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Oral Presentations

MASTERS ESTABLISH

Jaimeson Canie

Forming Authentic and Purposeful Relationships with Racialized Communities from an Anti-Oppressive Lens: A Framework for African, Caribbean, and Black Communities   Background:  Effects of systemic racism have been exacerbated and brought to the forefront throughout the COVID-19 pandemic. African, Caribbean, and Black (ACB) communities in particular have experienced poor health outcomes due to systemic inequities caused by racism, highlighting the need for anti-Black racism interventions. The best way to inform these interventions is to work with ACB communities throughout the anti-racism process.  Objectives:  In collaboration with London InterCommunity Health Centre (LIHC), which provides health/social services to those who experience barriers to care, this research will focus on creating a framework to direct how organizations can develop authentic and purposeful relationships with racialized communities, and how this can be achieved in a “power-with” way, with the goal of improved health outcomes via increased accessibility to, and trust in, health and social services.  Proposed Methods: Interviews with stakeholders from London’s ACB community will be conducted to identify current resources, needs, and priorities in terms of anti-Black racism, and to gather input on how organizations can form meaningful partnerships with ACB communities. Sally Thorne’s interpretive description will be used, guided by the structure of the interview questions, to understand best-practices regarding forming relationships with ACB communities and identifying priority anti-Black racism interventions.  Future Implications: Outcomes of this research project will be used to guide the work of LIHC’s Community Development program and will have broader applicability to health and social services, by creating improved and sustainable relationships with racialized communities in London, Ontario, and potentially beyond, thus improving health equity and racial disparities.

Mishele Kaplan

Exploring how COVID-19 impacts relationship dynamics among cohabitating heterosexual and female same-sex couples   Background: The emergence of COVID-19 and government-mandated stay-at-home orders has impacted every facet of life, including relationship dynamics among cohabitating romantic couples. Most of the emergent studies focus primarily on heterosexual relationships and very little attention has been paid to the experiences of same-sex couples, particularly women. With numbers of same-sex couples on the rise in Canada and elsewhere, acknowledging this discrepancy is essential to ensuring that sexuality research is both equitable and representative. Objectives: Our study addresses this research gap by focusing on heterosexual and female same-sex relationships to better understand how gender and relationship dynamics shape the resilience and self-expansion strategies used by these couple groups to alleviate COVID-induced stressors. Proposed Methods: Qualitative and phenomenological in design, data for this project will be gathered during interviews with heterosexual couples (n= 7-10) and female same-sex couples (n= 7-10), each of which will take part in a semi-structured interview on one occasion for roughly 30 to 60 minutes. Future Implications: The anticipated findings will contribute new insights into the impact of COVID-19 on two distinctive kinds of romantic relationships and the focus on same-sex couples, in particular, is very novel. These data may enhance the development of couples and marriage counselling practices among heterosexual and same-sex populations. The study results may also inform sexual policies and practices related to health emergencies going forward.

Sarthak Kohli

Cortical activation, standing balance, and fatigue - a post-stroke explorative study  Background: Stroke is one of the primary causes of physical disability in adults worldwide. Since stroke can alter neuronal activity in the affected brain region, rehabilitation can change cortical activation in patients. Clinical trials show functional electrical stimulation (FES) as a safe intervention to increase ambulation ability in patients. The primary aim of this study is to determine whether FES cycling training can change cortical activation patterns for patients with post-stroke hemiparesis. Secondary aims will explore changes to standing balance and fatigue over the intervention. Hypothesis: FES cycling training will alter cortical activation, improve standing balance, and decrease fatigue. Methods: Thirty patients will be recruited from the inpatients at Parkwood Research Institute. Inclusion criteria are first-ever incidence of stroke and presence of hemiparesis. Each session will last 30 minutes, two times per week for four weeks for all participants. To measure cortical activation, participants will be examined with functional near-infrared spectroscopy contralesionally over the supplementary motor areas and premotor cortices at baseline and post-intervention. Balance tasks would include a double-leg stance and a semi-tandem stance (one foot in front of the other). The primary outcome measure is a change in cortical activation during two balance tasks. Summary and Implications: This study will measure the impact of FES cycling training on cortical activation in patients post-stroke. Successful rehabilitation by the return of cortical activity near the lesion and an enhanced understanding of functional rehabilitation training may benefit Canadians through increased independence and overall quality of life.

Benson Law

Statistical and Ethical Implications of Pimavanserin Drug Trials Published with Unexplained or Missing Datasets on Parkinson’s Disease  Background: Parkinson’s Disease (PD) psychosis (PDP) is a concerning side effect of Levodopa, the primary intervention to treat PD. The concurrent use of antipsychotic and PD medications has yielded mixed results, with documented cases of worsening PD. A new pharmacotherapy, Pimavanserin, was recently approved by the FDA under the “Breakthrough Therapy” program to treat PDP. However, questions pertaining to Pimavanserin’s safety and efficacy, as well as the reliability of its clinical studies, specifically with regards to missing data, have emerged. Objectives: Missing data is a common and influential source of bias. This study will retrospectively examine if patient data was excluded without proper compensatory analysis. As well, the bioethical implications of publishing incomplete or unexplained datasets on the credibility of the drug trials will be examined. Proposed Methods: Pimavanserin’s clinical trial data will be collected from the US National Library of Medicine’s database. Possible sources of data attrition will be examined; the total percentage of missing data and statistical adjustments made will be compared to the reported trial outcomes to identify possible inaccurate conclusions. This process will be guided by Little et al. (2012) paper titled “The Prevention and Treatment of Missing Data in Clinical Trials”. Implications Missing data and improper statistical methodology may lead to improper efficacy interpretation. Given the mixed results of these aforementioned trials, their statistical strength must be carefully scrutinized to protect patients and reaffirm the public's trust in drug regulatory processes.

