Faculty of Kinesiology and Recreation Management

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Open Access
Use of video technology and GPS as a tool for driver education – a preliminary investigation with older drivers
(Canadian Multidisciplinary Road Safety Conference, 2004) Porter, Michelle M.; Melnyk, Micah G.
Driver education programs have traditionally taken two general forms: in-classroom or in-vehicle. This study explores a variation on traditional in-vehicle driver education programs by using video technology instead of a driver educator in the passenger seat. A program of this type would be appropriate for currently licensed drivers. Advantages of using video technology include: the possibility of driver behaviour more like their everyday driving, increased safety for the driver educator, and more effective instruction. In this study, 8 subjects aged 70 and older drove a 26 km road course in Winnipeg, Manitoba, Canada while their driving was recorded. The course included all road types including residential, collector, arterial and expressway. Subjects were shown the video and global positioning system (GPS) speed data some time after performing the drive. Subjects watched the video first without feedback, and then with feedback and instruction from a driver educator. Common feedback from the driver educator included instruction on changing lanes, signaling, and stopping at stop signs. Subjects were given three questionnaires at various stages to evaluate the perceived effectiveness of the program. Subjects all agreed that the program was useful to them and all but one self reported using the lessons from the driver educator in their everyday driving 2 to 4 weeks after the video session. The subjects found watching the video with the driver educator feedback more useful than watching the video without feedback. Using in-vehicle video technology is a new opportunity for driver education programs and is an alternative to in-classroom programs for those looking to update their driving skills.
Open Access
Speed and acceleration patterns of younger and older drivers
(Canadian Multidisciplinary Road Safety Conference, 2006) Nakagawa, Satoru; Kriellaars, Dean; Blais, Christine; Montufar, Jeannette; Porter, Michelle M.
Driving and aging is an area that is receiving more research attention. Most studies have been epidemiological or laboratory-based. Few studies have examined in-vehicle performance, and those that do usually rely on the subjective evaluation of an observer inside or outside the vehicle. The purpose of this study was to examine driver-induced vehicle longitudinal movements under real life conditions in younger (30 - 50 years) and older ($70 years) men and women. It was hypothesized that both the younger drivers and the male drivers would show higher speed and acceleration related values. A total of 49 drivers (13 younger men, age 37.8 ± 5.9; 12 younger women, age 40.2± 7.1; 13 older men, age 76.0 ± 4.6; and 11 older women, age 76.7 ± 5.5) drove a 26 km road course which included residential, collector, arterial and highway roads with 30 intersections. The vehicle movement data were collected by a Global Positioning System (GPS) receiver which was installed in each subject’s own vehicle. In addition, the scene in front of the driver was captured using a digital video camera, without the image of the driver, to provide context for the GPS data. The following maximum speed data were analysed: 1) the whole road course, 2) within all the sections between the 30 intersections and 3) within all the sections between the 12 stop signs. The acceleration and the deceleration data were analysed only between the stop sign intersections because of the consistent speed limits on these sections (50 km/hr). The data were then statistically analysed between the age and the gender groups by multivariate analysis of variance/covariance. Results showed that there were age differences for maximum speeds, for all three analyses (i.e., whole road course, all sections, stop sign sections), with the younger drivers having faster speeds than the older drivers. Acceleration results showed that older drivers accelerated over a longer distance than younger drivers, and that older female drivers had less deceleration over a longer distance than younger female and older male drivers. It is concluded that age group differences exist for speed and acceleration, under real-world conditions. The current study’s results have implications for road safety because previous studies have concluded that drivers with crashes had higher maximum speeds and accelerations than drivers with no crash record.
