Applied Health Sciences
Ph.D. Program
Faculty of Graduate Studies
500 University Centre
Winnipeg, MB
Canada R3T 2N2
Phone: (204) 474-8038
Fax: (204) 261-7553
University of Manitoba
Applied Health Sciences Research Event
Tuesday, May 21, 2013
Marshall McLuhan Hall, University Centre
STUDENT PRESENTATION
ABSTRACTS
AHS PhD Program
TASK-SPECIFIC TRAINING WITH COMPUTER GAMING IN PEOPLE WITH ARTHRITIS AFFECTING
THE HANDS
Cynthia S. Srikesavan1, Tony Szturm2, Barbara Shay2
1Applied Health Sciences PhD Program, 2Dept of Physical Therapy, School of Medical
Rehabilitation, University of Manitoba, Winnipeg, MB, Canada
Purpose: A computer based gaming platform that converts motion of many diverse objects to
signals used to control and interact with any computer game has been designed. Different
objects are selected to train graded finger mobility, strength, endurance or fine/gross
dexterous functions. A pilot RCT to test the effectiveness of our computer game-based hand
exercise program in 30 people with hand osteoarthritis or rheumatoid arthritis has begun. To
date, 3 participants per group have completed and results are presented.
Method: The control group (CG) performed conventional hand exercises and the experimental
group (EG) was provided with therapeutic objects to use in their game-based exercise program.
Both groups performed their respective exercises 4 times/ week for 6 weeks. The Arthritis Hand
Function Test (AHFT), Disabilities of Arm, Shoulder and Hand (DASH), computer-based
performance measure during object manipulation tasks, and exercise compliance were
evaluated.
Results: Grip strength increased by 5% in the EG while the CG showed no change. The AHFT
peg board dexterity task improved in both groups; 5% in the EG and 12% in the CG. Similarly,
AHFT applied dexterity improved in the EG (7%) and in the CG (5%). DASH scores improved by
13 (EG) and 16 (CG) points. Movement performance during an object manipulation task
improved by 31% in the EG while the CG showed no change. Exercise compliance was 100% in
both groups.
Summary: Initial findings are positive. The game based platform has sound potential to deliver
high- quality and personalized hand rehabilitation programs in home settings for people with
arthritis
AHS PhD Program
INFLUENCE OF NEIGHBOURHOOD ENVIRONMENT ON OBJECTIVELY MEASURED WALKING
AMONG OLDER ADULTS
Lucelia Luna de Melo1, Elizabeth Ready2 & Verena Menec3
1 Applied Health Sciences PhD Program, 2Faculty of Kinesiology and Recreation Management,
3Dept. of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
Purpose: This study examined whether perceived neighbourhood characteristics and personal
characteristics in 2007/2008 can predict change in steps taken per day among communitydwelling older adults in 2010/2011.
Methods: The sample consisted of 199 men and women above the age of 62 years old with
valid data between the two time points of data collection. Steps per day was measured using
pedometers for a 3-day period and the change score was reported as a binary outcome:
increased steps and decreased steps. The independent variable was ‘perception of the
neighbourhood environment’ assessed using select items of the Neighbourhood Environment
Walkability Scale in four categories: 1. presence and maintenance of sidewalks; 2. aesthetics; 3.
walkability safety; 4. traffic safety. Demographic and health information (sex, age, self rated
health, physical function limitations, number of chronic conditions and body mass index) were
also collected.
Results: Logistic regression analysis split by age groups (less than 70 years of age and 70 years
of age or older) showed that among those less than 70 years of age, being female and having
more chronic conditions were associated with decreased odds of increasing steps three years
later. Among those 70 years of age and older increased physical functional limitations, higher
BMI, and greater perception of health had increased odds of increasing steps three years later.
Among the perceived neighbourhood characteristics, those with greater perception of
walkability safety had increased odds of increasing steps three years later, but only in the older
group.
Summary: In this sample of community-dwelling older adults, change in steps per day was
mostly predicted by demographic and health-related characteristics than by environmental
characteristics.