Siying Luan

Discovering brain activation associated with sensorimotor stimulation after functional electrical stimulation cycling in patients with stroke  Background: Sensorimotor recovery is a major goal poststroke; however, somatosensory recovery is rarely reported during stroke rehabilitation. Aerobic exercise completed on a bike can aid with neuroplasticity in healthy adults. Thus, bike-based aerobic exercise may improve sensorimotor outcomes poststroke through neuroplasticity. Functional electrical stimulation (FES) cycling is effective in muscle strengthening after stroke; however, its effectiveness in changing brain activation remains unknown. Functional near-infrared spectroscopy (fNIRS) is a useful neuroimaging tool to assess brain activation, but it has never been used to explore sensorimotor recovery among patients with stroke. Objectives: This study aims to discover the effect of FES cycling on brain activation in participants with stroke with hemiparesis under three conditions: 1) somatosensory stimulation, 2) passive foot movement, and 3) active foot movement. Proposed Methods: Up to 30 individuals admitted to the inpatient stroke rehabilitation unit at Parkwood Institute will be recruited if they have hemiparesis and can tolerate the study protocol. fNIRS assessments will occur near admission and discharge and will collect three tasks: (1) somatosensory stimulation of the ankle using a cotton ball, (2) passive plantar- and dorsiflexion, and (3) active plantar- and dorsiflexion. The FES bike will be delivered using standard inpatient protocols. Future directions: We anticipate observing changes in brain activation with somatosensory stimulation after FES cycling. Due to limitations (e.g., sample size, stroke severity), questions surrounding generalization will remain. Connections between brain activation and sensorimotor stimulation in individuals with stroke should be studied with a larger sample, other lower extremity joints, and other activities (e.g., knee flexion).

Kendall Saravanamuttoo

Exploring the Role of Socio-Economic Status (SES) and Urbanicity on Parents’ Perspectives to Return Children to Play Post-COVID-19  Background: The benefits of physical activity for children are well-documented, with additional benefits seen from participation in organized sport and unstructured outdoor play. The COVID-19 pandemic and associated public health and safety measures have reduced access to many physical activity supporting environments, greatly altering children and parent’s physical activity levels and patterns. Given the influence that parents have on children’s physical activity, examining parent and/or legal guardian perspectives and broader tenants of the social-ecological model are needed. Objectives: The purpose of this study was to explore the influence of SES and urbanicity on parents’ perspectives of their child(ren)’s active play opportunities 6 months, and 1.5 years into the COVID-19 pandemic. As a secondary objective, this relationship will be explored for both structured (organized sport) and unstructured (outdoor) play opportunities. Proposed Methods: Parents and legal guardians of children (12 years of age and older) in Ontario, Canada completed a 148-item online survey approximately 6 months (August to December 2020) and 1.5 years (August to December 2021) into the pandemic. Descriptive statistics will be used to analyze demographics (e.g., SES items), and mixed linear models will be employed to explore the influence of SES/urbanicity on parents’ perspectives. Implications: The findings from this study will reveal whether SES and urbanicity disparities exist and explore the long-term impacts of COVID-19 on play to find equitable opportunities for Canadian children to return to play post-pandemic.

MASTERS ADAPT

Sydney DiFruscia

Management of Topic in the Spoken Discourse of persons living with Mild Cognitive Impairment and Alzheimer’s Dementia  Background: Spoken discourse features that distinguish persons with mild cognitive impairment (MCI) or Alzheimer’s dementia (AD) remain unclear. In particular, discourse features that show whether persons living MCI or AD stay on or drift off-topic when speaking are not well-known. Spoken discourse samples gathered empirically in the Ontario Neurodegenerative Disease Research Initiative (ONDRI) are an ideal data set on which to examine topic management among persons living with MCI or AD. Hypothesis/Objectives: The proposed study will explore the following research question: Are there differences in topic management in the spoken discourse between persons living with MCI vs. Alzheimer’s dementia. Proposed Methods: Spoken discourse samples from a sequenced story picture telling task were collected from participants with MCI and AD as part of the larger ONDRI study. Codes for topic management from the baseline ONDRI dataset form the basis of my proposed study. Data analyses using between group, parametric statistical analyses with p set at 0.05 will be completed to determine whether there are significant group differences between participants living with MCI vs. those with AD. Statistical corrections for multiple comparisons will be completed. Future Applications/Directions: It is anticipated that study findings will inform future investigations on longitudinal changes in topic management in the spoken discourse of persons living with MCI and AD. Moreover, findings may also inform examinations of topic management and related spoken discourse features in the other neurodegenerative disease cohorts in the ONDRI study (i.e., cerebral vascular disease, ALS, Parkinson’s disease, and frontotemporal dementia).