Open Access
The effect of a new road safety device with auditory alerts on older drivers
(Canadian Multidisciplinary Road Safety Conference, 2008) Porter, Michelle M.; Ash, Heather
The purpose of this study was to examine a newly designed road safety device as used by older drivers. The Otto Driving Companion (Persen Technologies, Winnipeg, MB) is a portable device that provides drivers with "instant information about [their] driving environment" and can act as a data logger. The device has a global positioning system (GPS) receiver so it can determine the vehicle’s location and speed approximately every second. If the speed limit has been exceeded, the driver will immediately be given an auditory alert telling them "Speed Limit Exceeded". In addition, the Otto will provide auditory alerts when the driver approaches potential hazards (e.g., a "Crosswalk"). Using the OttoLog feature and Persen Technologies’ software, driving patterns can be captured, saved and analyzed offline. This means that, for example, actual driving speed can be compared to the speed limit, across many days of driving. Although older drivers are not as likely to speed as young drivers, older drivers are more limited in their ability to quickly process all the visual information available during driving. This means looking at their speedometer might result in difficulties with seeing everything in their driving environment. Also, because there is a lot of visual information on our roads today they might not see warning signs (such as speed limit signs) at the side of the road. Therefore, auditory alerts might improve their road safety. Older drivers (69 to 91 years old, n = 12) completed a two-week study examining their speeding behaviours as well as their responses to the Otto. In the first week of the study only the data logging features of the Otto were operational, whereas in the second week, the auditory alerts were turned on. During the first week the subjects were unaware that their driving between week one and two would be compared. At the end of the second week the drivers were asked to respond to several questions about the Otto. In addition, their speed information across both weeks was examined to determine if the Otto resulted in less time above the speed limit, when auditory alerts were provided. Most drivers found the Otto to be useful, although a few drivers found the Otto to be a distraction. The subjects did speed less often (p < 0.05) in week two when the auditory alerts were turned on as compared to week one when the auditory alert feature was turned off. As most subjects found the Otto useful, and speed reductions did occur, this device seems to hold some promise as a road safety device for older drivers.
Open Access
Modeling age-related neuromuscular changes in humans
(NRC Research Press, 2009-08) Webber, Sandra C.; Porter, Michelle M.; Gardiner, Phillip, F.
With aging, motoneurons and muscle tissue undergo significant changes, which influence function in terms of strength, mobility, and overall independence. Mathematical modeling provides a practical method of studying the relationships among recruitment, rate-coding, and force output in motor units, and may be used to predict functional neuromuscular changes related to aging. For this study, the Heckman–Binder model was used to examine changes in human quadriceps motor units. Relationships among current input, firing frequency, and force output were defined for both a younger and an older individual. Included in the model were age-related effects associated with reduced muscle contractile speed; reduced muscle-fibre number, size, and specific tension; reduced gain of the frequency–current relationship; decreased size of motoneurons; and altered motor unit remodeling. Adjustment of this model to reflect age-related changes resulted in a leftward shift of the force–frequency function, lower firing frequency for any given current injected into the motoneuron, and a reduction in maximal force output. The model suggests that older individuals are capable of reaching force levels up to approximately 50% of those attained by younger individuals, with relatively similar or even slightly lower levels of current input. This could mean that the sense of effort and the contribution of factors other than degree of effort from afferent inputs to the pool, including conscious supraspinal centres, might be different in the older adult.
Open Access
Monitoring Mobility in Older Adults Using Global Positioning System (GPS) Watches and Accelerometers: A Feasibility Study
(Human Kinetics, Inc., 2009-10) Webber, Sandra C.; Porter, Michelle M.
This exploratory study examined the feasibility of using Garmin global positioning system (GPS) watches and ActiGraph accelerometers to monitor walking and other aspects of community mobility in older adults. After accuracy at slow walking speeds was initially determined, 20 older adults (74.4 ± 4.2 yr) wore the devices for 1 day. Steps, distances, and speeds (on foot and in vehicle) were determined. GPS data acquisition varied from 43 min to over 12 hr, with 55% of participants having more than 8 hr between initial and final data-collection points. When GPS data were acquired without interruptions, detailed mobility information was obtained regarding the timing, distances covered, and speeds reached during trips away from home. Although GPS and accelerometry technology offer promise for monitoring community mobility patterns, new GPS solutions are required that allow for data collection over an extended period of time between indoor and outdoor environments.
Open Access
An Evaluation of the Roadwise Review: A Mixed Methods Approach
(Traffic Injury Prevention, 2011) Porter, Michelle M.; Tuokko, Holly A.
