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Background: In Canada, as in other countries, the physical therapist (PT) must make a diagnosis to comply with direct access responsibilities. This means making a diagnosis is an entry-to-practice essential competency. However, there is no consensus across physical therapy practice domains and contexts regarding the diagnostic concept, i.e., the classification system, labelling and diagnostic format that should be used., Objective: To propose a universal diagnostic concept, one a PT could use regardless of their practice domain or context., Methods: The relevant scientific and grey literature (1986-2022) were searched and key information was synthesized., Results: Information from 194 retained documents (8506 identified) was synthesized to a list of seven essential criteria that were then used to develop a universal physical therapy diagnostic concept (PT-Dx-C). The PT-Dx-C format consists of three labels in the following order: (1) health problem, (2) primary impairment, and (3) primary activity limitation or participation restriction. Label definitions are those used by the World Health Organization. The specific health problem, impairment, and limitation or restriction making up the diagnosis are determined for each patient using valid tests and measures., Conclusions: The PT-Dx-C is consistent with best practices and could be applied to all patients, in all PT practice domains and contexts. It reflects the PT's expertise in the human movement system and their unique contribution to health care. Furthermore, its use may allow for communication of the PT's conclusions in a manner that can be understood by others thereby facilitating collaborative practice., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2023 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To investigate if the completion of a recently developed treadmill-based wheelchair propulsion maximal progressive workload incremental test alters the integrity of the long head of the biceps and supraspinatus tendons using musculoskeletal ultrasound imaging biomarkers., Method: Fifteen manual wheelchair users completed the incremental test. Ultrasound images of the long head of the biceps and supraspinatus tendons were recorded before, immediately after, and 48 hours after the completion of the test using a standardized protocol. Geometric, composition, and texture-related ultrasound biomarkers characterized tendon integrity., Results: Participants propelled during 10.2 ± 2.9 minutes with the majority ( N = 13/15) having reached at least the eighth stage of the test (speed = 0.8 m/s; slope = 3.6°). All ultrasound biomarkers characterizing tendon integrity, measured in the longitudinal and transversal planes for both tendons, were similar ( p = 0.063 to 1.000) across measurement times., Conclusion: The performance of the motorized treadmill wheelchair propulsion test to assess aerobic fitness produced no changes to ultrasound biomarkers of the biceps or supraspinatus tendons. Hence, there was no ultrasound imaging evidence of a maladaptive response due to overstimulation in these tendons immediately after and 48 hours after the performance of the test., Competing Interests: The authors declare that they have no conflict of interest., (Copyright © 2021 Mylène Leclerc et al.)

Objective: The 6-Min Manual Wheelchair Propulsion Test is proposed to easily and rapidly assess aerobic fitness among long-term (≥3 mos) manual wheelchair users with spinal cord injury. However, aerobic responses to this test have not been established. This study aimed (1) to characterize aerobic responses during the 6-Min Manual Wheelchair Propulsion Test, (2) to establish parallel reliability between the 6-Min Manual Wheelchair Propulsion Test and the Maximal Arm Crank Ergometer Test, and (3) to quantify the strength of association between the total distance traveled during the 6-Min Manual Wheelchair Propulsion Test and peak oxygen consumption., Design: Twenty manual wheelchair users with a spinal cord injury completed both tests. Aerobic parameters were measured before, during, and after the tests. Main outcome measures were peak oxygen consumption and total distance traveled., Results: Progressive cardiorespiratory responses, consistent with guidelines for exercise testing, were observed during both tests. Similar peak oxygen consumption values were obtained during both tests (6-Min Manual Wheelchair Propulsion Test: 20.2 ± 4.9 ml/kg·min; Maximal Arm Crank Ergometer Test: 20.4 ± 5.0 ml/kg·min), were highly correlated (r = 0.92, P < 0.001), and had a good agreement (mean absolute difference = 0.21, 95% confidence interval = -0.70 to 1.11, P = 0.639). The peak oxygen consumption and total distance traveled (mean = 636.6 ± 56.9 m) during the 6-Min Manual Wheelchair Propulsion Test were highly correlated (r = 0.74, P < 0.001)., Conclusions: The 6-Min Manual Wheelchair Propulsion Test induces progressive aerobic responses consistent with guidelines for exercise testing and can be used to efficiently estimate aerobic fitness in manual wheelchair users with a spinal cord injury., To Claim Cme Credits: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Explain how to administer the Six-Minute Manual Wheelchair Propulsion Test in long-term manual wheelchair users with a spinal cord injury; (2) Contrast how the workload is developed between the Six-Minute Manual Wheelchair Propulsion Test and the Maximal Arm Crank Ergometry Test and recognize how these differences may affect physiological responses; and (3) Explain why caution is advised regarding the use of the Six-Minute Manual Wheelchair Propulsion Test if aiming to estimate aerobic