Kristina Ferreira

Using arts-based methods to examine children’s understandings of chronic pain and coping Background: There is a paucity of knowledge relating to children’s experiences of chronic pain and coping. Many, if not most, of our understandings of how children conceptualize and cope with chronic pain are drawn from parents’ proxy accounts or extrapolated from research about pain in adult populations. Childhood pain research has focused primarily on the objective quantification of pain states and traits, with less research aiming to produce knowledge of children’s own perspectives of living with chronic pain. Objectives: This qualitative study begins to address these knowledge gaps by intentionally generating knowledge of how children with chronic pain portray their experiences and coping strategies for acute flare-ups of their pain. Proposed Methods: Using arts-based methods in combination with a critical social science lens, this study will generate data with young people aged 6-13 years who have experience of chronic pain. Participants will be invited to draw and/or photograph what comes to mind or represents a ‘good pain day’ as well as ‘a day when my pain is worse than usual'. Participants will subsequently be engaged in an open, dialogue-style interview to discuss their artwork. Implications: The study results will contribute to novel understandings of children’s experiences of chronic pain and coping, and provide insights that can inform best practices. In addition to academically oriented knowledge mobilization, an animated graphic storybook will be produced to share the study results in an engaging mode with children and youth.

Catie Johnson

The effects of dopaminergic medication on articulatory precision in Parkinson’s Disease  Background: Parkinson’s Disease (PD) is a neurodegenerative disorder which impacts various aspects of an individual’s motor function, such as their motor speech abilities. The primary method of treatment involves dopaminergic (levodopa/carbidopa) medication, which supplements the disease-related loss of dopamine in the brain. Previous studies of voice quality, speech intensity, and speech dysfluency indicate that the responsiveness to levodopa medication may be linked to the severity of speech symptoms. The present study will examine the effect of levodopa medication on the severity of perceptual and acoustic measures of articulatory precision in individuals with PD. Methods: Fifty individuals with PD had their speech audio-recorded after 12 hours without levodopa medication and 1 hour after a levodopa medication. Speech was also obtained from 10 healthy controls (HC). Two listeners used a visual analogue scale to rate articulatory precision. Acoustic analyses of articulatory precision will include measures of 1) vowel space, 2) voice onset time of plosives, and 3) spectral moments of fricatives. Simple paired and independent t-tests will be used to examine medication effects and group effects on measures of articulatory precision. Results: Preliminary results suggest that there is a significant correlation between the severity of articulatory precision and the response to levodopa medication. These initial results, for measures of articulatory precision, appear to support the speech severity and levodopa responsiveness hypothesis in PD. It appears that individuals with a more severe articulatory precision disorder show a greater response to levodopa medication than individuals with a less severe articulatory precision disorder.

Lauren Kelenc

The Acceptance of Robots in the Orthopaedic Joint Replacement Operating Room  Background: Robotic surgery has seen substantial growth over the years and continues to show promise. It has recently been implemented into orthopaedic surgery, however, prior to introduction in the operating room, it is crucial to understand patient attitudes and comfort level with robot versus surgeon autonomy. An understanding of patient views will lead to the development of informative patient education materials to help facilitate successful implementation. Objectives: 1) To assess and develop an understanding of prior assumptions, feelings, and knowledge on the use of robots during knee replacement, 2) to explore perspectives on the different robots that could be used during knee replacement. Proposed Methods: This study employs a qualitative descriptive methodology. Included subjects are those who have undergone total knee replacement in the last five years at University Hospital. Participants partook in online semi-structured interviews with questions assessing their past experiences, and fears, and assumptions on robot-assisted surgery. Thematic analysis will be completed to organize and present this information into themes. Preliminary Results: Major themes observed thus far focus on the reliability of robots being proven over time and a decrease in fear, safety and efficacy, and cleanliness. Many subjects compared this topic to self-driving cars, expressing their fear and uncertainty around it. Future Directions: Some participants' fear lies in complete autonomy of the robot, however, many have expressed they would feel more comfortable if given information prior to surgery. Patient education materials can be implemented into practice in hospitals to possibly help alleviate fears and perceptions patients may have prior to their robot-assisted knee replacement.

Jalesa Martin

Facilitators and Barriers to Diverse Patient and Caregiver Engagement in Health System Reform  Background: Diverse patient and caregiver engagement involves patients and caregivers who have differing roles and other characteristics of the community they serve, emphasizing those with health disparities. It is important because in most cases, it does not reflect the perspectives of all patients who are interacting with the healthcare system. Despite the need to prioritize patients and families with diverse experiences, there is little knowledge surrounding how to recruit them to be involved in engagement. There is also a need to explore what supports and hinders diverse patient engagement. Objectives: This research explores facilitators and barriers to engagement of diverse patients and caregivers in health system reform. This includes examining planning efforts, patient and caregiver perceptions of these efforts, and patient and caregiver-reported facilitators and barriers to meaningful and diverse engagement. Proposed Methods: We are conducting a framework-driven case study that is rooted in constructivism. Participants were recruited from working groups in the Western (Middlesex-London) Health Team. Data collection includes document analysis, participant observation, focus groups, and interviews. Data analysis is occurring simultaneously, while member-checking will be used to ensure that participant’s views are portrayed accurately. Future Implications: This research will fill a critical gap in our knowledge surrounding the specific facilitators and barriers to diverse patient and caregiver engagement in the context of provincial health system reform. It will also result in the development of recommendations that will inform the planning and implementation of equity-driven patient engagement strategies in a way that algins with the priorities of the Middlesex-London OHT (ML-OHT) and OHTs more broadly.  