Objective: The objective of this mixed methods study was to perform an evaluation of the Roadwise Review CD-ROM (RWR), a self-screening tool for older drivers. Methods: Ninety-six older drivers (67 to 91) used the RWR with a research assistant at two different sites, and then completed written surveys (closed and open-ended questions) immediately after the session as well as two weeks later. In addition, RWR test results by these 96 older drivers were compared to the results of the original sample that was used to establish normative data for the RWR. Results: When test scores were evaluated, almost all participants (96%) were found to have at least one impairment. The rates of impairment varied dramatically between tests from 3% (visual acuity) to 75% (visual search). Several average test scores were found to be different from the original samples upon which the normative data were derived. Several factors were found that influenced these older drivers’ scores on the various components of the RWR, although the explanatory power was very low. Participants reported that the RWR was useful, they made changes to their driving, and talked to their family and friends about driving. Participants also provided many good suggestions for improvements of this tool. Conclusions: The RWR offers promise for older drivers to self-screen their ability to drive as well as provide education on safe driving, however modifications are recommended for this tool.
Open Access
The use of a naturalistic driving route for characterizing older drivers
(Canadian Multidisciplinary Road Safety Conference, 2012) Smith, Glenys A.; Cull, Andrew W.; Mence, Rachel; Charlton, Judith; Langford, Jim; Koppel, Sjaan; Porter, Michelle M.
Although the vast majority of older drivers are safe, there are some older drivers who are at risk of crashes due to health-related changes in functional status. For licensing agencies worldwide it is a challenge to identify unsafe older drivers. One form of older driver assessment that can be done conducted is an on-road test. Often this occurs in an unfamiliar vehicle and on roads that are not familiar to the older driver. This could be detrimental to their driving performance and lead to an overestimation of their crash risk. Purpose: The purpose of the current study is to determine whether the route used for the Driving Observation Schedule (DOS), a specific driving task designed to observe and record driving performance, is actually representative of older drivers’ everyday driving in Melbourne Australia. This is a sub-study of the Ozcandrive study, which is a partner study to Candrive. Methods: Older drivers (75+ years old) were asked to describe locations where they typically drive. A route was then devised to incorporate those locations, and the older driver was observed for their driving behaviours over this route. Older drivers’ vehicles were equipped with a device that monitored their driving locations by global positioning system (GPS) technology at 1 Hz. These same older drivers were followed over several months for their everyday driving using the same device. All trips made were compared for their location against the DOS route. These results were then expressed as a percentage of the trips that included a road from the DOS route, in order to determine how representative the DOS route was of each older drivers’ everyday driving. In addition to location, speed patterns were also compared between the DOS route and everyday driving. Results: The average distance of the DOS route was 13.8 ± 5.3 km, and on average it took 31.0 ± 7.6 minutes to drive, for the 23 older drivers that were included in the sample for this study. Over the 108 ± 18 days whereby the older drivers were monitored for their everyday driving, the older drivers drove 2384 ± 1504 km, and made 385 ± 155 trips. The roads that were part of the DOS route represented 9 ± 8 percent of roads that were used during the everyday driving trips. The DOS route and driving was similar to everyday driving in terms of speed limits of the roadways, exceeding the speed limit, and speed of driving. Drivers spent the majority of time driving on roadways that had speed limits of 50 and 60 km/hr (DOS = 80.4%, everyday = 74.1%). There was a slight trend for everyday driving to be on roadways with faster speed limits and have faster driving than DOS driving. Conclusions: These results suggest that a route can be formulated that will be representative of most of the everyday driving of older drivers. Use of such a route has promise for determining the performance of older drivers under conditions which are typical for their everyday driving. Future research that combines driving behaviour observation, crash data, naturalistic driving as well as health and functional testing for individual older drivers will do much to provide more definitive information about this growing cohort of drivers.
Open Access
Motor interactions with another person: do individuals with Autism Spectrum Disorder plan ahead?
