varadi, MD, FRCPC, West Park Healthcare Centre, Toronto; Khushnuma Amaria, PhD, University of Waterloo; Roger Goldstein,MD, FRCPC, West Park Healthcare Centre, Toronto

During transition to adult healthcare services, ventilator assisted adolescents (VAA) are at high risk of negative outcomes such as loss to follow up, increased hospitalization and death. Our aim is to explore the experience and medical outcomes of VAAs and their caregivers as they transition from the program established by the pediatric Complex Respiratory Care Program at SickKids to the adult program at West Park Healthcare Centre (WPHC). We will perform longitudinal qualitative interviews of VAA-caregiver dyads at three time points: 1) during the last year in pediatric care; 2) within 1 month of the transition clinic visit at WPHC; and 3) 1 year after this transition clinic visit. Medical outcomes will also be reviewed. This study will determine if our current transition program is meeting the needs of VAAs and their caregivers, inform future improvements, and help us contribute to the design of similar programs in other institutions managing healthcare transition for VAAs across Canada and internationally.

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2013-2014

Balance Training for COPD in Pulmonary Rehabilitation: An effectiveness study
Dina Brooks, PhD, MSc, BScPT, West Park Healthcare Centre, Toronto; Samantha Harrison, PT, West Park Healthcare Centre, Toronto; Marla Beauchamp, PT, University of Toronto; Suzanna Mangovski-Alzamora, PT, West Park Healthcare Centre, Toronto; Roger Goldstein,MD, FRCPC, West Park Healthcare Centre, Toronto

Exercise with balance training is an important component of falls prevention for older adults. The exercise component of pulmonary rehabilitation (PR) is considered the cornerstone of rehabilitation to increase endurance. Balance training and fall prevention are not included in international guidelines for pulmonary rehabilitation and few programs include balance assessment. We reported that a pulmonary rehabilitation program without balance training resulted in only minor changes in balance. We then did a study of balance training in addition to pulmonary rehabilitation and established that it is effective in making balance better in patients with moderate to severe COPD. Despite this evidence, balance training has yet to be incorporated into a pulmonary rehabilitation program. Therefore, the aim of the study is to directly translate what we know from laboratory studies regarding balance training into a clinical setting of pulmonary rehabilitation. We will evaluate the feasibility and effectiveness of making balance training a component of the entire pulmonary rehabilitation program. In order for this training technique to be used in other PR programs, the implementation process needs to be clearly described and be appropriate for a clinical setting.

A Comparison of Upper and Lower Limb Muscle Function in Lung Transplant                 
Sunita Mathur, PhD, PT, University of Toronto; Dina Brooks, PhD, MSc, BScPT, West Park Healthcare Centre, Toronto; Denise Helm, PT, University Health Network, Toronto; Tania Janaudis-Ferreira, PhD, MScPT, West Park Healthcare Centre; Lianne Singer, MD, FRCPC, University Health Network, Toronto; Lisa Wickerson, PT, Toronto General Hospital, Toronto

Lung transplantation is a life-saving surgery for people with severe lung diseases. Lung transplant recipients experience vast improvements in their symptoms of breathlessness; however, they still experience long-term limitations in their physical function. One major factor limiting their function after transplant is muscle weakness. Previous research has focused only on studying weakness of the leg muscles which are important for walking. However, we actually use our upper body muscles for many of our daily activities such as grooming, leisure activities and housework. Our study will be the first to examine whether the upper body muscles undergo a similar decline in function as the leg muscles in people who have a lung transplant. We will examine muscle strength, muscle size and exercise capacity of the arms in people pre-transplant and then up to six months after their transplant. The findings from this study will inform us on whether upper body exercise training is needed for people pre- and post-lung transplantation to optimize their function and independence after surgery.

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2012-2013

Patient and Provider Perspectives on a Community-Based, Post-Rehabilitation Exercise Program for Chronic Cardiorespiratory Diseases
Dina Brooks, PhD, MSc, BScPT, West Park Healthcare Centre, Toronto; Roger Goldstein,MD, FRCPC, West Park Healthcare Centre, Toronto; Laura Desveaux, HBSc, MDcPT, University of Toronto, Toronto

There are a large amount of recent studies that support the use of community-based programs to optimize function in patients with chronic heart and lung conditions. What these studies do not address is what patients think about these programs and what they feel they need in order to consistently attend. One of the key factors linked to decreased function is a lack of completing a home exercise program. In lights of this, it is important to understand the factors that influence attendance to a community program in order to make it successful. In addition, it is important to understand the thoughts of all individuals involved in the programs, including healthcare professionals and community fitness instructors. The study aims to understand the thoughts of the patients, healthcare professionals and fitness instructors that would be involved in a community program in order to better inform development of the program.

Improving Measurement of Activities of Daily Living in Chronic Obstructive Pulmonary Disease
Tania Janaudis-Ferreira, PhD, MScPT, West Park Healthcare Centre; Dina Brooks, PhD, MSc, BScPT, West Park Healthcare Centre, Toronto; Mary Stergiou-Kita, PhD, University of Toronto; Roger Goldstein,MD, FRCPC, West Park Healthcare Centre, Toronto; Marla Beauchamp, PT, University of Toronto

This study has three objectives: 1) to develop a structured framework of activities of daily living (ADL) for individuals with chronic lung disease; 2) to list and review tools that evaluate ADL in elderly and chronic lung disease, and 3) to make recommendations for future research. We will conduct a literature review and use patient interviews to identify the factors that will help develop a framework for understanding ability during ADL. We will also identify and review tools that assess ADL in elderly and in those with chronic lung disease and map each measure to the concepts included in the developed framework. Finally, we will make recommendations for future research. This will be the first study to incorporate the three pillars of evidence-based practice (best available research, patients’ values and expert opinion) in the development of an ADL framework for individuals with chronic lung disease

Sleep Disturbance in Family Caregivers of Technology Dependent Children
Krista Keilty, RN, MN, PhD(c), University of Toronto; Robyn Stremler, RN, BSc(Hons), MSc(A), PhD, The Hospital for Sick Children, Toronto; Eyal Cohen, MD, FRCPC, The Hospital for Sick Children, Toronto; Eleanor Pullenayegum, PhD, The Hospital for Sick Children; Karen Spalding, RN, PhD, Ryerson University, Toronto

Society relies on family caregivers of technology dependent children (TDC), including those on home ventilation and oxygen, to provide ‘around the clock’ home care for these children. Sleep disturbance emerges as a common complaint among these family caregivers. Chronic sleep deprivation is associated with negative health and daytime consequences, such as depression and fatigue. This study will investigate sleep over one week in 40 family caregivers of TDC and compare it to sleep in 40 family caregivers of healthy children. Participants will be recruited from a paediatric hospital and community clinics. This study will be the first to use Actigraphy (a non-invasive wrist watch like device) to collect objective data about sleep-awake patterns in family caregivers of TDC. Daily sleep diaries will also be kept by the participants and measures of depression, sleepiness, fatigue and quality of life will be applied. This study will characterize sleep and related health and daytime consequences in family caregivers and explore which caregiver, child and environment factors influence their sleep disturbances. Results will inform targeted interventions and be of interest to caregivers, clinicians, researchers and policy makers.

Understanding the Process of Weaning from Mechanical Ventilation: A Grounded Theory Study Ventilation: A Grounded Theory Study
Deborah Lucy, PhD, MSc, MClSc, BScMR(PT), School of Physical Therapy, The University of Western Ontario, London; Tania Larsen, PT, London Health Sciences Centre, London

A small but significant proportion of patients admitted to the intensive care unit (ICU) are unable to wean from mechanical ventilation (MV) and resume breathing independent of the ventilator, requiring them to live in the ICU for long periods of time with very poor quality of life. Psychological factors such as anxiety, depression and hopelessness are thought to affect a person’s ability to be successfully weaned from the ventilator. Although recognized as important these factors are not currently used to determine whether a person is ready to wean from the ventilator; nor are the effects on the outcome if weaning well understood. In that regard, this study aims to develop a theory on the process of weaning by interviewing people both successful and unsuccessful in weaning attempts about their experiences. Findings of this study will further understanding about the impact of psychological factors on the process of weaning and as such may improve the process and ultimately patient outcomes.