Reanne Mundadan

Person-centered language-based strategies observed during home care interactions between personal support workers and persons living with dementia  Background: Persons living with dementia (PLwD) have communication needs and abilities that may present unique opportunities for their caregivers. The dementia caregiving literature offers language-based strategies that enhance coherence, clarity, reciprocity, and continuity. Person-centered communication (PCC) is also essential to high-quality care, especially formal care provided by personal support workers (PSW). However, little is known about which language-based strategies are person-centered in-home care contexts. Objective: This study aims to investigate the overlap between person-centered and language-based strategies observed during home care interactions between PSW and PLwD. Methods: Data analysis of audio-recorded routine care between eight PSW and their clients with dementia is being conducted. Conversation analysis protocols are being followed, involving coding for PCC and language-based strategies used by PSW. The overlap between PCC and language-based strategies observed during interactions will be analyzed. Preliminary Results: A preliminary review of the dementia caregiving literature identified 33 recommended effective language-based strategies. These findings guided the revision of a language-based strategy codebook used during conversation analysis of observed interactions. Language-based strategy and PCC coding of all interactions have been completed. Both coding systems presented a high degree of inter-rater reliability. Further analysis to determine the nature of overlap is currently underway. Future Directions/Implications: This is the first study examining naturalistic interactions between PSW and PLwD in home care and offer insights into which language-based strategies are person-centered in this context. The findings will thereby provide important insight for training and future research into PSW’s communication practices in the home care setting, given that older adults want to age at home.

Zakara Stampp

The Coping Strategies of Older Adults with Age Related Vision Loss: A Narrative Account  Background: Age related vision loss (ARVL) is associated with negative psychosocial implications (depression, decreased life satisfaction and decreased ability to perform daily occupations). Occupational depravation leads to further psychological distress. Maintaining meaningful occupations gives older adults the feeling of independence and joy, which is often taken away due to vision loss and lack of effective coping mechanisms. The stories of the coping mechanisms employed by older adults with ARVL will be shared and examined to gain further understanding of effective coping mechanisms employed by older adults with ARVL to maintain meaningful occupation. Objective: To understand how older adults share their stories about coping to support occupational engagement. Proposed Methods: This is a qualitative, constructivist, narrative study. Inclusion criteria: 60+ years old, diagnosis of ARVL for 1+ years and can communicate in English/French. At least 5 older adults from Ontario will be included. Study flyer was circulated through gatekeepers at local senior day programs, optometrists’ offices, and various Canadian associations for the blind. Following Wengraf’s Biographic-Narrative Interpretive Method, there are three 1-2 hours long interview sessions regarding stories about coping mechanisms and meaningful occupation. The elicited stories will be analysed using Fraser’s 7 phase line by line data analysis approach for a better understanding of the coping mechanisms employed by older adults with ARVL to maintain occupational engagement. Future Directions: A better understanding of the coping strategies used by older adults with ARVL can lead to implementing more comprehensive rehabilitation plans, including a focus on developing healthy coping strategies and improving low vision services.

Shaemus Tracey

The Development of a Piezoelectric Actuator for Wearable Mechatronic Devices  Background: Neck musculoskeletal disorders are some of the most common and debilitating in the world. Due to the need of hands-on interaction and use of equipment only available in clinics, access to treatment is quite limited. Wearable devices allowing at-home rehabilitation address these limitations. However, few have emerged from the laboratory as they are limited by industrial actuators. An overlooked type of technology is that of piezoelectric actuators, specifically, travelling wave ultrasonic motors (TWUM). Objective: To develop an actuation system that utilizes piezoelectric actuators for wearable neck rehabilitation devices, specifically to facilitate range of motion (ROM) and neuromuscular training exercises. Proposed Methods: A modular model of a TWUM capable of simulating its dynamic behaviour was developed within MATLAB’s Simulink. The model requires the TWUM’s modal mass, damping, and stiffness coefficients and coefficient of friction between rotor and stator. These can be identified through creating an equivalent circuit model (ECM) from the motor’s admittance response and custom friction testing. Preliminary Results: Utilizing a 30 mm TWUM from PCBMotor, the resulting ECM produced an admittance plot with a mean squared error of 1.23e-11 S^2 compared to the collected data. Frictional testing is still being conducted, but preliminary results show a static and kinetic coefficient of friction of 0.0612 and 0.0481 respectively. Implications: Next steps involve designing the control law for the motors so they can facilitate the desired exercises. This novel actuation system will be a major step in demonstrating that mechatronic devices can be truly wearable and have potential to reduce the limitations associated with traditional musculoskeletal rehabilitation.

Songlin Zhu

Using arts-based methods to examine children’s understandings of chronic pain and coping Background: Medial compartment knee osteoarthritis (MCOA) occurs when knee cartilage on the inner side wears down over time. MCOA patients usually demonstrate a compromised alignment of the lower limb with bowed legs (knee varus) and touching ankles (ankle valgus). This is problematic because it not only leads to abnormal movements of the foot/ankle during walking, but also associates with ankle cartilage damage and pain. Most previous studies treat the foot as one rigid block, which ignores subtle but important motions within the foot that could potentially be pathological manifestations. Objective: This study investigates how knee varus affects foot/ankle motions in walking and aims to locate at which segment(s) of the foot/ankle are abnormal motions happening when MCOA patients walk. Proposed Methods: A 3D motion capture system is used to video-tape and analyze participants’ gait. Participants have reflective markers attached to their skin then walk naturally while twelve digital cameras placed at different angles track the trajectories of these markers. The multisegment foot model used divides the foot into four segments (hindfoot, midfoot, forefoot, hallux). Intersegmental kinematic and kinetic measures are compared between MCOA patients and healthy controls. Preliminary Results: In MCOA patients, the midfoot demonstrates less dorsi-/plantar flexion but more eversion and internal rotation. Other foot/ankle segments show no significant difference between groups. Implications: The findings may help us better understand MCOA from a mechanical perspective by investigating its impacts further down the leg. It may also prompt new treatments (i.e. orthoses, exercise, etc.) for patients to manage pain and prevent ankle damage.