(frontiers, 2013-04-17) Gonzalez, David A.; Glazebrook, Cheryl M.; Studenka, Breanna E.; Lyons, Jim
Interpersonal motor interactions (joint-actions) occur on a daily basis. In joint-action situations, typically developing (TD) individuals consider the end-goal of their partner and adjust their own movements to accommodate the other person. The movement planning processes required for joint-action may, however, be difficult for individuals with an Autism Spectrum Disorder (ASD) given documented difficulties in performance on theory of mind (ToM) and motor tasks. The goal of this experiment was to determine if individuals with ASD exhibit end-state comfort behaviors similar to their TD peers in joint-action situations. Participants were asked to either pass, place, or use three common tools: a wooden toy hammer, a stick, or a calculator. These tools were selected because the degree of affordance they offer (i.e., the physical characteristics they posses to prompt proper use) ranges from direct (hammer) to indirect (calculator). Participants were asked to pass the tool to a confederate who intended to place the tool down, or use the tool. Variables of interest included beginning and end-state grip orientations of the participant and confederate (comfortable or uncomfortable) as a function of task goal, and the side to which the tool was placed or passed. Similar to Gonzalez et al. (2011),some individuals with ASD maximized their partner’s beginning-state comfort by adopting personally uncomfortable postures. That said, their performance was more variable than their TD peers who consistently passed tools in a manner that facilitated comfortable use by the confederate. Therefore, the movement planning processes used to prepare to pass a tool are not stereotypical across all individuals with ASD. We propose that the novel joint-action task described herein provides the basis for testing an important link between motor performance and more complex social and communication behaviors.
Open Access
Pilot study: Can older inactive adults learn how to reach the required intensity of physical activity guideline?
(Dove Press, 2013-04-30) Bouchard, Danielle R.; Langlois, Marie-France; Boisvert-Vigneault, Katherine; Farand, Paul; Paulin, Mathieu; Baillargeon, Jean-Patrice
Most individuals do not reach the recommended physical activity level of at least 150 minutes of aerobic exercise (AE) at moderate-to-vigorous intensity per week. For example, only 13% of older Canadian adults reach World Health Organization physical activity guideline (PAG). One of the reasons might be a difficulty identifying the required intensity. Twenty-five inactive older adults received one session about the AE-PAG and how to use a tool or strategy to help them identify AE intensity: heart-rate (HR) monitor (% of maximal HR; N = 9); manual pulse (% of maximal HR; N = 8); or pedometer (walking cadence; N = 8). Participants had 8 weeks to implement their specific tool with the aim of reaching the PAG by walking at home. At pre- and post-intervention, the capacity to identify AE intensity and AE time spent at moderate-to-vigorous intensity were evaluated. Only the two groups using a tool increased total AE time (both P < 0.01), but no group improved the time spent at moderate-to-vigorous intensity. No significant improvement was observed in the ability to correctly identify AE intensity in any of the groups, but a tendency was observed in the pedometer group (P = 0.07). Using walking cadence with a pedometer should be explored as a tool to reach the PAG as it is inexpensive, easy to use, and seemed the best tool to improve both AE time and perception of intensity.
Open Access
Older driver estimates of driving exposure compared to in-vehicle data in the Candrive II study
(Taylor and Francis, 2015-01) Porter, Michelle M.; Smith, G.A.; Cull, A.W.; Myers, A.M.; Bedard, M.; Gelinas, I.; Mazer, B.; Marshall, S.C.; Naglie, G.; Rapoport, M.J.; Tuokko, H.A.; Vrkljan, B.H.
OBJECTIVE: Most studies on older adults' driving practices have relied on self-reported information. With technological advances it is now possible to objectively measure the everyday driving of older adults in their own vehicles over time. The purpose of this study was to examine the ability of older drivers to accurately estimate their kilometers driven over one year relative to objectively measured driving exposure. METHODS: A subsample (n = 159 of 928; 50.9% male) of Candrive II participants (age >/= 70 years of age) was used in these analyses based on strict criteria for data collected from questionnaires as well as an OttoView-CD Autonomous Data Logging Device installed in their vehicle, over the first year of the prospective cohort study. RESULTS: Although there was no significant difference overall between the self-reported and objectively measured distance categories, only moderate agreement was found (weighted kappa = 0.57; 95% confidence interval, 0.47-0.67). Almost half (45.3%) chose the wrong distance category, and some people misestimated their distance driven by up to 20,000 km. Those who misjudged in the low mileage group (/= 20,000); that is, they always overestimated their driving distance. CONCLUSIONS: Although self-reported driving distance categories may be adequate for studies entailing broad group comparisons, caution should be used in interpreting results. Use of self-reported estimates for individual assessments should be discouraged.
Open Access
Programs for improving the safety of older drivers
(Canadian Geriatrics Society Journal of CME, 2015-04-30) Porter, Michelle M.