AHS PhD Program
MORPHOLOGICAL CHANGES OF GRAFT DONOR SEMI-TENDINOSUS AND GRACILIS AFTER ACL
RECONSTRUCTION
Shelia McRae1, Matt Kulas2 & Dean Kriellaars3
1Applied Health Sciences PhD Program, 2Faculty of Medicine, 3Dept. of Physical Therapy, School
of Medical Rehabilitation, University of Manitoba, Winnipeg, MB, Canada.
Objective: To evaluate change in muscle morphology of semi-tendinosus (ST) and gracilis (G)
graft donor muscles used during ACL reconstruction
Methods: Longitudinal assessment was performed on 20 adult participants awaiting ACL
reconstruction surgery. Bilateral lower extremity MRI was obtained at 2-weeks pre- and 12months post-surgery to include the ischial tuberosity to 10 cm proximal to the lateral knee joint
line with 5.0 mm slice-thickness and a 1.5 mm inter-slice gap (repetition time 660 ms, echo time
15 ms) using a Siemens 1.5T (Siemens, Burlington, ON). Cross-sectional areas of ST and G were
computed for each slice (minimum 25 slices per participant) using a custom algorithm in
MatLab (Mathworks, Natick, MA). The difference in muscle areas within the harvested limb was
examined between time points, as well as a between limbs at 12 months.
Results: Mean (SD) age of the participants was 29.2 (7.1) years with fifteen males and five
females. From pre- to 12-months post surgery, there was a significant reduction (p<0.001) in
muscle area of the proximal muscle belly in both graft donor ST and G, but no reduction in
muscle area in the corresponding contralateral unharvested muscles. At 12 months, the graft
donor muscle areas were significantly reduced (p<0.001) by 79 (8.2)% and 49 (5.0)% for ST and
G, respectively, relative to the contralateral limb. Complete atrophy of the graft donor muscle
was observed in 29% of participants for ST and no participants for G. In addition, there was a
mean proximal shift of 5.7 (2.9) cm for ST and 4.2 (2.3) cm for G. At 12 months, there were no
participants that maintained muscle cross section within 5% of the pre-surgical values or within
5% of the contralateral limb.
Conclusions: Marked or complete atrophy of graft donor STG muscle has implications for
functional outcome. Regardless of compensatory hypertrophy in other muscles, a resultant
change in the line of action at the knee and the potential shift from bi-articular to uni-articular
force generation are inevitable. Approach to muscle harvest in surgery and/or greater
emphasis on hamstring rehabilitation may mediate this consequence and should be further
investigated.
AHS PhD Program
THE EFFECT OF INCREASED BODY MASS ON BODY SEGMENT INERTIAL PARAMETERS AND
LOW BACK LOAD DURING MATERIALS HANDLING
Rob Pryce1 & Dean Kriellaars2
1Applied Health Sciences PhD Program, 2Dept. of Physical Therapy, School of Medical
Rehabilitation, University of Manitoba, Winnipeg, MB, Canada.
Purpose: Exposure to deleterious mechanical load has been identified as a causal factor in low
back pathology. Increased body mass (obesity) is associated with increased severity and
duration of back pain. In spite of the obvious relation, the extent that increased body mass
alters mechanical load on the low back has not been quantified. The objectives were to: a)
determine obesity-related changes in mass and mass distribution of the trunk; b) estimate the
effect on forces and torque acting on the low back.
Methods: Body segment inertial parameters (mass, centre of mass, inertia) were derived using
a subject-specific photogrammetric approach for 5 high-BMI individuals (M=34.5, SD=4.0
kg/m2) and 3 height-matched, normal-BMI participants (M=22.4, SD=0.5 kg/m2). Mechanical
load (torque & force) was estimated using inverse dynamics for 3 conditions: 1)standing, 2)load
carrying, 3)lifting.