Paediatric Home Long-Term Mechanical Ventilation: Healthcare Costs and Utilization
Mika Nonoyama, RRT, BSc, PhD, University of Toronto; Sherri Katz, MD, FRCPC, Children’s Hospital of Eastern Ontario, Ottawa; Louise Rose, RN, PhD, University of Toronto; Douglas McKim, MD, FRCPC, The Ottawa Hospital; Denise Guerriere, PhD, University of Toronto; Judy King, PT, PhD, University of Ottawa; Reshma Amin,MD, MSc, FRCPC, The Hospital for Sick Children, Toronto

Children requiring long-term assistance from breathing machines (ventilators) live at home to promote quality of life, despite the potential physical, psychological and financial burden. In Canada there is little information describing the healthcare use and financial costs of caring for ventilated assisted individuals (VAIs) under the age of 16 years old living at home. The objective of the study is to assess healthcare use and financial cost and the health-related quality of life (HRQoL) of VAIs living at home. We will interview 195 caregivers of VAIs every 2 weeks for 6 months. Public and private healthcare expenditures, HRQoL, caregiver burden, and VAI ability to perform daily activities will be collected. Our study population requires the highest level of respiratory support – mechanical ventilation – and extends to many respiratory diseases, disorders or syndromes. Study results will inform policy makers to distribute funds that would optimally support VAIs and their families living at home, including the development of effective, consistent and cost-efficient programs aimed at prevention of complications, health management and health promotion.

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2011-2012

Arm activity in daily life in chronic obstructive pulmonary disease
Dina Brooks, PhD, MSc, BScPT, Department of Physical Therapy, University of Toronto, Roger Goldstein, MD, FRCPC, West Park Healthcare Centre, Toronto, Tania Janaudis-Ferreira PhD, MSc, BScPT, West Park Healthcare Centre, Toronto

Many patients with chronic lung disease report difficulty in performing simple activities of daily living that involve arms, such as showering, dressing, making the bed and carrying groceries. These difficulties limit their independence during daily life. Despite this, there is currently no research specifically comparing arm activity during daily life in people with lung disease and healthy age matched individuals. This study will address two questions: (i) does arm activity during daily life differ between those with COPD and healthy age matched individuals?, and (ii) is there an association between arm activity during daily life, disease severity, breathlessness during daily life, arm exercise capacity or muscle strength? Individuals who agree to participate in the study will be asked to wear an activity monitor around their wrist for 5 days. Arm exercise capacity, arm strength and breathlessness during daily life will be collected. Measures will be compared with those of healthy age matched controls.

Mechanical ventilator weaning: a knowledge synthesis to guide practice and improve outcome
Louise Rose PhD, MN, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Bronagh Blackwood, PhD, MSc, BScN, Queen’s University, Belfast, Northern Ireland, Karen Burns, MD, MSc (Epid), FRCPC, St. Michael’s Hospital, Toronto, Sean Clarke, RN, PhD, FAAN, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Katie Dainty, MSc, CRPC, PhD, St. Michael’s Hospital, Toronto, Philippe Jouvet, MD, PhD, Hopital Ste Justine, Montreal, Dr. Danny McAuley (Queen’s University, Belfast, Northern Ireland), Dr. Jane Noyes (Bangor University, Wales) and Dr. Marcus Schultz (University of Amsterdam, The Netherlands).

Critically ill patients receiving assistance from breathing machines (ventilators) may be restored to normal breathing using clinical methods (termed weaning). Inappropriate weaning practices may result in prolonged time on a ventilator putting patients at risk of lung injury, pneumonia, and death. Weaning protocols (written guidance and/or computer programs built into the breathing machine) are potential solutions to inefficient weaning methods. By conducting this evidence review we aim to identify factors, such as intensive care unit organization, staffing, and leadership, as well as clinician attitudes, influencing the use and effect of weaning protocols and computerized weaning programs on reducing the time spent on a ventilator. Our project will inform future ventilator weaning management including clarification of what works, for whom, and in what circumstances.

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2010-2011

Peripheral muscle strength, functional exercise capacity and physical activity before and after lung transplantation
Dina Brooks, PhD, MSc, BScPT, Department of Physical Therapy, University of Toronto and Lisa Wickerson, BScPT, MSc(c), Department of Physical Therapy, University of Toronto, Sunita Mathur, BScPT, MSc, PhD, Department of Physical Therapy, University of Toronto, Lianne Singer, MD, FRCPC, University Health Network, Toronto, Roger Goldstein MD, FRCPC, West Park Healthcare Centre, Toronto, Denise Helm BScPT, Toronto General Hospital, Toronto

The study will compare peripheral muscle function, functional exercise capacity and daily physical activity in thirty-five people pre- and post-lung transplant. Measurements will be taken pre-transplant, at the time of hospital discharge post-transplant, and three and six months post-transplant. This study will also explore the associations between peripheral muscle strength, functional exercise capacity and daily physical activity. The results of this study will quantify the functional changes that occur after lung transplantation and describe the relationship between clinical measures of strength and exercise capacity with physical activity patterns in the community. The information provided can be utilized in the implementation of rehabilitation programs designed to improve functional outcomes in this population.

Non-invasive examination of muscle composition in people with chronic obstructive pulmonary disease
Sunita Mathur, BScPT, MSc, PhD, Department of Physical Therapy, University of Toronto, Ali Naraghi, FRCR, MD, University of Toronto, Marshall Sussman, PhD, Medical Imaging, University Health Network, Toronto, Lawrence M. White, MD, FRCPC, University Health Network, Toronto, Roger Goldstein, MD, FRCPC, West Park Healthcare Centre, Toronto

In addition to the primary condition affecting the airways and lungs, chronic obstructive pulmonary disease (COPD) is characterized by the loss of muscle mass (atrophy) and muscle weakness. Muscle atrophy alone does not explain the loss of strength and mobility observed in people with COPD. Changes in muscle composition, such as the inclusion of fat or edema within the muscle tissue, may also account for impaired strength and mobility. Previous studies have provided only limited information about the composition of skeletal muscle in people with COPD, and have used invasive procedures (muscle biopsies). Therefore, the overall objective of this proposal is to examine skeletal muscle composition in people with COPD using non-invasive measures, specifically magnetic resonance imaging and spectroscopy (MRI/MRS). The results of this study will provide a better understanding of the causes of muscle dysfunction in people with COPD and assist clinicians in developing targeted rehabilitation programs to improve muscle function and mobility in this population.

A meta-synthesis of qualitative findings on improving care in COPD
Christina McMillan Boyles, RN, MScN, Laurentian University, Sudbury, Julie Duff Cloutier, RN, BScN, MSc, Laurentian University, Sudbury, Dr. Phyllis Montgomery, RN, B.ScN, MScN, Ph.D, Laurentian University, Sudbury, Patricia Bailey RN, MHSc, PhD, Laurentian University, Sudbury

Health care providers and policy makers are becoming more aware of the limitations of randomized controlled trials as the only source of “evidence” in Chronic Obstructive Pulmonary Disease (COPD) research. There are numerous narrative types of studies about persons living with COPD. This body of evidence, however, includes a range of study approaches and results. This, in turn, makes it challenging to use such sources of evidence in response to practice issues, to inform interventions and to strengthen the delivery of COPD care. The purpose of this project is to summarize the content of findings across a family of published national and international narrative studies. The studies of particular interest for this project focus on patients’, family members’ and health care providers’ experiences in COPD. The core question is, “How do patients, families and health care providers suggest COPD care be improved?” By combining all the evidence in selected reports, a unique interpretation will be offered. The results of this study will be a summary of the multiple care approaches of COPD as reported by participants in the sample of studies. The refinement of the narrative evidence for practice and the identification of future research endeavours will assist in strengthening the use of evidence in COPD care interventions and services.

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2009-2010

Balance Impairment in COPD and the effect of pulmonary rehabilitation on the recovery of balance
Dina Brooks, PhD, MSc, BScPT, Department of Physical Therapy, University of Toronto, Roger Goldstein, MD, FRCPC, West Park Healthcare Centre, Toronto, Katherine Berg, PhD, MSc, BScPT, University of Toronto, Kathryn M. Sibley, PhD, MSc, Department of Physical Therapy, University of Toronto

We have recently shown, for the first time, that individuals with COPD have greater impairments in the balance control than healthy people of the same age. This places them at an increased risk of falls. The control of balance is complex and involves interaction of several components of the musculoskeletal and neural systems. To date, no study has examined which specific components of balance are impaired in individuals with lung disease. Understanding which elements of balance control are affected is critical for planning treatment strategies. Moreover, it is unknown whether traditional respiratory rehabilitation programs confer any benefits in terms of balance that are impaired in individuals with COPD. Therefore, this study aims to; 1) indentify the specific components of balance that are impaired in individuals with COPD and 2) describe the effect of respiratory rehabilitation on balance in this population.

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2008-2009

The Six-Minute Walk Test: Responses in healthy Canadians aged 45 – 85 years
Dina Brooks, PhD, MSc, BScPT, Department of Physical Therapy, University of Toronto and Kylie Hill, PhD, BScPT, West Park Healthcare Centre, Toronto, Tom Overend, PhD, BScPT, The University of Western Ontario, London, Roger Goldstein, MD, FRCPC, West Park Healthcare Centre, Toronto.