Open Access
Velocity during Strength and Power Training of the Ankle Plantar and Dorsiflexor Muscles in Older Patients Attending Day Hospital Rehabilitation
(2015-2-23) Rajan, Pavithra; Porter, Michelle M.
Power training has been proposed as a more effective type of resistance training for older adults for functional performance. It is not yet known whether older adults respond appropriately to instructions for power versus strength training. The purpose of this study was to determine the velocity during strength and power training, with elastic resistance bands, in older adults attending a geriatric rehabilitation day program. It was hypothesized that power training would be faster than strength training, but that there would be large interindividual differences. Nine older patients (70 to 86 years) performed power and strength training of the ankle dorsiflexor and plantar flexor muscles using elastic resistance bands. Training sessions were filmed to assess the velocity of training. Power training occurred at faster velocities as compared to strength training () for both muscle groups. However, a wide variation was observed between participants in the training velocities. Older adults attending geriatric rehabilitation do have the potential to develop faster contractions during power training as compared to strength training. Nevertheless, the actual velocities achieved differed between individuals. This could explain some of the mixed findings of studies on power training. Hence, researchers should monitor velocity when comparing different types of resistance training.
Open Access
Seasonal and Weather Effects on Older Adults’ Driving Trip Distances
(Canadian Journal on Aging, 2016-06) Smith, Glenys A.; Porter, Michelle M; Cull, Andrew W.; Mazer, Barbara; Myers, Anita M.; Naglie, Gary; Bedard, Michel; Tuokko, Holly A.; Vrkljan, Brenda H.; Gelinas, Isabelle; Marshall, Shawn C.; Rapoport, Mark J.
The purpose of this study was to determine if season or weather affected the objectively measured trip distances of older drivers (≥ 70 years n=279) at seven Canadian sites. During winter, for all trips taken, trip distance was 7% shorter when controlling for site and whether the trip occurred during the day. In addition, for trips taken within city limits, trip distance was 1% shorter during winter and 5% longer during rain when compared to no precipitation when controlling for weather (or season respectively), time of day, and site. At night, trip distance was about 30% longer when controlling for season and site (and weather), contrary to expectations. Together these results suggest that older Canadian drivers alter their trip distances based on season, weather conditions and time of day, although not always in the expected direction.
Open Access
Impact of a randomized possible selves experiment on new retirees’ physical activity and identity
(2016-08-27) Perras, Mélanie G M; Strachan, Shaelyn M; Fortier, Michelle S; Dufault, Brenden
Abstract Background Retirement is not always associated with greater engagement in physical activity. Previous interventions informed by possible selves, a type of future-oriented self-representation, proved useful to increase physical activity in young adults. We thus wanted to explore if a similar intervention would yield favorable outcomes in new retirees. We also examined whether possible selves could help increase identity relative to the physical activity context. Identity circumscribes the meanings which help individuals define who they are in a given role (i.e., what it means to be a physically active person). The strength of identification as a physically active person increases when individuals endorse these meanings more strongly. Possible selves may be tied to identity as they allow individuals to imagine themselves as physically active, which has been argued to incite changes to one’s sense of self. Hence, the overall aim of this study was to determine whether a possible selves intervention would increase physical activity behaviour and physical activity identity in a group of newly-retired individuals. Methods A total of 294 participants were randomized into one of three groups: (a) a repeated group with three possible selves image generation exposures, (b) a one-time group with one possible selves image generation exposure, or (c) a control group. Participants completed self-report measures at baseline and follow-up assessments were taken at weeks 4, 8, and 12 of the study. The measures for the outcomes of interest were the Godin Leisure Time Exercise Questionnaire and the modified Exercise Identity Scale. Results Repeated measures mixed-effects models analyses with maximum likelihood estimation revealed no significant differences between groups on physical activity behaviour (p = 0.34) or physical activity identity (p = 0.97) at follow-up time points. However, a time effect was found for physical activity (p <.01) and physical activity identity (p <.01), which increased across time (baseline-to-12-week follow-up) in all three groups. Such a time effect (inconsequential to group assignment) suggests that the observed increases in physical activity and identity cannot be attributed to an exposure to a possible selves intervention. Conclusions While the intervention failed to significantly increase physical activity identity and physical activity in newly retired individuals, we suggest future research directions for interventions targeting new retired individuals.