MASTERS DEDUCE

Maram Omar

Internet Use, Social Media Risks, and Satisfaction with Life Among University Students During the COVID-19 Pandemic: A Cross-Sectional Study  Background: There has been a documented increase in internet and social media use among young adults during the pandemic, raising concerns for potential health and social risks and their impact on overall life satisfaction. Objectives: The purpose of this descriptive cross-sectional study was to examine university students’ self-reported: (1) internet use both prior to and during the early stages of the COVID-19 pandemic; (2) social media risks; and (3) satisfaction with life. Methods: University students in Ontario were invited to complete an online survey in March/April 2020 as part of the larger “iBelong” project. Survey items examining internet use and social media risks were adapted from the Canadian Internet Use Survey (Statistics Canada, 2018). A 5-item Satisfaction with Life Scale (Diener et al., 1985) was also administered. Results: A total of 1,625 students (Mage = 22.4, SD = 5.1; 78.8% female) from 21 Ontario universities provided data for this study. Significant changes were observed for students’ internet use (p <.001), with 18.2% and 44.5% indicating that they spent 40+ hours/week online before and during the pandemic, respectively. Students reported spending more time online than intended (48.8%), having trouble concentrating on school/work tasks (34.6%), and losing sleep (26.4%) due to their social media use. Students also reported slightly below average satisfaction with life (M score = 17.1, SD = 9.6; range 5-30). Conclusion: Results will be discussed with a focus on implications for university students, as well as next steps which include an exploration of potential relationships among these variables.

Alexander Paish

Altered kinematics responses following suprathreshold cortical and spinal stimulation  

This studies aim was to assess kinematic and electromyographical (EMG) responses throughout reaction-based elbow extension movements, with and without suprathreshold cortical or spinal stimulation delivered during the preparatory time of voluntary movement. 

We hypothesized that a single transcranial magnetic stimulation (TMS) pulse to the primary motor cortex will both delay reaction time and decrease movement kinematic potency during maximal voluntary efforts, whereas evoked transmastoid motor evoked stimulation (TMES) will have minimal effect.

 In five participants, muscle activity was recorded via surface EMG electrodes from the triceps brachii and biceps brachii muscles. Following a visual go cue, prior to EMG activity, one of three stimulation conditions was randomly executed: TMS, TMES or control (no stimulation). Each condition was repeated at least three times per participant. 

Results show reaction time (triceps brachii EMG onset) was significantly slower (x̄≈107ms; 48%) with TMS compared to control, whereas the TMES quickened reaction time (x̄≈50ms; 18%). Additionally, Peak amplitudes of torque and velocity, as well as the time to peak torque, velocity, and position were significantly lower with TMS (17%, 7%, 12%, 14%, and 6%, respectively). Whereas the time to peak torque, velocity, and position were quickened (22%, 6%, 2%, respectively) with TMES. 

These results indicate an inability to fully recover motor execution following cortical disruption during maximal voluntary elbow extension movements. Yet, stimulation at the spinal cord, and presumably the motor unit pool, quickened movement outcomes. Supported by NSERC.

Ravneet Singh

Effectiveness of physical activity in reducing cancer-related fatigue and improving mental health in cancer patients during chemotherapy: A Pilot randomized clinical trial  Background: Physical activity is a standard option for reducing fatigue levels and improving psychological health in cancer patients. Cancer-related fatigue causes physical and psychological exhaustion that limits a patient’s ability to actively engage in activities of daily living and with their family, so engaging cancer patients in aerobic and strength exercise protocols is challenging for clinicians. Objectives: This present study was aimed at evaluating the effectiveness of exercise training versus implementing simple physical tasks by engaging family members in reducing fatigue and improving mental health. Methodology: Patients were randomly divided into two groups. The control group (n = 10) performed stationary bicycle ergometers at 60% of Maximum Heart Rate for 10 minutes twice a day. The experiment group (n = 10) performed physical tasks like catching and kicking a ball with a family member for ten minutes, two rounds of walking around the hospital corridor and garden accompanied by a family member and therapist twice a day. We used the fatigue severity scale (FSC) and profile of mood status (POMS) scales as primary outcomes. The data was collected at baseline and post-intervention (3 weeks). Results: An experimental group showed significant improvements in fatigue level and mental status than the control group (fatigue severity score: t = 2.93 (P = 0.008), (profile of mood status: depression: t = 7.54 (P = 1.17), anxiety: t = 4.67 (p = 0.005), anger: t = 1.34 (P = 0.04), and confusion: t = 2.14 (p = 0.03).