In Canada, the six-minute walk test (6MWT) is the most commonly used test of functional exercise capacity in patients with chronic obstructive pulmonary disease (COPD). The test requires individuals to walk as far as possible in six minutes, with the outcome of interest being the distance covered. To interpret the results of this test in people with chronic lung disease, distances covered during the six-minutes (6MWD) are compared with those expected in healthy people of similar age. Previous studies have shown that the 6MWD in health people varies with different test protocols and between different ethnicities. To date, no study has described the normal responses to a 6MWT in healthy Canadians using the test protocol endorsed by the American Thoracic Society. Therefore, this study aims to: (I) develop an equation to allow a normal 6MWD to be estimated and, (ii) examine the cardiorespiratory responses during the test in healthy adult Canadians.

A Survey of Suctioning Practices among Physiotherapists, Nurses and Respiratory Therapists
Tom Overend, PhD, BScPT School of Physical Therapy, The University of Western Ontario, London, Cathy Anderson, BScPT, MSc, London Health Sciences Centre, Dina Brooks, PhD, MSc, BScPT, Department of Physical Therapy, University of Toronto, Lisa Cicutto, RN, PhD, Faculty of Nursing, University of Toronto/National Jewish Medical and Research Center, Denver, Colorado, Michael Keim, RRT, St. Joseph’s Health Care London, Debra McAuslan, RN, MScN, London Health Sciences Centre, Mika Nonoyama, RRT, BSc, PhD(c), West Park Healthcare Centre, Toronto

Patients who cannot clear their own respiratory secretions through coughing need to have their airways cleared through a technique called suctioning. Physiotherapists, nurses and respiratory therapists carry out suctioning in various care settings ranging from intensive care units to home care. Although absolutely necessary for breathing, the technique is invasive and not without risk. A survey of suctioning practices of physiotherapists, nurses and respiratory therapists in Ontario was last conducted in 1997. Subsequent to this, a clinical practice guideline (CPG) was published in 2001. We propose to re-survey health care professionals on their suctioning practices for two reasons: 1) to assess changes in practice since the first questionnaire, and 2) as part of the preparation for an updated CPG that our research team is developing. Our research team is interdisciplinary, including physical therapists, nurses and respiratory therapists who will pool their respective knowledge and expertise in the development of the survey, analysis of the data, and dissemination of the results.

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2007-2008

Exercise Following Heart or Lung Transplant: A Qualitative Exploration of Adolescent Perceptions and Behaviours
Alison Hassall, BScPT, MSc, Department of Rehabilitation Services, The Hospital for Sick Children, Toronto, Robin Deliva, BScPT, MSc, The Hospital for Sick Children, Toronto, Barbara Gibson, BMR(PT), MSc, PhD, Department of Physical Therapy, University of Toronto

Exercise helps to prevent some of the problems that can occur due to having a transplanted organ, e.g., weight gain, high blood pressure. At the Hospital for Sick Children, part of the transplant protocol for children over the age of six years is that they participate in an exercise program under the direction of a physiotherapist. There is a lack of research on how children view exercise, what their perceptions of their physical activity behaviours are when they return to their communities, or what difficulties they face in maintaining long-term fitness. In this study, we will interview children between the ages of 10-18 who have undergone a heart or lung transplant to ascertain their perceptions and experiences of post transplant exercise program. Interviews will occur at 3 months and one year post transplant. The study will contribute to further development of pediatric exercise programs and guide long-term fitness for this population.

The Long-Term Psychosocial Impact of SARS: Perspectives of Children who were Hospitalized for SARS and their Parents
David Nicholas, MSW, RSW, PhD, Academic and Clinical Specialist, Department of Social Work, The Hospital for Sick Children (HSC), Toronto, Donna Koller, PhD, Department of Child Life, HSC, Robin Gearing, MSW, RSW, PhD, Department of Social Work, HSC

The Severe Acute Respiratory Syndrome (SARS) outbreaks that occurred in the Spring of 2003 had profound effects in various global regions. Aside from a few studies, relatively little is known about the psychosocial impact of SARS and in particular, the long-term impacts of the outbreaks on children and families directly affected by the virus. In many ways, the SARS experience mirrors that of other traumatic events, (i.e., natural disasters), which can pose lasting psychological effects on those who experienced the crisis. Ethnographic in-depth interviews were previously conducted with children who were hospitalized for suspected or probable SARS, their parents and health care professionals who provided direct care to pediatric patients. Results indicated that even several months after the SARS outbreaks, participants experienced a range of emotional responses including fear, anxiety and post-traumatic distress resulting from imposed outbreak isolation. In this present study, we plan to repeat interviews with children and families directly affected by SARS so that we can appreciate the long-term impact of the SARS experience on children and their parents. In particular, the identification of potential post-traumatic responses will be explored. This will provide a unique opportunity to inform future best practices in terms of responding and mediating any long-term impacts on children and their families. Objectives include providing recommendations for contingency planning in the event of a future health emergency such as a flu pandemic, and knowledge transfer strategies for ensuring that study findings are shared with families and professionals who work with children.

Evidence-based Suctioning: An Interdisciplinary Systematic Review
Tom Overend, PhD, BScPT, Associate Professor, School of Physical Therapy, The University of Western Ontario, London, Cathy Anderson, BscPT, MSc, London Health Sciences Centre, Dina Brooks, PhD, MSc, BScPT, Department of Physical Therapy, University of Toronto, Lisa Cicutto, RN, PhD, Faculty of Nursing, University of Toronto/University of Colorado, Michael Keim, RRT, St. Joseph’s Health Care London, Debra McAuslan, RN, MScN, London Health Sciences Centre, Mika Nonoyama, RRT, BSc, PhD(cand.), West Park Healthcare Centre, Toronto
Funded jointly with Canadian Respiratory Health Professionals section of CLA
Patients who cannot clear their own respiratory secretions through coughing need to have their airways cleared through a technique called suctioning. Physiotherapists, nurses and respiratory therapists carry out suctioning in various care settings ranging from intensive care units to home care. Although absolutely necessary for breathing, the technique is invasive and not without risk. It is thus important to use best practice, which must be based on the best-available literature. We propose to update current recommendations for suctioning by carefully and systematically reviewing all relevant research studies. Our research team is interdisciplinary, including physical therapists, nurses and respiratory therapists who will share their respective knowledge and expertise in the systematic review of the literature. All papers identified will be carefully assessed for quality to ensure that only the best papers contribute to the new recommendations. We expect to reduce some of the uncertainty currently associated with the act of suctioning so that our patients will benefit from this new standard of best practice.

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2006-2007

Satisfaction with Rollators among Individuals Living in the Community
Dina Brooks, BScPT, MSc, PhD, Associate Professor, Department of Physical Therapy, University of Toronto; Cathy Relf, BScPT, Physiotherapist/Kylie Hill, PhD, Research Fellow, West Park Healthcare Centre, Toronto, Roger Goldstein, MD, Respirologist, Elizabeth Gartner, Occupational Therapist, West Park Healthcare Centre, Toronto

Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory disorder of which the main symptoms include shortness of breath and limited exercise tolerance. For most people with COPD, walking is a preferred form of exercise and is usually part of their rehabilitation program. Ambulation aids are funded by the government based on an assessment by a healthcare professional. A popular ambulation aid is the rollator, which is a walker with four wheels, equipped with swivel castors in the front two wheels, hand brakes, a basket for carrying items and a seat that allows the user to rest. Despite the popularity of rollators and the substantial cost to the government, little is know about satisfaction level among users with COPD. The purpose of this study is to determine how satisfied individuals with COPD are with rollators, explore reasons for dissatisfaction and investigate the effect of demographics and severity of their disease on satisfaction. Patients with COPD from the Respiratory Medicine Clinic at West Park Healthcare Centre will be recruited as potential subjects. Subjects who meet the eligibility criteria will be interviewed using a generic questionnaire to assess a person’s satisfaction with a wide range of assistive technology. We will also use a standardized questionnaire with specific questions to those with COPD.

Increasing Access to Supportive Care for Lung Cancer Patients: A Feasibility Study
Margaret Fitch, RN, PhD, Head, Oncology Nursing and Supportive Care, Toronto Sunnybrook Regional Cancer Centre, Rose Steele, RN, PhD, Associate Professor, York University School of Nursing

Patients with lung cancer experience a wide range of supportive care needs – social, psychological, spiritual, informational, physical and practical issues arise for them. However, often they do not get the help they need in a timely way, if at all. This project is designed to determine if all patients coming to a lung cancer clinic could be screened so that those at risk for having difficulties could be identified and referrals to help (i.e., supportive care services) could be made quickly. Escalating levels of intervention will be assessed through follow-up interviews three months after accrual. The results will uncover the feasibility of screening all patients as well as identify which intervention is most efficient and effective. In busy clinic environments, it is important to have standardized ways of identifying the patients who need help immediately. If health care professionals do not have a quick way to identify people who need supportive care, patients might not get the help required to meet all their needs.

