It is well established that engaging in a physically active lifestyle benefits the long-term development and well-being of all children and youth. For children living with chronic medical conditions (CMCs), the benefits of participating in physical activity are critically important for achieving positive health outcomes and mitigating the risk of secondary chronic disease and more significant morbidity. Unfortunately, most children with CMCs are insufficiently active to achieve its associated benefits, often citing disease-related barriers to participation. To better understand how children with CMCs navigate their participation in physical activity, the concept of physical literacy can be applied as a helpful lens. In brief, physical literacy describes one’s physical, cognitive, and affective capacities to engage in an active lifestyle. Despite facing unique risks and barriers in active contexts, some evidence suggests that children with CMCs can still achieve or excel in their physical literacy. This suggests that those who are struggling to navigate their participation in an active lifestyle would benefit from potential support in their physical literacy development. However, efforts to intervene could be misplaced or misguided without adequate contextual knowledge about how the lived experiences of children with CMCs inform their physical literacy development. The overall purpose of this research was to comprehensively examine how physical literacy is developed among children with CMCs. Collectively, this is accomplished throughout the dissertation by contextualising, describing, and reflecting on how children with CMCs develop physical literacy. Margaret Whitehead’s conceptualisation of physical literacy was the guiding framework for this work, built on a philosophical foundation combining monism, existentialism, and phenomenology. A pragmatic approach was applied to guide the research process, employing mixed and multiple methods. This research was conducted with school-aged children, 8 to 12 years old, living with CMCs and recruited from outpatient Cardiology, Endocrinology, Hematology, Cystic Fibrosis/Respirology, and Neurology clinics at a local children’s hospital in Ottawa, Ontario. Where applicable, physical literacy was measured using the second edition of the Canadian Assessment of Physical Literacy. Qualitative methods were strategically applied and combined throughout the research program, including interviews, focus groups, open-ended questionnaires and field notes. This research was conducted during the COVID-19 pandemic, which dramatically influenced physical activity behaviours worldwide. Thus, the physical literacy development of children with CMCs could only be understood by first acknowledging the relative impact of the pandemic. The purpose of Article 1 was to evaluate and understand how the COVID-19 pandemic influenced the physical literacy development of children with CMCs during the first two years (2020-22). Compared to pre-pandemic matched pairs, the overall physical literacy levels of children with CMCs were significantly diminished during the pandemic, driven primarily by decreases in physical competence and daily behaviour. It was challenging for children with CMCs to play active games in the context of the pandemic, where they had to learn how to navigate additional constraints to prevent the spread of COVID-19. These precautions also constrained how children with CMCs developed social connections, which was cited as a reason that participants felt less motivated to engage in physical activities during the pandemic. Children with CMCs also spoke hesitantly about returning to pre-pandemic activities, as they perceived changes in their physical competence and the participation contexts would make it difficult to be engaged (i.e., mask-wearing requirements, uncertain safety rules, potentially sudden closures). Nonetheless, participants with CMCs maintained high levels of measured intrinsic motivation and confidence in physical activity. Once the pandemic context was better understood, the purpose of Article 2 was to describe the overall physical literacy development of children with CMCs by examining measured outcomes and comparing the experiences and perspectives of those with high and low levels of physical literacy. Most children with CMCs (~80%) were beginning (< 17th percentile) or progressing (<65th percentile) in their physical literacy journey when compared to normative classifications. Total physical literacy seemingly contributed to a sense of self and how participants with CMCs approached new experiences. In the affective domain, attitudes towards physical activity were generally informed by prior experiences, and the meaningfulness of physical activity was more salient than enjoyment. In their physical competence, participants with CMCs found it particularly difficult to navigate bodily self-regulation alongside complex movement patterns and understood the implications of practice for sustained participation in physical activity. Cognitively, it is promising that children with CMCs adopted general definitions of physical activity, recognising the benefits of an active lifestyle for