fitness., Level: Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Background: Many wheelchair users adopt a sedentary lifestyle, which results in progressive physical deconditioning with increased risk of musculoskeletal, cardiovascular and endocrine/metabolic morbidity and mortality. Engaging in a walking program with an overground robotic exoskeleton may be an effective strategy for mitigating these potential negative health consequences and optimizing fitness in this population. However, additional research is warranted to inform the development of adapted physical activity programs incorporating this technology., Objectives: To determine cardiorespiratory demands during sitting, standing and overground walking with a robotic exoskeleton and to verify whether such overground walking results in at least moderate-intensity physical exercise., Methods: We enrolled 13 long-term wheelchair users with complete motor spinal cord injury in a walking program with an overground robotic exoskeleton. Cardiorespiratory measures and rate of perceived exertion (RPE) were recorded by using a portable gas analyzer system during sitting, standing and four 10m walking tasks with the robotic exoskeleton. Each participant also performed an arm crank ergometer test to determine maximal cardiorespiratory ability (i.e., peak heart rate and O 2 uptake [HR peak , VO 2peak ])., Results: Cardiorespiratory measures increased by a range of 9%-35% from sitting to standing and further increased by 22%-52% from standing to walking with the robotic exoskeleton. During walking, median oxygen cost (O 2Walking ), relative HR (%HR peak ), relative O 2 consumption (%VO 2peak ) and respiratory exchange ratio (RER) reached 0.29mL/kg/m, 82.9%, 41.8% and 0.9, respectively, whereas median RPE reached 3.2/10. O 2Walking was moderately influenced by total number of sessions and steps taken with the robotic exoskeleton since the start of the walking program., Conclusion: Overground walking with the robotic exoskeleton over a short distance allowed wheelchair users to achieve a moderate-intensity level of exercise. Hence, an overground locomotor training program with a robotic exoskeleton may have cardiorespiratory health benefits in the population studied., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Objectives: To investigate and compare the feasibility, safety, and preliminary effectiveness of home-based self-managed manual wheelchair high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) programs., Methods: Eleven manual wheelchair users were randomly assigned to the HIIT ( n = 6) or the MICT group ( n = 5). Both six-week programs consisted of three 40-minute propulsion training sessions per week. The HIIT group alternated between 30 s high-intensity intervals and 60 s low-intensity intervals, whereas the MICT group maintained a constant moderate intensity. Cardiorespiratory fitness, upper limb strength, and shoulder pain were measured before and after the programs. Participants completed a questionnaire on the programs that explored general areas of feasibility., Results: The answers to the questionnaire demonstrated that both training programs were feasible in the community. No severe adverse events occurred, although some participants experienced increased shoulder pain during HIIT. Neither program yielded a significant change in cardiorespiratory fitness or upper limb strength. However, both groups reported moderate to significant subjective improvement., Conclusion: Home-based wheelchair HIIT appears feasible and safe although potential development of shoulder pain remains a concern and should be addressed with a future preventive shoulder exercise program. Some recommendations have been proposed for a larger study aiming to strengthen evidence regarding the feasibility, safety, and effectiveness of HIIT.

Background: Cardiorespiratory fitness training is commonly provided to manual wheelchair users (MWUs) in rehabilitation and physical activity programs, emphasizing the need for a reliable task-specific incremental wheelchair propulsion test., Objective: Quantifying test-retest reliability and minimal detectable change (MDC) of key cardiorespiratory fitness measures following performance of a newly developed continuous treadmill-based wheelchair propulsion test (WPT Treadmill )., Methods: Twenty-five MWUs completed the WPT Treadmill on two separate occasions within one week. During these tests, participants continuously propelled their wheelchair on a motorized treadmill while the exercise intensity was gradually increased every minute until exhaustion by changing the slope and/or speed according to a standardized protocol. Peak oxygen consumption (VO 2peak ), carbon dioxide production (VCO 2peak ), respiratory exchange ratio (RER peak ), minute ventilation (VE peak ) and heart rate (HR peak ) were computed. Time to exhaustion (TTE) and number of increments completed were also measured. Intra-class correlation coefficients (ICC) were calculated to determine test-retest reliability. Standard error of measurement (SEM) and MDC 90% values were calculated., Results: Excellent test-retest reliability was reached for almost all outcome measures (ICC=0.91-0.76), except for RER peak (ICC=0.58), which reached good reliability. TTE (ICC=0.89) and number of increments (ICC=0.91) also reached excellent test-retest reliability. For the main outcome measures (VO 2peak and TTE), absolute SEM was 2.27 mL/kg/min and 0.76 minutes, respectively and absolute MDC 90% was 5.30 mL/kg/min and 1.77 minutes, respectively., Conclusion: The WPT Treadmill is a reliable test to assess cardiorespiratory fitness among MWUs. TTE and number of increments could be used as reliable outcome measures when VO 2 measurement is not possible.