PHD ESTABLISH

Joseph Adu

Exploring the Experiences of Familial Stigma Among Individuals Living with Mental Illnesses  Background: Mental illness stigma appears in many forms, with the most pervasive being public or social stigma, and the least being familial stigma. Familial mental illness stigma implies stigma perpetuated by family members or close relatives of persons with mental illnesses. Familial mental illness stigma is rarely talked about in literature and the media despite its universality. This form of stigma is often hidden and can be exceptionally malicious due to alienation within the affected person’s environment Aim: This current study explores the experiences of familial mental illness stigma among persons with mental illnesses. Specifically, this study will shed light on experiences of familial mental illness stigma in Ontario, Canada and thus, fill a research gap. Methods: Interpretive phenomenology with qualitative in-depth interviews will be employed to obtain information from 45 individuals [persons with mental illness (15), family members (15), and health providers (15)] in the London-Middlesex area to answer the research questions: What are the lived experiences of stigma among individuals with a diagnosis of mental illness from family members? How do family members of individuals with a diagnosis of mental illness address potential familial mental stigma? Results Findings from this study will help in the enactment of mental health promotion and anti-stigma approaches to provide some safety-nets for individuals with mental illnesses at the family level. Additionally, the study results will serve as a guide to policy-makers on ways to create and enact programs to safeguard people with mental illnesses from stigma within their families. That is, understanding this most concealed form of stigma will support the development of policies and interventions towards illuminations to circumvent social exclusion while emboldening all-inclusiveness in our societies.

Gabrielle Crichlow

Impact of the Social Determinants of Health on Cardiovascular Disease  Background: The WHO reports that 32% of all global deaths in 2019 are from people who died from CVD, and for Canada, 33% of total deaths are from CVD. Most cardiovascular diseases can be prevented by addressing behavioural risk factors pre-emptively. Social determinants of health (such as socioeconomic status, education, physical environment, and race) play an important role in shaping these maladaptive behaviours and intervention outcomes. Objective: To determine how the social determinants of health shape behaviour change in individuals with a predisposition to cardiovascular disease. Proposed Methods: A constructivist research paradigm will be used to conduct an interpretive, hermeneutic, American phenomenology study. The study will incorporate two theoretical frameworks, notably the Health Belief Model and the Transtheoretical Model of Behaviour Change. Inclusion criteria for participants are: English speakers, individuals with a family history of cardiovascular disease (specifically those that are preventable). In order to gather data on the lived experiences of participants, multiple one-on-one semi-structured interviews will be conducted. Sentiment analysis will be used to interpret the transcribed data collected from the interviews, ultimately leading to the development of case studies for the presentation of the lived experience of the participants. Implications: Findings will hopefully show how the social determinants of health could drive behaviour change for individuals with predisposition to CVD. While current research informs on different causal links to CVD, there is very little knowledge of the role that the social determinants of health could play in fostering behaviour change for mitigating the effects of CVD.

Cara Davidson

Exploring How Gender-Based Violence Determines Breast Cancer Biomarkers, Treatment, and Outcomes for Canadian Women  Background: One-third of Canadian women have experienced one or more incidents of gender-based violence (GBV). Troublingly, 42.3% of women diagnosed with breast cancer report GBV by an intimate partner, with 12.5% experiencing GBV concurrently with breast cancer. Women with GBV history are more likely to experience aggressive forms of breast cancer and have poorer treatment trajectories and symptomatology. Specific biopsychosocial factors linking GBV and breast cancer are unknown. Hypotheses/Objectives: This project aims to: 1. Identify the prevalence of IPV for Canadian women with breast cancer; 2. Compare breast cancer characteristics between women with and without IPV history; and 3. Understand women’s lived experiences of IPV in the context of breast cancer. Proposed Methods: The Reducing the burden of Breast cancer in Young women (RUBY) database will be leveraged to contact ~1200 women who have completed breast cancer treatment. Participants will complete a survey about their demographics, breast cancer history relationship history, and perspectives on care, and be offered an optional 60-minute interview. Chi-squares will evaluate differences in biomarkers and treatment between GBV and no GBV groups. Adjusted odds ratios will compare biomarker likelihood between GBV and no GBV groups. Multivariable logistic regression will identify the association between GBV history and tumor receptor status. Repeated measures MANOVAs (IPV pre-cancer, IPV during cancer, IPV post-cancer) will compare health outcomes. Interpretive description methodology will articulate interview patterns and themes. Future Directions/Implications: These findings will provide the first evidence of the relationship between GBV and breast cancer biomarkers, treatment, and outcomes in Canada, creating the foundation for directions for future study in the area.

Holly Schaafsma

SmartAppetite: A Smartphone-based Intervention to Improve Adolescent Nutrition Knowledge and Diet Quality  Background: Poor diet quality is a significant contributor to chronic disease, the leading cause of premature death in Canada. Despite the critical role of nutrition in chronic disease prevention, less than 25% of Canadian youth consume the recommended five or more servings of fruits and vegetables per day. Currently, 96.3% of Canadian youth own a smartphone, making it an ideal platform for adolescent health interventions. SmartAPPetite, a smartphone app created by a team of experts in nutrition and behaviour change, sends users daily nutrition education messages and uses GPS-tracking to notify users of healthy food options from nearby food vendors. Objective: This study’s objective is to evaluate the impact of SmartAPPetite on 13-18 years old participants’ food and nutrition knowledge, food purchasing decisions, and diet quality over 12-weeks. My hypothesis is that SmartAPPetite will improve participants’ food literacy and diet. Proposed Methods: Participants will be recruited from schools across Ontario and social media sites. Participants will be randomly assigned into the intervention group where they will use SmartAPPetite throughout the intervention, or the control group who will not receive access to the app. Participants will complete a youth survey assessing nutrition knowledge and food purchasing behaviours and a 24hr diet recall pre-intervention, post-intervention, and at 5-months follow-up. Results will be analyzed using Intent-to-Treat analysis and structural equation modeling. Future Directions: This research will improve our understanding of mobile-based nutrition interventions, particularly for youth. As this is an emerging research field, our findings can inform future research and public health initiatives surrounding mobile health promotion.