their health, and understood the relative importance of evaluating risks in active contexts. Participants with higher scores spoke more about physical activity experiences where the affective, cognitive, physical, and behavioural domains seemingly overlapped (i.e., curiosity in active settings, valuing practice experiences, performing complex movement patterns in game contexts, etc.). Overall, findings identified multiple areas where children with CMCs may be supported in their physical literacy development, including opportunities to practice bodily self-regulation strategies and develop confidence in risk evaluation. Finally, the purpose of Article 3 was to reflect upon the acquired knowledge of physical literacy among children with CMCs by observing how it may be applied within a community-based setting. The “I Can Play Anything” multi-sport program was developed for the RA Centre, a community-based recreational facility in Ottawa, Ontario. The program was designed based on the concept of physical literacy and teaching principles drawn from various behaviour change theories, including self-determination theory. Descriptive, reflective and reflexive data were collected using a combination of interviews, focus groups, field notes and open-ended questionnaires. The developed themes represent the combined expectations, applications, and potential implications of the program for children with CMCs, which are: 1) Learning to play, 2) Inclusion supported by individualised variations, and 3) Understanding one’s need for rest. Reported perceptions and experiences within the community-based multi-sport program reflect how children with CMCs may be effectively supported in similar, active contexts. The final chapter of this dissertation integrates the results from all three articles, emphasising areas of physical literacy development which are particularly relevant to the lived experiences of children with CMCs. Salient ideas discussed throughout this dissertation were recognising and valuing skill progressions developed through practice, the influence of meaningful experiences on active behaviours, self-regulating activity intensities in active contexts, and applying a general definition of embodied participation to physical literacy. My research contributes valuable knowledge to the methodological, theoretical, and practical advancement of physical literacy research, particularly among children with CMCs. This dissertation emphasises and encourages the unique potential for collaboration between the health and recreation sectors to facilitate the ongoing physical literacy development of children living with CMCs.

Background: Pediatric chronic pain is prevalent and comes with diagnostic uncertainty and biopsychosocial complexity. The literature significantly lacks evidence and clinical guidance to inform triage decisions to interdisciplinary pediatric chronic pain programs, which likely impacts timely and appropriate access to much needed interdisciplinary care. Purpose: To methodically conduct foundational investigation into triage within interdisciplinary pediatric chronic pain programs to develop a preliminary series of Clinical Decision Support (CDS) triage tools grounded in evidence to facilitate nurses' triage decision-making. Methods: A pragmatic, multi-method study was conducted and fundamentally guided by the Knowledge to Action Framework (KTA). Included studies involved: 1) A modified Delphi study to attain expert consensus on the diagnostic expectations of pediatric patients referred to interdisciplinary chronic pain programs; 2) A systematic review of multidimensional biopsychosocial tools used in the pediatric chronic pain population, guided by the Multidimensional Biobehavioral Model of Pediatric Pain; and 3) An explorative descriptive qualitative study guided by the Cognitive Continuum Theory (CCT) and the Theoretical Domains Framework (TDF) to explore and describe the decision-making practices of and contextual influences on nurses triaging patients to interdisciplinary pediatric chronic pain programs. Findings: Following two survey rounds, the Delphi study demonstrated consensus on 84% of diagnostic items and general agreement regarding the diagnostic expectations of referred patients. The systematic review revealed six valid and reliable multidimensional biopsychosocial tools and highlighted 84 significant relationships between pain and functional interference across 11 biopsychosocial variables. The qualitative study emphasized the leading and complex triage role nurses lead in interdisciplinary pediatric chronic pain programs, and comprehensively described the triage process and determinants of the triage decision. Conclusions: Findings from the three studies have been integrated into the preliminary development of a series of CDS triage tools to be used in interdisciplinary pediatric chronic pain programs. This series offers decision guidance to accept or redirect care based on diagnostic clarity and a strategy to prioritize access to interdisciplinary care based on biopsychosocial needs. To determine clinical utility and validity of the tool, future research will target end-users to finalize tool development.