Results: The trunk mass of high-BMI participants was a mean(SD) 1.84(0.11) times greater (+34
kg) than normal-BMI participants, which exceeded the difference in body mass (M=1.54,
SD=0.20). Trunk centre of mass was farther anterior (M=3.2, SD = 1.2cm) in high BMI
participants, which contributed to an increase in torque during standing (M=18.3, SD=1.8Nm)
and load carrying (M=35.9, SD=3.8Nm). Moments of inertia were 2.1(0.2) – 3.2(0.3) times
greater in high-BMI participants, with a corresponding 105.5(9.4)Nm increase in inertial torque
during lifting. The total obesity-related increase in mechanical load on the low back during
lifting was +197.3(16.8)Nm (1.76x greater) and +2923(253)N for torque and normal force,
respectively.
Summary: The obesity-related change in body segment inertial parameters varied across
parameters, which contributed to differential loading effects across conditions. The obvious
(and substantial) effect of increased body mass on low back load is task dependent, and cannot
be predicted based upon simple estimates of body mass. These findings have relevance for back
injury mechanisms and design of injury prevention strategies.
AHS PhD Program
BODY IMAGE, EATING ATTITUDES AND BEHAVIOURS, AND PHYSICAL ACTIVITY: SCHOOL AGE
CHILDREN IN CHILD CARE
Kelly Andrushko1, Carol Harvey2, Roberta Woodgate3 & Susan Prentice4
1Applied Health Sciences PhD Program, 2Dept of Family Social Sciences, Faculty of Human
Ecology, 3Faculty of Nursing, 4 Dept. of Sociology, Faculty of Arts, University of Manitoba,
Winnipeg, MB, Canada.
Abstract: A multi-method qualitative study of a childcare facility was conducted to examine
body image, eating attitudes and behaviours, and physical activity among Canadian school age
children. Observations of six- to twelve-year-old children were made over a four-month period
to examine interrelationships among the three concepts. These observations were in
conjunction with selected interviews with children, parents, and Early Childhood Educators
(ECEs), and with learning activities with the children. The primary goal was to recognize and
understand the behaviours and social interactions of school age children related to these three
issues, and how these behaviours and interactions influenced, and could be influenced by, child
care practice. Guided by ecological systems theory, the data was examined using content
analysis and general inductive analysis. In the end, four main themes emerged: (1) “How to be
a better, healthier person,” (2) “Out of their hands” (3) “Puppets cutting their strings,” and (4)
“Reaching out.” In the findings, it was determined that children were knowledgeable about
ideas and behaviours that influenced health, which was due in part to formal and informal
teaching about health at the Centre. The children also exhibited, or were learning to exhibit,
healthy behaviours, which were directly influenced by the child care program philosophy, goals,
and children’s rights and responsibilities. These healthy behaviours included a positive sense of
self, healthy eating habits and food choices, and regular physical activity. However, some
children’s behaviour reflected the influences of sociocultural forces, specifically in regards to
physical appearance and physical activity. This research has provided support for the idea that
early learning and child care environments have a significant impact on the health of school age
children: Child care practice does influence children’s ideas and behaviour around body image,
eating and activity. Therefore, the establishment and delivery of a child care program must be
acknowledged as a critical influence on the health and development of children using beforeand after-school age care.
AHS PhD Program
THE ASSOCIATION BETWEEN INCOME AND MENTAL DISORDERS IN A NATIONAL SAMPLE OF
CANADIAN VETERANS
Kristen Klassen1, Elizabeth Ready2 & Jitender Sareen3
1Applied Health Sciences PhD Program, 2Facutly of Kinesiology & Recreation Management,
3Dept of Psychiatry, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.
Purpose: To examine negative outcomes (i.e., suicide ideation, suicide attempts, posttraumatic
stress disorder (PTSD), heavy alcohol use, and anxiety and mood disorders) in relation to both
household and personal income, satisfaction with income as well as the Low Income Measure
(LIM) developed by Statistics Canada in Canadian Forces veterans.