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2005-2006

What is the effect of aerobic exercise training on inspiratory muscle training in individuals with chronic lung diseases?: a systematic review
Lynne Geddes, BScPT, MRE, School of Rehabilitation Sciences, McMaster University, Hamilton, Kelly O’Brien, BScPT, Department of Physical Therapy, University of Toronto, Dina Brooks, PhD, MSc, BscPT, Department of Physical Therapy, University of Toronto, W Darlene Reid, PhD, School of Rehabilitation Sciences, University of British Columbia, Jean Crowe, MHSc, School of Rehabilitation Sciences, McMaster University
Funded jointly with the Canadian Respiratory Health Professionals

Individuals with chronic obstructive lung diseases often have weak breathing muscles. This muscle weakness can cause shortness of breath and poor exercise tolerance, resulting in significant limitation in their level of activity. At this time, it is unclear whether general aerobic exercise of the extremities (such as walking, cycling) results in improvement in inspiratory muscle strength and endurance or whether specific inspiratory muscle training is required. This study will systematically review the evidence to see if general aerobic exercise increases strength and endurance of the breathing muscles and will look at the type, intensity, frequency and duration of exercise needed to have an effect on the breathing muscles. Recommendations for type, intensity, frequency and duration of exercise needed to promote increases in strength and endurance of breathing muscles will then be made to assist health care professionals to prescribe exercise for individuals with chronic obstructive lung diseases.

A critical exploration of the relationship between personal support workers and ventilator-users
Barbara Gibson, BScPT, MSc, PhD(c), Dina Brooks, PhD, MSc, BscPT, Department of Physical Therapy, University of Toronto,Dina Brooks, PhD, MSc, BscPT, Department of Physical Therapy, University of Toronto, Dr. Beverley J. Antle, The Hospital for Sick Children, Catherine Frazee, School of Disability Studies, Ryerson University

Technical advances and shift away from institutions have resulted in community living for “severely” disabled persons such as those who rely on ongoing mechanical ventilation (ventilator-users). Many ventilator-users require several hours per day of assistance that is provided by non-professional personal support workers (PSWs). In this study, we will examine the relationship between ventilator-users and paid PSWs. One-on-one qualitative interviews will be conducted with 10 ventilator-users and 10 of their PSWs in supported housing environments in the greater Toronto area. By exploring both sides of the relationship, this study may inform policy changes for both caregivers and recipients of care.

Abdominal support and functional outcomes in patients undergoing major abdominal surgery: a randomized control trial
Deborah Lucy, PhD, MSc, MClSc, BScMR(PT), School of Physical Therapy, The University of Western Ontario,Tom Overend, PhD, BScPT, The University of Western Ontario,

Following major abdominal surgery, patients commonly experience adverse effects such as incisional pain and anxiety and distress, making it difficult to breathe deeply and move. The purpose of this study is to investigate the effects of supporting the abdominal incision with an elastic binder on the ability to move, perceived distress and breathing of patients after surgery. The physical and emotional function of study volunteers will be evaluated with four tests: a 6-minute walk test, a questionnaire about perceived distress, a pain questionnaire and a breathing test. The investigators will compare the results of those patients who get standard physical therapy alone, which includes deep breathing exercises, assistance with moving, and walking, to those who get standard physical therapy and an elastic abdominal binder. We hypothesize that supporting the abdominal incision with an elastic binder will facilitate the recovery of the patients’ physical function and improve emotional well-being. The results of this study may assist in improving care for people after major abdominal surgery.

Validation of the Asthma Control Questionnaire in children
Wendy Ungar, PhD, The Hospital for Sick Children Research Institute, Toronto, Elizabeth Juniper, Department of Clinical Epidemiology and Biostatistics, McMaster University, Sharon Dell, MD, FRCP(C), Division of Respiratory Medicine, The Hospital For Sick Children

The primary goal of asthma therapy is to achieve optimum control whether the underlying disease is mild or severe, intermittent or persistent. Currently, there is no measure of asthma control for children. The Asthma Control Questionnaire (ACQ) is a valid and reliable tool that has been used widely in adults. The primary objective is to evaluate whether the ACQ is a valid and feasible tool to measure asthma control in children. One hundred children with asthma aged 8 to 15 years will be recruited. In addition to the self-administered ACQ, children will be administered two asthma-specific and two generic quality of life instruments. Children will return at 3 months for repeat assessment. Validity will be assessed by comparing how well the ACQ correlates with the other instruments. Increasing physician understanding and awareness of asthma control through use of this simple tool can improve communication between physician and patient, and result in better patient management and better health outcomes.

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2004-2005

Comparison of two methods of Continuous Positive Pressure (CPAP) to support successful extubation of infants of birth weights # 1500 grams (C2CPAP)
Marilyn Hyndman, RRCP, RRT, MRS(c), Sunnybrook & Women’s College Health, Sciences Centre, Toronto, Sharyn Gibbins, M.Sc. (Nursing), Ph.D., Hospital for Sick Children, Toronto, Bruce Graham, M.Ed., M.Sc., Ph.D., Charles Sturt University, Wagga Wagga, NSW, Australia

Continuous Positive Airway Pressure (CPAP) has been used successfully to promote extubation in the premature infant population. Many institutions use the two methods of CPAP to be examined; yet no study has compared these methods to determine which is better in this population of newborns of # 1500 grams to support extubation. This study also has relevance regarding cost implications. If bubble CPAP is shown to be as effective in this application, then places that may not be able to afford an Infant Flow System™ (IFS) may have another option of providing effective and affordable CPAP to this fragile population. This randomised controlled, single site clinical trial is to determine if Bubble CPAP or IFS CPAP is more effective at supporting extubation in infants of birth weights # 1500 grams. The primary outcome is successful extubation, for the seven days post. Failure criteria are defined as pH < 7.25 and PCO2 > 65 mmHg, a sustained increase in FiO2 of 0.15. Multiple ANOVA analysis will be used for continuous variables, chi-square for categorical variables, including primary outcome.

An examination of the nutritional factors affecting the severity of Bronchiolotis Obliterans Syndrome (BOS) in the Lung Transplant population: A pilot study
Janet Madill, Ph.D.(c), RD, Toronto General Hospital, University Health Network, Toronto, Johane Allard, MD, FRCPC, University Health Network

The one-year survival rate post lung transplantation is 70-75%. However, five-year rates are decreased due to chronic rejection, diagnosed as Bronchiolitis Obliterans Syndrome (BOS). The actual cause of BOS is not known, although rejection episodes contribute to this condition. There is some belief in the scientific literature that homocysteine, an amino acid, and/or antioxidants may also contribute to BOS. The purpose of this study is to examine if oxidative stress is associated with BOS, or if high levels of homocysteine in the blood are associated with BOS and if nutritional factors contribute to BOS in lung transplant recipients. Lung transplant patients will be asked at one time point to have some additional bloodwork, scheduled at the same time as their regular bloodwork. Since BOS is very devastating, research to decide if other factors contribute to this problem will be helpful to increasing long-term survival.

Psycho-social experiences of families with SARS from the perspectives of hospitalized children and adolescents, their parents and health care providers
David Nicholas, MSW, RSW, Ph.D., The Hospital for Sick Children, Toronto, Donna Koller, Ph.D.(c), Robyn Salter Goldie, MSW, RSW, Robin Gearing, Ph.D.(c), RSW,The Hospital for Sick Children

The recent outbreak of Severe Acute Respiratory Syndrome (SARS) had profound effects in various global regions. Currently, little is known about the psychosocial impact of SARS and the related precautions used in pediatric care. Ethnocentric in-depth interviews are being conducted with: (1) children who were hospitalized for suspected or probable SARS, (2) their parents, and (3) health care professionals who provided direct care to pediatric patients. Analysis will include systematic identification of intra-group themes as well as comparative analysis between children, parents and health care provider data. Findings will identify key pediatric-based experiences related to SARS, needs of affected families and health care providers, and recommendations for contingency planning in the event of a future health emergency such as SARS. Knowledge transfer strategies are planned in ensuring effective dissemination of study findings.