Thesis (M.S.)--Boston University / The chronically ill patient in a general hospital designated for the treatment of the acutely ill presents serious problems to the medical team. With the advancements made in the medical profession, together with improved hospital facilities, more people today can benefit from hospitalization. Because of this fact, more people utilize hospital facilities today than in the past, with the results that hospitals are often overcrowded and cannot accommodate all who require treatment. Consequently, it is extremely important that the period of hospitalization be as short as possible, and consistent with the patient's condition, both for the chronically and the acutely ill if these services are to be available to all.

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Bakgrund:Långvarig smärta definieras som smärta som kvarstår i över 3 månader. Det är vanligt förekommande i befolkningen och många söker vård för sina problem. Smärta är ett komplext begrepp som har inverkan på många olika faktorer hos individen men även en inverkan på samhället och dess resurser. Detta kan innebära utmaningar vid handläggning och framför allt vid val av behandling. Syfte:Syftet var att utforska kliniskt resonemang vid val av behandling för patienter med långvariga smärttillstånd hos en grupp fysioterapeuter i primärvården. Metod:Studien är en kvalitativ studie baserad på semistrukturerade intervjuer som analyserades med kvalitativ innehållsanalys.   Resultat:Det som ansågs spela stor roll för valet av behandling var behandlaren och patientens egenskaper och erfarenheter, relationen mellan dem samt analysen inför behandling. De riktlinjer som användes ansågs vara ett stöd men också svåra att applicera då behandlingen alltid behöver individanpassas i och med att patientgruppen är komplex. Möjlighet till samverkan ansågs vara viktigt för att bredda perspektivet och erbjuda patienten fler behandlingsalternativ. I behandlingsupplägget var målet alltid att öka funktionsnivå, vilket påverkade resonemanget kring val av behandling. Ökad kunskap hos patienten samt en ökad förmåga till smärthantering var ofta första steget. Slutsats:Många faktorer spelar in i det kliniska resonemanget för val av behandling för patienter med långvarig smärta. Erfarenhet hos behandlaren ansågs avgörande för beslutet och man kan därmed tänka sig att det är extra viktigt att nyexaminerade får möjlighet att samverka med kollegor med mer erfarenhet av patientgruppen. / Background:Chronic pain is defined as pain that remains in more than 3 months. Chronic pain is a widespread problem worldwide and there are many people who seek health care for their problems. Pain is a complex syndrome which impacts several aspects of the individual's life but also the society, which brings challenges in the assessment and the choice of treatment.  Purpose:The purpose of the study was to explore physiotherapists' clinical reasoning when choosing a treatment for patients with chronic pain in primary care.  Method:The study is a qualitative method based on semi-structured interviews which was analyzed with a qualitative content analysis.  Results:Factors that played a big part in the choice of treatment were the physiotherapist and the patient characteristics and experiences, the relationship between them and the significance of the examination. The guidelines that were used were considered to support the choice but were also seen to be difficult to apply, as the treatment always needs to be individualized because of the complexity in the patient group. The ability of cooperation was considered as a key factor to broaden the perspective and offer the patient different treatment alternatives. The treatments intended to increase function, knowledge and pain-management which had an impact on the clinical reasoning. Conclusion:Many factors play a part in the clinical reasoning for choosing treatment for patients with chronic pain. The physiotherapists experience was a crucial part of the decision and therefore it could be of importance that newly graduated physiotherapists get the possibility to cooperate with colleagues who have more experience of the patient group.

Background: According to the Center for Disease Control and Prevention, approximately 1.6 to 3.8 million Americans suffer a sports related concussion each year. Concussion is defined as a transient alteration of the brain structure caused by a direct or indirect force. During the last decade, a vast amount of clinical research on the long term effects of repetitive head trauma has occurred, especially on the subject of chronic traumatic encephalopathy (CTE), depression and dementia. Objective: The purpose of this literature review is to examine the literature pertaining to multiple concussion and the long-term effects of multiple concussion such as neurodegenerative diseases and psychological. Methods: A literature review was conducted using an electronic search of the following databases: MEDLINE, Cochrane Database of Systematic Reviews, and SportDiscus. The key search terms included were concussion, "sport concussion" and "sports concussion". One of the above three terms needed to be in conjunction with one of the following key search terms: depression, dementia, "mild cognitive impairment", "chronic traumatic encephalopathy" (CTE), or "psychological disorder". Additional inclusion criteria also included studies that targeted the adult athlete population who had sustained more than one concussion. Studies only were included if they were peer-reviewed, in the English language, and were published after 1990. To be included in the review, the study must have examined the long term effects of repetitive concussion. Results: The research completed to date suggests there is a strong correlation between the number of concussions an athlete suffers and the long-term ramifications of neurodegenerative and psychological disorders. However, more research is needed.