Michelle Solomon

A Picture of Spirituality in Youth Living with Bipolar Disorder  Background: What is the meaning of spirituality in today's world, and how can we understand how youth experience it? Spirituality is associated with lower rates of depression, lower substance use rates, and lower suicide rates. It can be thought of as the meaning in life that a person gains in relation to something bigger than themselves or the "transcendent." Bipolar disorder is a multifaceted mood disorder carrying the highest risk of suicide. Psychosocial interventions such as spirituality may increase treatment effectiveness, allowing patients to better cope with symptoms and reduce the negative impacts of the disorder. Psychosocial interventions are essential to investigate in the management of bipolar disorder since pharmacotherapy has not been found to fully restore mood and quality of life. Objectives: The purpose of this study is to raise awareness of how youth living with bipolar disorder describe their understanding of and experiences of spirituality to better support their spiritual needs and promote their mental health. Proposed Methods: Photovoice research is a novel participatory approach that captures in images abstract concepts that may be difficult to express in words. Using cameras, youth between the ages of 18 to 29 living with bipolar disorder will show us how they understand and experience spirituality. They will participate in individual interviews regarding their photos, co-analyze them with the researcher, and create an art exhibit to share with the public. Future Directions/Implications: This essential information will help health professionals, educators, and policymakers better understand spirituality and its role in supporting youth mental health.

Selina Teti

Examining telehealth administration of aphasia and cognitive screening tests  Introduction: Aphasia, most caused by a stroke, is a language disorder which hinders the ability to communicate effectively. It is a significant disability affecting daily life and is linked to poor functional outcome after stroke. Early identification of patients with stroke-induced aphasia is essential so patients can seek proper referrals or rehabilitation. Objectives: The purpose of this study is to test the validity and feasibility of a telehealth screening tool for the early identification of stroke patients with potential language problems, and any associated extra-linguistic cognitive dysfunctions. Method: Thirty participants from US and Canada will be recruited and will undergo telehealth administration using both a cognitive-based screening tool along with an aphasia-based screening tool. Patient and caregiver-reported measures will also be used to provide a more holistic view of the individual. Each participant will complete a feasibility questionnaire comprised of rating the quality, interpretability, and applicability of their telehealth experience. Data Analysis: Pearson Correlation Coefficient will be used to examine the relationship between the aphasia and cognitive screening test results along with the patient and caregiver-reported measures. Descriptive statistics will be compiled for the feasibility of telehealth administration, summarizing whether telehealth is feasible and which areas/categories were more positively or negatively rated. Conclusion: This telescreening protocol may overcome the limitations of test administration and may be a convenient and cost-effective alternative to the existing in-person assessment process for patients with post-stroke aphasia.

PHD ADAPT

Lauren Straatman

The Exploration of the Relationship between Kinematic Joint Contact and Subchondral Volumetric Bone Mineral Density in People With and Without Wrist Trauma  Background: Pain and disability following wrist trauma are highly prevalent, however the mechanisms underlying these outcomes are unknown. The purpose of this study is to explore the impact of kinematic joint contact on the underlying subchondral bone, to better understand potential mechanisms underlying pain and disability following wrist trauma. Methods: We analyzed the wrists of 10 participants (n = 5 healthy; n = 5 wrist trauma). Participants underwent 4DCT scans while performing flexion to extension to estimate radiocarpal (radiolunate (RL) and radioscaphoid (RS)) joint contact area (JCa), presented using inter-bone distances. They also underwent a static CT scan accompanied by a calibration phantom with known material densities that was used to estimate subchondral BMD, at three normalized depths from the subchondral surface (0 - 2.5, 2.5 - 5 and 5 - 7.5 mm). Results The healthy participants demonstrated larger JCa in the RS joint throughout the range of motion, while the trauma cohort demonstrated larger JCa in the RL throughout the range of motion. Overall, the healthy cohort demonstrated a higher BMD for all normalized depths compared to the trauma cohort. Conclusion: Results from our preliminary analysis demonstrate that in the RL joint specifically, a larger JCa throughout movement was associated with an overall lower BMD across all three layers. This association could be due to altered joint contact mechanics following wrist trauma that has led to overloading in the RL region. The overloading in this region may have led to a decrease in the underlying BMD when compared to a healthy wrist.