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2003-2004

Self-care and Adherence Issues in Managing COPD: A provincial survey
Lisa Cicutto, B.Sc.N., M.Sc., Ph.D., ACNP, CAE, University of Toronto, Toronto, Dina Brooks, B.Sc.PT., M.Sc., Ph.D.,Department of Physical Therapy, University of Toronto

This study will explore the use of common management activities used by people with chronic obstructive pulmonary disease (COPD). These activities include: flu shots, medications, exercise (aerobic training, breathing exercise and strengthening), oxygen therapy and follow-up appointments. We will also identify factors that influence the use of these activities such as: confidence in ability to use the activities, mood, supports from family/friends/community, and how well the activity works. Individuals who want to participate will be sent a questionnaire and asked to complete it and return it. The questionnaire takes approximately 30 minutes to complete. The results of the study will provide insight into how individuals with COPD manage their disease and what influences their behaviour.

Supportive Care Needs of Patients with Lung Cancer: Understanding the desire for assistance
Margaret Fitch, RN, Ph.D., Toronto-Sunnybrook Regional Cancer Centre, Toronto, Rose Steele, RN, Ph.D., Faculty of Nursing, York University, Toronto

The number of Canadians who develop lung cancer is in a slight decline, but lung cancer continues to be one of the leading causes of premature death due to cancer. The poor survival rates mean that close to 20,000 Canadians die of lung cancer each year. Many of these people face difficulties in managing their day-to-day activities and, thus, supportive care is extremely important. While some information is known about the supportive care needs of patients with lung cancer, there is a paucity of knowledge about what type of help these patients might want and from whom they want the help. This study builds on previous work that explored supportive care needs of patients with lung cancer in an urban outpatient cancer centre. The purpose of this study is to identify the reasons why some patients decline assistance with certain needs, even though, paradoxically, they may identify a high level of need in the area. Surveys and interviews will be used to collect the data.

Effects of Chest Wall Mobility Exercises in People with COPD
Deborah Lucy, BScPT, PhD, The University of Western Ontario, London, Tom Overend, Ph.D., B.Sc.P.T., School of Physical Therapy, University of Western Ontario, Justyna Minda, B.Sc.P.T., St. Joseph’s Health Care London

Our goal is to investigate the effects of specific chest wall mobility exercises on lung function and quality of life in people with COPD, many of whom are characterized by having stiff chest walls (rib cages) due to hyper-inflated lungs. A recent study from Japan has provided some intriguing preliminary evidence that rib cage expansion, lung capacity and breathlessness can be improved by a program of these exercises. Thus, after a 4 week period to determine stability of baseline measures, 30 people with COPD will perform a set of 5 chest wall mobility exercises, 3 times daily for 4 weeks. At the start of the baseline period, and before and after the 4 week training period, the subjects will be tested for lung function, health-related quality of life, and rib cage expansion. The results of this study may provide evidence for an effective, non-invasive method of treating the diminished breathing capacity in people with COPD.

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2002-2003

Is Ventilatory Muscle Training Effective?
Lynne Geddes, BScPT., MRE., School of Rehabilitation Science, McMaster University, Hamilton, Dina Brooks, B.Sc.PT., M.Sc., Ph.D.,Department of Physical Therapy, University of Toronto, Jean Crowe, BHSc, MHSc,McMaster University, Institute for Applied Health Sciences, Hamilton, Darlene Reid, PhD, University of British Columbia

Ventilatory muscle training (VMT) is used clinically in acute care and rehabilitation practice in the management of patients with chronic obstructive pulmonary disease (COPD) or with a spinal cord injury (SCI). At present, however, no clear recommendations related to the use of VMT exist. This project will consider the following questions. Does VMT result in improvement in respiratory muscle strength and endurance in patients with COPD or SCI? Does this improvement translate into gains in functional measures and/or gains in quality of life? What is the recommended frequency, intensity, duration and type of manoeuvre for strength VMT and endurance VMT? Using a survey of clinicians, current practice patterns for VMT will be assessed. An accurate and comprehensive analysis of all available literature related to the use of VMT in each of these patient populations will be completed. Specific recommendations for evidence-based practice and future research directions will be provided.

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2001-2002

Adherence & Self Care In Managing Chronic Obstructive Pulmonary Disease: Perspectives of Individuals Living with the Disease
Lisa Cicutto, Ph.D., A.C.N.P., C.A.E., University of Toronto, Dina Brooks, B.H.Sc.P.T., M.Sc., Ph.D., University of Toronto, Denise Gastaldo, University of Toronto

The purpose of this research project is to learn about self-care and use of different management activities by individuals with Chronic Obstructive Pulmonary Disease (COPD). The first step involves a face-to-face meeting between individuals with COPD and a facilitator will ask questions about self-care and their approach to managing their disease. The information collected will be analysed and recurring themes identified. Based on this information, a questionnaire will be developed and tested. Ultimately, a provincial survey will be conducted to assist in identifying important factors affecting the use of various management strategies. These findings will clarify whether strategies are needed to assist individuals with the multiple management components of COPD.

A Clinical Practical Guideline on Cardiorespiratory Physical Therapy for Acute Respiratory Conditions in Non-Surgical Patients
Jean Crowe, BHSc, MHSc,McMaster University, Institute for Applied Health Sciences, Hamilton, Dina Brooks, B.Sc.PT., M.Sc., Ph.D., Carol Kelsey, B.Sc.PT., M.Sc., Janet Parsons, B.Sc.PT., M.Sc., Sherra Solway, B.Sc.PT., M.Sc., University of Toronto

There is a great diversity among the physical therapy management techniques used in these populations, resulting in wasted health care resources, ineffective treatments and perhaps detrimental interventions. Clinical practice guidelines (CPGs) are tools that can be used to foster evidence-based practice. The following questions guide this CPG initiative: Does CPT promote patient recovery in adult patients with (for example) pneumonia, congestive heart failure, adult respiratory distress syndrome, and acute bronchitis? Are any physical therapies effective in these patients? Are there any contraindications or risks associated with cardiorespiratory PT in this patient population? Current PT practice patterns will be elicited using a survey, the literature rigorously evaluated and specific guidelines designed.

Air Leakage through the Mouth during Nocturnal Non-Invasive Ventilation in Individuals with Kyphoscoliosis and Neuromuscular Disease
Lori Davis, B.Sc., R.P.S.G.T., R.C.P.T., Respiratory Medicine, West Park Healthcare Centre, Toronto, Dina Brooks, B.Sc.PT., M.Sc., Ph.D., Roger Goldstein, MD, FRCPC, West Park Healthcare Centre, Toronto

Non-invasive mechanical ventilation requires individuals to wear a nasal or nasal/oral mask through which the ventilation is introduced. Wearing a mask and using a ventilator can result in sleep disruption as the equipment can be noisy and cumbersome. For many non-invasively ventilated individuals, air that is delivered through the nasal mask can escape through the mouth, instead of being delivered to the lungs. This can result in arousals from sleep that reduce sleep quality. It can also result in impaired gas exchange if the leaking is severe enough to affect ventilation. Symptoms of daytime sleepiness and fatigue can then occur. Our intention is to quantify the air leaking from the mouth during sleep to assess its effects on sleep quality and gas exchange.

Validity of the Shuttle Walk Test as a Clinical Evaluative Instrument
Deborah Lucy, Ph.D., B.Sc.M.R.P.T., School of Physical Therapy, University of Western Ontario,Tom Overend, Ph.D., B.Sc.P.T., School of Physical Therapy, University of Western Ontario, Carrie Higgins, B.Sc.P.T., University of Western Ontario

Valid outcome measures are required to accurately assess the impact of rehabilitation and treatment programs. The gold standard for exercise capacity is a laboratory test of maximal oxygen consumption. This test, while accurate, is expensive, time-consuming, and may be intimidating. Thus clinically, lower intensity tests are used to predict maximal exercise capacity. The submaximal test of choice in patients with pulmonary problems is a 6-minute walk test. However, two practice tests are required before a stable performance is obtained, and the 6-minute walk test is not well related to the gold standard lab test. A new test, the Shuttle Walk Test, is reliable in people with lung problems, and only one test is required before a stable estimate is obtained. Thus our purpose is to determine if, in people with chronic obstructive lung disease, the Shuttle Walk Test is a) valid and responsive to change following a rehabilitation program, and b) a better predictor of maximal exercise capacity that the 6-minute walk test. The results of this study may impact on the selection of outcome measures used in pulmonary rehabilitation programs.