Chronic pain disorders are estimated to affect a significant proportion of the global population. These disorders are often debilitating and pose a substantial challenge to the everyday life of those affected. Modern medicine has made great strides in understanding the physiological processes involved in chronic pain. However, chronic pain is more than merely a physiological process. Chronic pain is an embodied mode of being-in-the-world that manifests in multiple aspects of lived experience, from the ability to perform day-to-day tasks to the relationship between body and self. Consequently, it is essential to cultivate a rich appreciation of chronic pain as a lived experience. To rely solely on physiological knowledge in conceptualizing chronic pain precludes the development of such an appreciation. This work examines the ways that phenomenology can be leveraged to broaden the current medical understanding of chronic pain to better incorporate subjective experience. As a rigorous methodology for studying embodied consciousness, phenomenology provides the theoretical and conceptual tools to form a rich description of chronic pain's lived experience. First, a brief history of theories of pain is presented to contextualize the development of modern medical understandings of chronic pain. Following this, the writings of three classical phenomenologists—Husserl, Heidegger, and Merleau-Ponty—are presented, and key phenomenological concepts are introduced. Phenomenology is then used to examine the lived experience of chronic pain. Finally, means of integrating phenomenology into the current medical framework are explored.

INTRODUCTION: There is uncertainty in the prevalence of chronic non-cancer pain (CNCP) in military veterans. A systematic review and meta-analysis was conducted to elucidate this issue, and examine potential effect modifiers of CNCP prevalence. Additionally, chronic pain is a pervasive and debilitating condition that disproportionately affects military veterans. We recently completed a qualitative study of Canadian veterans living with chronic pain to identify their research priorities; however, the generalizability of our findings was uncertain. METHODS: MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science were searched from 2013 to January 21, 2021, for observational studies reporting “chronic pain” or pain ≥ 3 months in military veterans. The random-effects meta-analysis was used for pooling data, the Grading of Recommendations, Assessment, Development and Evaluations approach was used for rating quality of evidence, and the Instrument to Assess the Credibility of Effect Modification Analyses was used to rate credibility of the subgroup analyses. Furthermore, from January to March 2021, we emailed a 45-item cross-sectional survey to a list of Canadian veterans that asked about the relative importance of 20 research priorities regarding chronic pain. We explored for statistical significance between male and female responses for any item in which the proportion of endorsement showed a ≥10% difference. RESULTS: 41 observational studies with 5,550,375 military veterans were included. The overall pooled CNCP prevalence is 34% (95% confidence interval (CI) 25% to 45%). However, significant subgroup effect was found for type of prevalence measure (generic or specific) among military veterans (test of interaction p=0.007, moderate subgroup credibility): the pooled generic CNCP prevalence of 43%, 95% CI 29% to 57% (Low-certainty evidence) vs. the pooled specific type of CNCP prevalence of 14%, 95% CI 6.7% to 23% (Moderate-certainty evidence). A multivariable meta-regression model adjusted for proportion lost to follow-up found the type of prevalence measure to be the only significant predictor of CNCP prevalence (p < 0.0001). 