PHD DEDUCE

Armaghan Dabbagh

A systematic review of the psychometric properties of the patient-reported outcome measures for persons with ulnar nerve entrapment at the elbow  Background: Ulnar nerve entrapment at the elbow (UNE) constitutes the second most prevalent compressive neuropathy in the upper extremity. Given the certain number of studies on the psychometric properties of patient-reported outcome measures (PROMs) in people with UNE, there is a substantial need for a systematic review to summarize them, to assist clinicians with the clinical decision-making process. Objective: To systematically review, critically appraise, and synthesize the evidence on the measurement properties of the PROMs for people with UNE. Methods: CINAHL, Medline, EMBASE, and Scopus were searched for studies reporting on the psychometric properties of the PROMs for the assessment of pain, disability, and quality of life of people with UNE. Data were extracted using the COSMIN 2018 checklist. Two authors independently rated the quality and the risk of bias of the studies. The results were categorized based on the PROMs that emerged, and the psychometric properties were summarized and presented. Results: Eight included studies had a quality score of very good or higher. Among all the included PROMs, the Patient-Rated Ulnar Nerve Evaluation (PRUNE) was comprehensively evaluated in four studies and had high reliability, appropriate correlation to the physical component summary score of the SF-36 (r= - 0.68), excellent content (cognitive interviews), structural (factor analysis), and discriminative validities, and high responsiveness. The Disability of Arm, Shoulder and Hand questionnaire (DASH) was assessed in five studies and indicated appropriate properties, with a high correlation with SF-8 (r= 0.77) and PRUNE (r= 0.75), and a moderate responsiveness.

Olayinka Ariba

What makes supportive housing work? Understanding health promoting practices post-homelessness in Canada  Background: Secure housing is a platform for health and well-being. Those who struggle with housing stability have complex life and health histories and often require some level of support services such as provision of permanent supportive housing. Poor access to of supportive resources creates an exacerbation of chronic homelessness, particularly affecting individuals who need immediate access to mental health and addiction supports. This paper presents the first phase of a three-part study examining how on-site supports impact housing stability for persons recently re-housed. Methods: This study utilized a community-based participatory research methodology. Twenty in-depth interviews were conducted with permanent supportive housing residents from a single site dwelling. Interpretative description analysis was used to draw common themes and understand the experiences and challenges of housing support. Results: Three interconnected themes were identified: 1) Available and timely supports; 2) Affordability; and 3) Community, but with independence as desired. These interconnected components are helping residents’ transition from homelessness or long-term mental health inpatient care to life in the community. Despite some participant concerns about resident conflicts, staff availability, and affordability, this has been a welcome and successful move for most. Conclusion: Supportive housing is essential for successful tenancies as a platform for health and well-being among Canada’s most vulnerable and, from the perspective of persons recently re-housed, permanent supportive housing is a worthwhile investment.

Kristin Nugent

Investigating perceived balance confidence using the Activities-specific Balance Confidence scale among people with a lower extremity amputation    Background: The Activities-specific Balance Confidence scale (ABC) is the most commonly used scale to evaluate balance confidence in people with lower extremity amputations (PLEA). The content validity of items within this scale may not fully address the challenges for PLEA as the scale was developed for community-dwelling older adults. Aim: Determine which items on the ABC align with the functional abilities of PLEA. Methods: Cross-sectional, web-based survey. Individuals were recruited from Parkwood Institute. Inclusion criteria were 18 years or older and currently using a prosthesis for ambulation. Balance confidence was assessed using the 16-item ABC. Participants were asked if they were physically unable to complete any of the items on the ABC. Data Analysis: The total ABC score was the average of all items, with scores ranging from 0% (no confidence) to 100% (complete confidence). The frequency of ABC items that individuals indicated they were unable to perform was reported. Results: Forty-eight adults (61.8±11.6 years, 33 males) participated. Total ABC scores ranged from 32% to 100%. Sixty-seven percent of participants indicated they were unable to perform at least one activity on the ABC, including “Stand on a chair and reach for something” (n=26) and “Step onto or off an escalator while holding onto parcels such that you cannot hold onto the railing” (n=20). Conclusions: This study has demonstrated that multiple items on the ABC do not align with the functional capabilities of the majority of PLEA. To effectively monitor balance confidence during rehabilitation, understanding the limitations of standardized scales used among PLEA is required.

Katie Shillington

A Cross-Sectional Examination of Ontario Graduate Students’ Levels of Resilience And Health-Related Quality of LifE During the COVID-19 Pandemic: The CARE Study   Background: Public health measures to slow the spread of COVID-19 have altered the lives of post-secondary students worldwide. Graduate students have unique responsibilities which, in addition to pandemic-related pressures, might impact students’ mental wellbeing and resilience. Purpose: The three-fold purpose of this cross-sectional study was to: (1) describe Ontario graduate students’ self-reported resilience and health-related quality of life (HRQOL) 18 months into the COVID-19 pandemic; (2) examine whether participants’ self-reported resilience predicted HRQOL; and (3) examine the extent to which graduate students’ resilience predicted HRQOL based on gender and degree program. Methods: Participants completed an online survey that included demographic questions, the Connor-Davidson Resilience Scale-10, and the RAND 36-Item Health Survey 1.0. Data analyses involved computing descriptive statistics for demographic characteristics and tools. To answer the research questions, linear regression was used. Results A total of 376 graduate students completed the survey. Participants reported low resilience and low scores on two HRQOL domains (i.e., role limitations due to emotional problems and energy/fatigue). Resilience was found to be a predictor of HRQOL (p < 0.01) broadly, as well as within gender and degree program. Conclusion: Compared to pre-COVID studies conducted with similar populations, participants in the current study reported lower resilience and HRQOL scores. As such, the pandemic may have heightened stress levels of graduate students, beyond what is typical, although further research is necessary. The current study may aid researchers and student affairs personnel in understanding the impact of the COVID-19 pandemic on graduate students’ levels of resilience and HRQOL.