Methods: Participants were selected from the Survey on Transition To Civilian Life (STCL; n =
4800, response rate =70%) conducted by Statistics Canada and Veterans Affairs Canada in 2010.
Income was divided into quartiles and crosstabulations were calculated to determine the
proportion of individuals in each quartile who self-reported a diagnosis of a mental disorder or
endorsed suicidal ideation or attempts. Differences in prevalence of mental disorders in each
quartile was then examined by employing multiple logistic regression analyses adjusted for age,
sex, marital status, education, domicile, military rank and branch at release, type of release,
and previous deployment.
Results: Preliminary results suggest that low income is associated with mental disorders in
Canadian veterans. Associations between low income and suicide ideation, suicide attempts,
PTSD, any anxiety disorder and any mental health condition were statistically significant to the
p<.001 level. This was also true for dissatisfaction with income. Falling below the LIM was also
significantly (p<.005) associated with PTSD, any mental health condition and suicide attempts.
Summary: The transition from military service to civilian life is a complex process that
ultimately impacts all domains of an individual’s life, including socioeconomic facets. To date,
very little research has been conducted investigating the relationship between income and
mental disorders in individuals who transition out of the military. Given that military personnel
often experience a decrease in income immediately following release, this research has
significant implications for the development of programming and policy that may assist low
income personnel and guide effective prevention strategies such as suicide prevention
initiatives.
AHS PhD Program
FACTORS RELATED TO WOMEN’S EXPERIENCES AND SATISFACTION WITH PRENATAL CARE
Patricia A. Gregory1, Maureen Heaman2, Javier Mignone3 & Michael Moffatt4
1Applied Health Sciences PhD Program, 2Faculty of Nursing, 3Dept. of Family Social Sciences,
Faculty of Human Ecology, 4Dept. of Community Health Sciences, Faculty of Medicine,
University of Manitoba, Winnipeg, MB, Canada
Abstract: Prenatal care provides numerous maternal and infant health benefits, and it is more
likely to be effective if women begin receiving care early and continue their care throughout
pregnancy. Patient satisfaction is recognized as a predictor of adherence to medical
recommendations and utilization of care. The purpose of this study was to identify the factors
associated with pregnant women’s satisfaction with prenatal care in Winnipeg. A crosssectional, descriptive, correlational design was used to examine the relationships between
expectations, interpersonal processes of care, the quality of prenatal care, personal
characteristics, and the type of provider with overall satisfaction, as well as with satisfaction
with each of the following dimensions: information, provider care, staff interest, and system
characteristics. Donabedian’s (2003) structure, process, and outcome framework guided the
study. A convenience sample of 216 pregnant women from diverse socioeconomic backgrounds
was surveyed using self-administered questionnaires in late third trimester; providers were
obstetricians (58.2%), midwives (15.9%), family physicians (13.9%), nurse practitioners (4.8%),
or mixed (7.2%). Multiple linear regression analyses were used to identify predictors of
satisfaction. Perceived quality of care was a significant predictor of overall satisfaction and all
the satisfaction subscales. The provider’s interpersonal style was a significant predictor in all
but one of the satisfaction measures, satisfaction with information, where patient-centered
decision-making was significant. The type of prenatal care provider (midwife) was a predictor of
satisfaction with system characteristics. Expectations for prenatal care were unrelated to
satisfaction. Although most of the participants in this study were satisfied with prenatal care, 520% reported dissatisfaction with various dimensions. The findings of this study have
implications for future research, practice, education and policy. Important information on
structure and process was generated, with the potential to improve the experience and
satisfaction of women receiving prenatal care.