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2000-2001

Chronic Obstructive Pulmonary Disease and Disability
Patricia Hill Bailey, R.N., B.N., M.H.Sc., Ph.D, Associate Professor of Nursing, Laurentian University, Sudbury, Julie Duff Cloutier, RN, B.Sc.N., Sharolyn Mossey, RN, M.Sc.N., School of Nursing, Laurentian University, Sudbury, Judy Riedel, RN, Linda Newton, RN, Winnipeg Health Sciences Centre, Manitoba

COPD is a significant health care problem in Canada. Disabilities associated with COPD have the potential for reducing a person’s material, economic and social capital, and their sense of self. In response, people with COPD may develop strategies to overcome barriers. This project will explore the meaning of disability for people with COPD and their family members in two Canadian cities. The information gained from the research will serve as an essential complement to the existing knowledge about this important yet often invisible chronic illness. The involvement of an advisory research group of people with COPD (i.e., insiders) will enhance the validity of the study and distribution of its findings. Ultimately the new knowledge will be used to: i) inform social and health policy development, ii) improve health and social services practice around the care of individuals and families living with COPD, and iii) empower individuals who live with disabilities associated with chronic lung disease. (funded jointly with CNRS)

An Outdoor Six-Minute Walk Test to Evaluate Functional Status for Individuals with COPD
Dina Brooks, Ph.D., M.Sc., B.Sc.P.T., Assistant Professor, Department of Physical Therapy, University of Toronto, Sherra Solway, B.Sc.PT, M.Sc., Scott Thomas, Ph. D., University of Toronto, Krisztina Weinacht, Dip.PT., Toronto East General Hospital

The six-minute walk test is a measure of functional status that is commonly utilized for individuals with chronic obstructive pulmonary disease; however, to date, investigations have administered this test only in an indoor corridor free of distractions. This setting is somewhat artificial and may not reflect activities of an individual with chronic obstructive pulmonary diseaseon a daily basis. In order to utilize the six-minute walk test as a measure of functional status, it is important to establish the validity and reliability of this test in settings more representative of daily living and to determine the relationship of performance in these settings to that of an indoor corridor. In this study, we will 1) investigate the feasibility of an outdoor six-minute walk test as an measure of functional status in individuals with chronic obstructive pulmonary disease, 2) determine the test-retest reliability of an outdoor six-minute walk test, 3) determine the relationship between performance on the indoor and outdoor walk tests, and 4) determine the relationship between the indoor and outdoor walk test performance and a functional status questionnaire.

Evaluating the Effects of Music on Exercise-Induced Dyspnea in Patients with COPD
Souraya Sidani, B.S., M.S., Ph.D., Assistant Professor, Faculty of Nursing, University of Toronto, Jane Graydon, RN, Ph.D., University of Toronto, Leslie Hall, Ph.D., Sandra McBride, RN, Ph.D., Ryerson Polytechnic University, Toronto

People who have chronic obstructive pulmonary disease (COPD) experience shortness of breath frequently. Shortness of breath is a distressing feeling that occurs with anxiety and prevents people with COPD from doing their usual activities. Listening to music is a possible strategy to help in relieving shortness of breath and anxiety. This study will examine how effective is listening to music in relieving shortness of breath and anxiety in people with COPD. The study will involve two groups of people. The first group will be asked to take a six-minute walk and to rest for 20 minutes while listening to soothing music. They will be requested to indicate how short of breath and how anxious they are before the walk and before and after each of the rest periods. The second group will do the same, but will be asked to walk for 10 minutes without and while listening to music. The results of this study will indicate if listening to music is beneficial to people with COPD.

Effect of Drug Plan Status on Health Outcomes and Use of Health Services in Children with Asthma
Wendy Ungar, B.A.cl., M.Sc., Ph.D., Scientist, Population Health Sciences, Hospital for Sick Children Research Institute and Assistant Professor, Health Administration, University of Toronto, Teresa To, Ph.D., Hospital for Sick Children Research Institute, Toronto

Asthma is a common and serious health problem. The prevalence of asthma is rising and the incidence is highest in children. Children with asthma may be prescribed several long-term medications and are therefore susceptible to pharmaceutical policies that influence access to required medicines. It is anticipated that a barrier such as full or partial out-of-pocket payment for medications will lead to inferior medical management of children with asthma. This may be reflected as increased use of health services and a greater symptom frequency. This study will use data from a 1995-96 study of children with asthma to examine the relationship between access to a drug plan and 1) use of health services, 2) asthma symptom frequency and 3) asthma medication use. Knowledge of the impact of drug plan access on the use of health services and health outcomes should result in improved health policies governing pharmaceutical access and the provision of care for children with asthma.

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1999-2000

An Evaluation of Peer Support for Family Caregivers of Technology-Assisted Children with Chronic Lung
David Nicholas, Ph.D, M.S.W., C.S.W., Social Worker/Academic and Clinical Specialist, Department of Social Work, The Hospital for Sick Children, Toronto, Krista J. Keilty, R.N., M.N., A.C.N.P., Clinical Nurse Specialist, Division of Respiratory Medicine, The Hospital for Sick Children, Toronto

This study evaluates one-to-one peer support for family caregivers of technology-assisted children who have chronic lung disease. Following a four month peer support intervention in which family caregivers engage with another family caregiver (a peer) in weekly supportive interactions via telephone, internet or in-person visits, the intervention will be evaluated. Pre- and post-intervention standardized instruments, monthly interviews, post-intervention semi-structured qualitative interviews, and health care record reviews will be used to evaluate the peer support intervention. The study will: 1. measure the impact of peer support on: (a) social isolation, (b) illness intrusiveness, and (c) caregiver burden; 2. evaluate family caregivers’ perceptions of peer support; and 3. identify the elements of peer support that facilitate coping for family caregivers of children with chronic lung disease.

Discharge Criteria for Peri-Operative Physical Therapy
Janet Parsons, B.Sc.P.T., M.Sc., Lecturer, Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Dina Brooks, Ph.D., M.Sc., B.Sc.P.T., Department of Physical Therapy, University of Toronto, Janet Newton, G.A.P., M.Sc.(cand.), Physiotherapy Department, St. Michael’s Hospital, Cheryl Dear, B.Sc.P.T., Physiotherapy Department, The Toronto Hospital, Ellen Silaj, B.Sc.P.T., Physiotherapy Department, Sunnybrook & Women’s College Health Sciences Centre

Surgery and general anaesthesia have direct effects on the respiratory system, Physiotherapy aims at preventing and treating respiratory complications after surgery using a wide variety of techniques. At present, there are no established valid and reliable criteria to be used when discharging patients from physical therapy after surgery. Informal results from a national survey show that a large number of criteria are presently applied in the clinical setting and that these criteria have been consistently used over the last eight years. The objectives of this study are to undertake a multi-centred trial to develop objective, valid and reliable discharge criteria and a scoring system that would be used to assess when a patient should be discharged from physical therapy care after either cardiac, thoracic or upper abdominal surgery. In an age of careful attention to minimizing health care resources while at the same time promoting early discharge from the acute setting, it is essential to establish the outcomes and criteria used to discharge patients from physical therapy. Such information will assist those who plan or participate in managing surgical patients to maximize their function and recovery, while minimizing cost.

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1998-1999

Randomized Controlled Trial of the Influence of Post-Rehabilitation Programs on Health Related Quality of Life and Functional Exercise Capacity in Patients with Chronic Obstructive Pulmonary Disease
Dina Brooks, BScPT, MSc, PhD, Assistant Professor, Department of Physical Therapy, Faculty of Medicine, University of Toronto, Roger Goldstein, MB, ChB, FRCPC and Suzanna Mangovski, BScPT, West Park Hospital, Toronto

Chronic obstructive pulmonary disease is a common respiratory condition causing considerable morbidity. Respiratory rehabilitation, a program consisting of supervised exercises, education and psychosocial support has been shown to improve quality of life and functional capacity in patients with chronic obstructive pulmonary disease. However, these programs are often only 6-12 weeks in duration; to date, there is no research on whether these patients, upon discharge, adhere with the exercise program and maintain the benefits gained during the program. In this study, patients with chronic obstructive pulmonary disease who have completed a respiratory rehabilitation program will be randomized to receive either conventional follow-up for 6 months or an enhanced discharge program, consisting of group sessions, regular telephone contact and frequent follow-up visits. Outcomes to be evaluated include quality of life, functional exercise capacity and lung function tests.

Psychometric Evaluation of a New Clinical Assessment Tool: The Fatigue Pictogram
Margaret Fitch, RN, PhD, Head, Oncology Nursing, Toronto-Sunnybrook Regional Cancer Centre; Coordinator, Supportive Care, Cancer Care Ontario, Andrea Bezjak, MD, MSc, FRCPC, Princess Margaret Hospital, John Granton, MD, FRCPC, The Toronto Hospital, General Division, Debra Bakker, RN, PhD, Northeastern Ontario Regional Cancer Centre, Sudbury, Pat Sevean, MScN, Northwestern Ontario Regional Cancer Centre, Thunder Bay

Fatigue is one of the most common and distressing side effects of cancer and COPD. The purpose of this study is to evaluate the Fatigue Pictogram developed by the investigators to clinically assess fatigue. The psychometric properties to be evaluated are: test-retest reliability, equivalency of two data collection methods, validity, sensitivity in terms of correctly categorizing patients as fatigued and tracking change over time and feasibility. The Pictogram measures the intensity and impact of fatigue. Colour, pictures and words are used to describe a five-point Likert scale. The card is two-sided with one question on each side. It is 7 by 3 inches, laminated and fits easily into a lab coat pocket. Four cancer centres and three COPD clinics will participate in the study. Two respiratory disease populations will participate in the study: lung cancer patients and COPD patients. The sample size will be 280 with 140 patients in each disease group. Despite its prevalence, fatigue is often not taken into account when caring for patients. A clinical tool to assess fatigue that is easy to use and psychometrically proven can help make fatigue visible and open to intervention.