Background: Cardiorespiratory fitness assessment and training among manual wheelchair (MW) users are predominantly done with an arm-crank ergometer. However, arm-crank ergometer biomechanics differ substantially from MW propulsion biomechanics. This study aimed to quantify cardiorespiratory responses resulting from speed and slope increments during MW propulsion on a motorized treadmill and to calculate a predictive equation based on speed and slope for estimating peak oxygen uptake (VO 2peak ) in MW users., Methods: In total, 17 long-term MW users completed 12 MW propulsion periods (PP), each lasting 2min, on a motorized treadmill, in a random order. Each PP was separated by a 2-min rest. PPs were characterized by a combination of 3 speeds (0.6, 0.8 and 1.0m/s) and 4 slopes (0°, 2.7°, 3.6° and 4.8°). Six key cardiorespiratory outcome measures (VO 2 , heart rate, respiratory rate, minute ventilation and tidal volume) were recorded by using a gas-exchange analysis system. Rate of perceived exertion (RPE) was measured by using the modified 10-point Borg scale after each PP., Results: For the 14 participants who completed the test, cardiorespiratory responses increased in response to speed and/or slope increments, except those recorded between the 3.6 o and 4.8 o slope, for which most outcome measures were comparable. The RPE was positively associated with cardiorespiratory response (r s ≥0.85). A VO 2 predictive equation (R 2 =99.7%) based on speed and slope for each PP was computed. This equation informed the development of a future testing protocol to linearly increase VO 2 via 1-min stages during treadmill MW propulsion., Conclusions: Increasing speed and slope while propelling a MW on a motorized treadmill increases cardiorespiratory response along with RPE. RPE can be used to easily and accurately monitor cardiorespiratory responses during MW exercise. The VO 2 can be predicted to some extent by speed and slope during MW propulsion. A testing protocol is proposed to assess cardiorespiratory fitness during motorized MW propulsion., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Objective: To determine the safety and effectiveness of a self-monitored, home-based phase II exercise program for high risk patients after cardiac surgery., Methods: High risk patients were defined as those presenting with severe left ventricular dysfunction with an ejection fraction less than 35%, severe ventricular arrhythmias, incomplete revascularization, abnormal response to a standard walking test or significant (grade 3/4) valvular regurgitation persisting postoperatively. Eighty patients (mean age 58.5 +/- 8.9 years) were randomly assigned to two groups. The experimental group (n = 37) received a home program of aerobic training with an intensity gradually increasing from 1.5 to 4.0 multiples of resting oxygen consumption (METs). This program was started at discharge from the hospital and lasted eight weeks. The control group (n = 43) received general guidelines for progressive increase of their activity level. Functional capacity was measured at discharge by the 6 min walking test and between the sixth and eighth week following discharge by a symptom-limited exercise test, according to the Naughton protocol., Results: No cardiovascular complications occurred during the training program. At the final evaluation, there was no significant difference between the experimental and control groups regarding aerobic capacity (5.1 +/- 1.8 versus 4.9 +/- 1.6 METs respectively, P = 0.61), nor peak rate-pressure product (22.8 +/- 4.9 versus 23.6 +/- 5.2 beats/min x mmHg x 10(3) respectively, P = 0.54).

Women report more symptoms than men in mental health surveys. The evidence shows that psychometric biases cannot explain this significant difference. This study attempts to explore other factors that could bias the results--for example, that women are likely to report less serious symptoms than men or are less apprehensive in reporting symptoms because they have a higher tendency to report symptoms than men. A random sample of 213 women and 222 men, all married and between the age of 25 and 40, were interviewed at home in two districts of Montreal (Canada) and given the Health Opinion Survey (HOS). As has been usually found, women scored higher than men on the HOS. A variety of scales assessed the seriousness of the symptoms and the results did not indicate any sex difference in this regard. Moreover, there was no correlation between the mental health and the Jourard Self-Confidence Scale. Finally, women did not confide more about their symptoms than men, contrary to the prevalent opinion according to which they are more likely to do so. Sex differences on mental health scales do not, therefore, appear to be related to the type of bias assessed in this survey.