313 of 699 Canadian military veterans living with chronic pain completed ≥50% of the survey (45% response rate). Respondents were predominantly male (77%) with a median age of 52 (interquartile range [IQR] 44-58). All 20 research priorities listed in the survey were endorsed as very important by ≥52% of respondents, and three received endorsement by ≥85%: (I) optimizing chronic pain management after release from the military; and (II) identifying and (III) treating mental illness among veterans living with chronic pain. Women were more likely than men to endorse research on post-surgical care for chronic pain prevention or research on holistic care for chronic pain. Men were more likely than women to endorse research on physical activity or exercise for chronic pain. Individuals with higher gross income (≥$80,000) were less likely to endorse research into physiotherapy for chronic pain, or chiropractic for chronic pain compared to those with lower gross income. Individuals with greater age are less likely to endorse research on medical cannabis for chronic pain. CONCLUSIONS: The overall prevalence of CNCP is 34% among military veterans. For generic CNCP, the prevalence is 43%; for a given subtype of CNCP, the prevalence is 11%. Methodologically robust studies are required to more precisely determine CNCP prevalence. The most salient research priorities among our respondents were optimizing chronic pain management during service and after discharge from the military, including co-morbid mental illness. Differences in gender, gross income, and age are implicated in the endorsement of therapy-related priorities, which include surgery, physical activity or exercise, chiropractic, and medical cannabis. Our findings provide insight into the research priorities of Canadian military veterans living with chronic pain. These findings should be considered by granting agencies when formulating calls for proposals, and by researchers who wish to undertake research that will address the needs of military veterans living with chronic pain. / Thesis / Master of Science (MSc)

Background: Cannabis is increasingly used for management of chronic pain; however, the benefits and harms of this therapy remain uncertain. We conducted a systematic review to inform harms associated with inhaled cannabis for chronic pain. Methods: We searched MEDLINE, EMBASE, PsychInfo, and Web of Science for non-randomized studies reporting on harms associated with inhaled cannabis use, from inception to October 6, 2021. We used random-effects models for meta-analyses and assessed the certainty of evidence using the GRADE approach. Results: We identified 29 eligible studies enrolling 174,562 participants that reported 145 adverse events. Moderate certainty evidence suggests inhaled cannabis use is probably associated with dry mouth (prevalence: 56%; 95%CI 49 to 64), thirst (prevalence: 44%; 95% CI 33 to 55), fatigue (prevalence: 38%; 95%CI 31 to 45), nausea (prevalence: 17%; 95%CI 8 to 27), increased appetite (prevalence: 13%; 95%CI 9 to 18), dizziness (prevalence: 10%; 95%CI 6 to 14), diarrhea (prevalence: 9%; 95%CI 3 to 18), confusion (prevalence: 9%; 95%CI 5 to 13), mood changes (prevalence: 8%; 95%CI 4 to 15), hallucinations (prevalence: 7%; 95%CI 4 to 10), amnesia (prevalence: 6%; 95%CI 3 to 11), impaired coordination (prevalence: 5%; 95%CI 4 to 6), and disorientation (prevalence: 3%; 95%CI 1 to 7). Moderate certainty evidence shows that, compared to non-users, inhaling cannabis is probably associated with increased risk of shortness of breath (risk difference [RD]: 7%; 95%CI 4 to 10). Conclusions: Our review found moderate certainty evidence that dry mouth, thirst, and fatigue are probably frequently experienced with inhaled cannabis use. Several other adverse events are also probable associated with inhaled cannabis use but were less common. Rigorously conducted cohort studies are needed to inform harms associated with inhaled medical cannabis for chronic pain. / Thesis / Master of Science (MSc) / Increasing recognition of harms associated with long-term opioid therapy for management of chronic pain has generated enthusiasm for alternatives, including medical cannabis which is often consumed through inhalation. This review assesses the harms associated with the use of inhaled cannabis for management of chronic pain. Among serious adverse events, we found that inhaled cannabis is likely associated with amnesia, disorientation, impaired coordination, hallucinations, confusion, dizziness, chronic wheeze, and shortness of breath. Inhaled cannabis may be associated with palpitations, paranoia, anxiety, and cannabis dependence. The effects of inhaled cannabis on lung cancer, depression, and psychosis were uncertain. Among less serious adverse events, we found that inhaled cannabis is likely associated with thirst, fatigue, increased appetite, nausea, mood changes, diarrhea, and dry mouth. Inhaled cannabis may be associated with red eyes, vomiting, phlegm, asthma, and cough. The effects of inhaled cannabis on euphoria and irritability were uncertain.

No description available.