A Study to Evaluate the Effectiveness of a Non-Pharmacological Nursing Intervention in the Management of Breathlessness in Lung Cancer
Doris Howell, RN, MScN, Interlink Community Cancer Nurses, Margaret Fitch, RN, PhD, Toronto-Sunnybrook Regional Cancer Centre, Edmee Franssen, MSc, Toronto-Sunnybrook Regional Cancer Centre, Cynthia Struthers, RN, MScN, Princess Margaret Hospital, Toronto

Lung cancer is among the most common cancers in Canada with approximately 20,300 new cases reported each year. One of the most distressing symptoms of lung cancer is breathlessness. A non-pharmacological nursing intervention was found to be effective in minimizing the distress of breathlessness in lung cancer patients in the United Kingdom (U.K.). Using a clinical trial methodology, this study will replicate the U.K. intervention in a Canadian population to evaluate its “true effectiveness” in increasing numbers of patients.

Asthma Management: A Survey of Individuals with Asthma
Lisa Cicutto, RN, PhD, Assistant Professor, Faculty of Nursing, University of Toronto, Hilary Llewellyn-Thomas, PhD, MSc, Clinical Epidemiology Unit, Sunnybrook Health Science Centre, Toronto

In Canada, asthma is a significant health concern because of the personal and societal costs associated with the disease. Studies suggest the existence of sub-optimal asthma management which is due to patient and medical factors. Previous work of the investigators explored the physicians’ approaches to asthma management and noted some areas for further improvement. It is now time to explore the approaches individuals with asthma use and desire to manage the disease. This study will survey individuals with asthma from across Ontario about their approaches to asthma care regarding use of medications and medical services (treatment strategies), asthma education strategies and level of involvement in management decisions. This study will help us to determine if the approaches to self care of individuals with asthma are appropriate or inappropriate and if gaps exist in areas of asthma care. If warranted, we will design actual interventions based on the study’s results, for example, the development of a patient friendly version f the Canadian asthma practice guidelines.

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1997-1998

Randomized Controlled Trial of the Influence of Post-Rehabilitation Programs on Health Related Quality of Life and Functional Exercise Capacity in Patients with Chronic Obstructive Pulmonary Disease
Dina Brooks, B.Sc.P.T., M.Sc., Ph.D., Roger Goldstein, M.B., Ch.B., F.R.C.P.C. and Suzanna Mangovski, B.Sc.P.T., West Park Hospital, Toronto

Chronic obstructive pulmonary disease is a common respiratory condition causing considerable morbidity. Respiratory rehabilitation, a program consisting of supervised exercises, education and psychosocial support has been shown to improve quality of life and functional capacity in patients with chronic obstructive pulmonary disease. However, these programs are often only 6-12 weeks in duration; to date, there is no research on whether these patients, upon discharge, adhere with the exercise program and maintain the benefits gained during the program. In this study, patients with chronic obstructive pulmonary disease who have completed a respiratory rehabilitation program will be randomized to receive either conventional follow-up for 6 months or an enhanced discharge program, consisting of group sessions, regular telephone contact and frequent follow-up visits. Outcomes to be evaluated include quality of life, functional exercise capacity and lung function tests.

The Development & Evaluation of an Educational Strategy to Promote Adherence to TB Therapy
Edith Costello, R.N., M.Sc.N., Ed.D., School of Nursing, Queen’s University, Dick Zoutman, M.D., F.R.C.P.C. and Jacquelyn Gerlach, B.Sc.N., Queen’s University, Kingston

Tuberculosis, a persistent public health issue in Canada, is managed through monitoring and treatment of those who have been exposed to TB bacteria. For many patients, the lengthy treatment regimen, side effects of the drugs and other factors discourage completion of the full drug treatment. Unfortunately, failure to complete the treatment increases risk of ongoing and drug resistant infection for the patient, and new infections in those with whom the patient has contact. Educational programs that assist the patient to understand TB, its treatment and the ways in which they can manage the lengthy treatment period have proven successful in promoting completion of the drug treatment. The goal of this study is to develop and test a strategy for self-directed computer and video teaching that will promote adherence to TB treatment. Both computer and video teaching have been shown to be particularly useful for promoting comprehension in patients with a wide range of learning skills. In addition, the self-paced learning and frequent repetition afforded by computer and video teaching methods are important to achieve full understanding of the information presented.

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1996-1997

Effectiveness of Strategies Used by People with COPD and Asthma to Cope with their Dyspnea
Sandra McBride, RN, MHSc, EdD, School of Nursing, Ryerson Polytechnic University, Dr. Jane Graydon & Dr. Souraya Sidani, Faculty of Nursing, University of Toronto; Dr. Leslie Hall, Department of Philosophy and Music, Ryerson Polytechnic University

Most people with chronic bronchitis, emphysema, and/or asthma will experience shortness of breath at some point in time. Since the causes of shortness of breath are not clearly understood, there is a need to examine strategies other than medical interventions that people can use to control their shortness of breath. The purpose of this study is to explore the strategies used by people with chronic bronchitis, emphysema and/or asthma to relieve their shortness of breath and to determine the effectiveness of these strategies. A survey will be conducted using mailed questionnaires. In-depth interviews with a small subsample also will be performed. It is hoped that the findings of this study will contribute to knowledge of effective strategies people with chronic lung disease can use to relieve their shortness of breath.

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1995-1996

Assessment of the Impact of Asthma Education on the Well-Being of Parents and Children
Nancy Roblin, R.N., B.Ed., M.Ed., Clinical Nurse Specialist, Paediatrics, Hotel Dieu Hospital, Kingston, Dr. Michael Flavin, Hotel Dieu Hospital; Sharon Jessup, The Lung Association, Frontenac, Lennox and Addington Region; Rose Nolan, Kingston

This study proposes to assess the usefulness of hospital and community-based intervention programs for patients with asthma and their families relative to current practice. The hospital-based asthma teaching program involves three classes and utilizes an asthma nurse educator. The Lung Association provides asthma education for groups of parents and children. Current hospital practice does not include a standardized educational approach by nurses and physicians. Outcome measures for this research project include: family functioning, psychosocial impact of the illness, parent quality of life and knowledge level as demonstrated by parents and affected children.

Informational Needs of Individuals Newly Diagnosed with Lung Cancer
Sherrol Palmer-Wickham, R.N., B.Sc.N., Toronto-Sunnybrook Regional Cancer Centre, Dr. Jane Graydon, Faculty of Nursing, University of Toronto; Barbara Evans-Boyden, Susan Galloway, Sunnybrook Health Science Centre; Dianne Harrison-Woermke, Toronto-Sunnybrook Regional Cancer Centre; Louanne Rich-vanderBij, Sunnybrook Health Science Centre; Pam West, Markham-Stouffville Hospice; Stephanie Burlein-Hall, Princess Margaret Hospital, Toronto; Pat Sevean, Thunder Bay Regional Cancer Centre

This study will examine the informational needs of people newly diagnosed with lung cancer, who are being assessed for possible treatment or are in the first course of treatment by radiation therapy or chemotherapy. Understanding the type of information these people desire may assist health care providers to design appropriate educational programs to meet their needs.

Verification of a Revised Inventory to Identify Lung Cancer Patients’ Non-Medical Needs, Barriers to Needs Resolution and Supportive Care Preferences
Terry Bunston, M.A., M.S.W., Ph.D., Ontario Cancer Institute/Princess Margaret Hospital, Deborah Mayer, Dr. Andrea Bezjak, Deborah Mings, Ontario Cancer Institute/Princess Margaret Hospital

The impact of lung cancer is often devastating, with a particularly bleak diagnosis. Lung cancer shares with other respiratory disease compromised physical functioning and an uncertain future that often results in psychological and social difficulties. Despite clinical and empirical evidence of the distress and disruption that lung cancer can create, little work has been undertaken to link the nonmedical needs of patients to either the availability of social support or to patient satisfaction with care. There is also little information on how nonmedical needs and patient satisfaction with care impact on the quality of life. Our proposed research study asks what the nonmedical needs of patients are, why needs remain unresolved, what are the gaps in the help patients and families receive to cope with their difficulties and what services patients feel would be helpful in meeting these needs, The purpose of this study is to verify the usefulness of a questionnaire designed to evaluate the needs of patients with lung cancer in the areas of physical, psychological, social, financial, vocational and spiritual functioning. We will survey patients with lung cancer twice, one week apart, by telephone. The information from this study will help us identify high risk groups, align specific needs and service preferences to specific populations and identify barriers to needs resolution. The intention is to use this information to develop a better understanding of how we, as health care professionals, can help maintain or enhance patients’ quality of life.