AHS PhD Program
PREGNANCY AND INTIMATE PARTNER VIOLENCE IN CANADA: RISK FACTORS, SEVERITY, AND
HEALTH EFFECTS
Tamara L. Taillieu1, Douglas Brownridge2, Kimberly A. Tyler3, Agnes Tiwari4, Ko Ling Chan5 &
Susy C. Santos6
1Applied Health Sciences PhD Program, University of Manitoba, Winnipeg, MB, Canada, 2 Dept.
of Family Social Sciences, Faculty of Human Ecology, University of Manitoba, Winnipeg, MB,
Canada, 3 Dept. of Sociology, University of Nebraska-Lincoln, 4 Dept. of Nursing, University of
Hong Kong, 5 Dept. of Social Work and Social Administration, University of Hong Kong, 6Director,
Clinical Institute of Applied Research, Victoria General Hospital, Winnipeg, MB, Canada.
Purpose. Violence against women is an important public health issue, and violence during
pregnancy is of special concern due to the potential negative consequences to both the mother
and her unborn child. The purpose of this study was to examine risk factors, indicators of
severity, and differences in post-violence health effects for victims who experienced violence
during pregnancy compared to victims who experienced violence outside the pregnancy period
only.
Methods. Data were from Statistics Canada’s 2009 General Social Survey (GSS), a nationally
representative sample of 23,766 Canadians aged 15 years and older. The subsample used in
the current study consisted of all heterosexual women who reported experiencing violence
from a current or previous marital or common-law partner in the 5 years preceding the survey.
Results. Of these victims, 10.5% experienced violence during pregnancy and 89.5% experienced
violence outside the pregnancy period only. Victims who had experienced violence during
pregnancy were significantly more likely than women who were not abused during pregnancy
to experience each individual form of violence. As well, differences were greatest on some of
the most severe forms of violence. In the fully adjusted models, respondent younger age,
separated or divorced marital status, as well as partners’ possessiveness, patriarchal
domination, destruction of property, and drinking were significant predictors of pregnancy
violence. Victims who experienced pregnancy violence were significantly more likely to report
variables that were indicative of more severe violence than victims who were not abused
during pregnancy. Finally, victims of pregnancy violence were significantly more likely than
victims not abused during pregnancy to report a number of adverse health effects as a
consequence of the violence.
Summary. Given the severity and consequences of violence reported by women who have
experienced violence during pregnancy, it is evident that frequent and universal screening of
pregnant women is warranted.
AHS PhD Program
A CASE STUDY OF THE IMPLEMENTATION OF REGULATED MIDWIFERY IN MANITOBA
Kellie Thiessen1 & Maureen Heaman2
1 Applied Health Sciences PhD Program, 2 Faculty of Nursing, University of Manitoba, Winnipeg,
MB, Canada.
Purpose: In 2000, midwifery was regulated in the Canadian province of Manitoba. Since the
inception of the midwifery program, little formal research has been done to critically analyze
the utilization of regulated midwifery services. Currently, many women are denied access to
midwifery care due to a shortage of midwives in Manitoba. The purpose of this study was to
explore factors influencing the implementation and utilization of regulated midwifery services
in Manitoba.
Method: This study used a case study design. The case to be studied was regulated midwifery
services in Manitoba. Both qualitative and quantitative methods of data collection were used.
The case study evidence was derived from three sources: analysis of population-based
administrative data at the Manitoba Centre for Health Policy; document review, and interviews
with key 24 key informants. The Behavioral Model of Health Services Use and a feminist
framework were used to conceptualize and guide the interpretation of the results.
Results: Administrative data demonstrated an overall increase in number of midwives and
midwifery births in the province from 2001/02 to 2009/10. Themes and sub-themes from
interviews were organized into three main topic areas: barriers, facilitators, and future
strategies/recommendations. Themes arising under barriers included conflict, power, and
political will; lack of an educational program; and a precarious profession. Issues of gender
underpinned some of these barriers. Constituent influence was a prominent facilitator of the
profession. Future strategies for sustaining the midwifery profession focused on ensuring
avenues for registration and education, improving management strategies and accountability
frameworks, enhancing the work environment, and evaluating the model of practice and
employment.
Summary: In spite of scientific evidence that supports the midwifery model of care, there
remains an inherent struggle to justify the profession globally. The findings have implications
for maternal/child health professionals working on collaborative efforts to facilitate access to
midwifery services for women.