An Analysis of Factors that Influence Variability in Nursing Workload in COPD Patients
Linda Lee O’Brien Pallas, RN, MScN, PhD, University of Toronto/Women’s College Hospital, Claire Mallette, M.Sc.N., Student, University of Toronto

Currently, little is known about the nursing care hours required by clients with respiratory disorders, nor the best method to assign staff to give this care. Clients with COPD require complex nursing care that the tasks outlined in existing measurement systems do not account for. Current research has indicated that the study of variability in nursing workload must include more than the tasks in which nurses are involved. The complexity of the client’s medical and nursing condition as well as the length of stay and the environment in which care is delivered must be identified in order to account for the large variability. The purpose of this study will be to examine the client, nursing and medical conditions as well as the environmental factors using primarily quantitative methods, to determine the causes in shifts in nurse resource requirements while caring for clients with COPD.

Dyspnea and Anxiety in COPD: The Potential Role of Music
Sandra McBride, RN, MHSc, EdD, School of Nursing, Ryerson Polytechnic University, Dr. Jane Graydon & Dr. Souraya Sidani, Faculty of Nursing, University of Toronto

Chronic lung conditions such as chronic bronchitis and emphysema are very prevalent in Canada. Many individuals with these conditions experience shortness of breath and anxiety. Attempts to limit or control the anxiety and shortness of breath are varied and may produce sporadic effects. Music has been reported to produce a relaxation effect in some people. The current study is designed to examine the feasibility of exploring the relationship between music and anxiety and shortness of breath in individuals with chronic bronchitis or emphysema who live in their home. The findings should provide further information about whether people with COPD would use music to relieve their shortness of breath and anxiety.

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1994-1995

The Prevention of Deep Vein Thrombosis and Pulmonary Embolism through Foot and Ankle Exercises: Is there a physiological basis for their use?
Cathy Anderson, B.Sc., B.H.Sc.P.T., M.Sc.P.T. (cand.), Victoria Hospital Corporation, London; Dr. Deborah Lucy, Dr. Mark Speechley, Faculty of Applied Health Sciences, Elborn College, University of Western Ontario, London; Dr. J.M.O. Arnold, Cardiovascular Investigation Unit, Victoria Hospital Corporation, London.

It has been estimated that in North America each year there are some five million cases of Deep Vein Thrombosis (DVT) or blood clot occurring usually in the leg. Approximately 10% of these clots (500,000) become dislodged and travel through the circulation to the lung, forming a Pulmonary Embolism (PE). Here these clots interfere with the uptake of oxygen from the air, which is the vital function of the lung. Ten percent (50,000) of PE result in death. One of the causes of DVT, slowing of blood flow, is seen following surgery, heart attacks and in individuals confined to bed. The purpose of this study is to determine whether specific foot and ankle exercises, thought to be beneficial in preventing DVT and thus PE, do in fact increase blood flow and for how long.

The Effect of Attending Social Information Sessions on the Quality of Life of People With Chronic Lung Disease
Jane E. Graydon, Ph.D., R.N., Faculty of Nursing, University of Toronto, Toronto and Eleanor Ross, M.Sc.N., R.N., Women’s College Hospital, Toronto

The study will evaluate the impact of attending social information meetings on the quality of life of people with chronic lung disease. For many people with lung disease, their usual activities are restricted as a result of the disease, particularly their social and recreational activities. The social information meetings provide opportunities for people with chronic lung disease to socialize with others. It is expected that those with chronic lung disease who attend these meetings will have better functioning, fewer symptoms and less negative mood following the series of meetings than they did when they started them. Findings from the study will be useful to health professionals in planning future programs for individuals with chronic lung disease.

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1993-1994

Effect of Three Different Oxygen Flow Rates on Exercise Endurance in Chronically Hypoxemic Patients with COPD
Reny Szambor, R.R.T., David Stubbing, M.B., B.S., M.R.C.P.(UK), F.R.C.P.(C) Chedoke-McMaster Hospital, Hamilton

This study will try to determine if higher than usual flow rates of oxygen improve the exercise endurance and breathlessness with different levels of oxygen and if a change is found to assess the reasons for that change. The long-term goal is to find ways and means of minimizing the disability (breathlessness) and handicap (the overall effect of the disease on a person’s life) in patients with chronic lung disease.

Effectiveness of an Inhaler Education Program for Patients with Chronic Obstructive Pulmonary Disease
Edith A. Costello, R.N., M.Sc.N., Ed.D., Queen’s University School of Nursing, Sue Saulnier, R.N., B.N.Sc., Glenna Churchill, R.N., Kingston General Hospital

Morbidity and mortality rates for chronic obstructive pulmonary disease are rising in Ontario in spite of enhanced treatment regimes. A pilot study will determine whether an enhanced educational program by nurses can improve patients’ knowledge and effective use of inhalers. A group who receives a special education format will be compared with a matched group who is prescribed regular use of inhalers but has not yet received the special education. This Ontario demonstration study may provide important clues to the management of chronic respiratory illness in times of fiscal constraint.

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1992-1993

Parental Perceptions and Experiences of Managing Their Child’s Asthma
Mary D. Jerrett, R.N., Ed.D., Edith A. Costello, R.N., Ed.D., Jane C. Nagy, R.N., M.N. School of Nursing, Queen’s University, Kingston

Chronic Asthma is not only the most common childhood illness, but can also be fatal for children. The complexity of the management of the child’s asthma challenges parents at a number of levels. The treatment of asthma will have little benefit if not implemented effectively and consistently by parents at home. The focus of this research will be the parents’ perceptions of their experience of managing the child’s illness on a day-to-day basis. The demands and practices around managing the treatments, concerns of the parents themselves and the impact on family life will be explored. Parents’ perspectives of their situation provide important information about their subjective sense of the work involved in family care giving, and what constitutes effective control of the child’s asthma. The results of this study will expand our understanding of the problems asthma management cause for parents in order to develop interventions more sensitive to their concerns.

Understanding the Symptoms of Lung Disease: a focus on lung cancer
Margaret I. Fitch, R.N., Ph.D., Toronto-Bayview Regional Cancer Centre, Jane E. Graydon, R.N., Ph.D., Faculty of Nursing, University of Toronto

The majority of lung cancer patients die within two years of their diagnosis and as many as 50% in the first year. As symptoms appear and become more evident, they can have a significant influence on activities of daily living, roles and responsibilities for both the patient and the family. Research designed to understand the symptoms from the patients’ perspective is limited and it is not clear how symptoms change over time or what patients think is most troublesome. This study proposes to attend to these gaps by describing the pattern of symptoms experienced by lung cancer patients, how that pattern changes and what makes the symptoms better. The findings of this study would provide an excellent basis for designing appropriate ways to help individuals with lung cancer manage at home with their symptoms.

Inter-Rater Reliability of Chest Assessment Among Physical Therapists
Jackie Thomas, B.Sc.(PT) M.Sc.(Candidate), Research Physiotherapist, Physiotherapy Department, The Toronto Hospital; Dina Brooks, B.Sc.(PT), M.Sc., Faculty, Physical Therapy Division, Department of Rehabilitation Medicine, Faculty of Medicine, University of Toronto

This research project will assess the agreement between physiotherapists in performing the various components of an assessment of the respiratory system. Subjects will then receive a training session as to the standardized approach for these components. The effects of this training on agreement will be determined. The study will also attempt to determine whether clinical experience has an effect on agreement.

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1991-1992

Clients with Chronic Obstructive Pulmonary Disease: Their Beliefs About Behaviours that Promote Activity Tolerance
Sandra McBride, R.N., Ed.D., School of Nursing, Ryerson Polytechnical Institute, Toronto

Chronic obstructive pulmonary disease (COPD) is a major health problem in Canada. Due to the need for long term management of this disorder, patients must assume a great deal of the responsibility for the control of their symptoms. Little research has been done to assess the decision-making processes used by these patients in relation to their own care. The current study is designed to examine the impact of attitudes on intentions of adult patients with COPD to engage in behaviours that increase their activity tolerance. The findings of this study should provide greater direction for teaching

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