Open Access
Transgender Eligibility Policy in Sport: Science, Ethics, and Evidence
(Parnassos Press, 2017) Teetzel, Sarah
In response to cases of high-profile athletes’ sex being called into question, prior to the 2012 London Olympic Games, the International Association of Athletics Federations (IAAF) updated its policy addressing the conditions under which athletes are eligible to compete in the women’s sport category. The IAAF’s policy, which stipulated the eligibility conditions that transgender athletes, as well as athletes with disorders of sex development (DSD) and hyperandrogenism, must meet to participate in high-performance sport, was subsequently endorsed by the International Olympic Committee (IOC), and remained in effect until 2015 when the Court of Arbitration for Sport (CAS) ordered the immediate suspension of the policy. The decision rendered mixed reactions, with some dissenting voices echoing American athlete Summer Pierson’s (2011) view that “it is a privilege to compete, and in order to enjoy such a privilege, the sacrifice of certain rights is required” (323). To engage in moral evaluation of the policy, more information is needed about how the rules in force apply to and impact athletes. To gain new knowledge about athletes’ views of the sex verification regulations, athletes who identify as a trans and high-performance female athletes were invited to participate in semi-structured, in-depth interviews about their understanding of, and reactions to, rules governing sex verification in sport. Athletes, such as Pierson, who speak openly about their concerns regarding rule changes that promote inclusive sport have faced criticism and charges of intolerance, and may fear losing sponsorship opportunities for speaking their minds (Ljungqvist & Genel, 2005). For example, MMA fighter Ronda Roussey received negative publicity after questioning whether trans women MMA fighters compete at an advantage compared to athletes identified as female at birth (Samano, 2013). In discussing the results from this study, this presentation analyzes athletes’ public and private experiences supporting and challenging sex verification rules mandated by sport governing bodies, such as the IOC, IAAF, and CAS. The philosophy of sport literature is quite silent on the extent that athletes’ views should shape policymaking on contentious ethical issues. The perspectives of the people impacted most (that is, the athletes) certainly need to be included in the dialogue; however, the extent that their perspectives should be privileged over other views remains unclear. Thus, this chapter focuses on the impact of athletes’ voices in determining the moral acceptability of rule changes in sport.
Open Access
Citizen science applied to building healthier community environments: advancing the field through shared construct and measurement development
(2017-09-29) Hinckson, Erica; Schneider, Margaret; Winter, Sandra J; Stone, Emily; Puhan, Milo; Stathi, Afroditi; Porter, Michelle M; Gardiner, Paul A; dos Santos, Daniela L; Wolff, Andrea; King, Abby C
Abstract Background Physical inactivity across the lifespan remains a public health issue for many developed countries. Inactivity has contributed considerably to the pervasiveness of lifestyle diseases. Government, national and local agencies and organizations have been unable to systematically, and in a coordinated way, translate behavioral research into practice that makes a difference at a population level. One approach for mobilizing multi-level efforts to improve the environment for physical activity is to engage in a process of citizen science. Citizen Science here is defined as a participatory research approach involving members of the public working closely with research investigators to initiate and advance scientific research projects. However, there are no common measures or protocols to guide citizen science research at the local community setting. Objectives We describe overarching categories of constructs that can be considered when designing citizen science projects expected to yield multi-level interventions, and provide an example of the citizen science approach to promoting PA. We also recommend potential measures across different levels of impact. Discussion Encouraging some consistency in measurement across studies will potentially accelerate the efficiency with which citizen science participatory research provides new insights into and solutions to the behaviorally-based public health issues that drive most of morbidity and mortality. The measures described in this paper abide by four fundamental principles specifically selected for inclusion in citizen science projects: feasibility, accuracy, propriety, and utility. The choice of measures will take into account the potential resources available for outcome and process evaluation. Our intent is to emphasize the importance for all citizen science participatory projects to follow an evidence-based approach and ensure that they incorporate an appropriate assessment protocol. Conclusions We provided the rationale for and a list of contextual factors along with specific examples of measures to encourage consistency among studies that plan to use a citizen science participatory approach. The potential of this approach to promote health and wellbeing in communities is high and we hope that we have provided the tools needed to optimally promote synergistic gains in knowledge across a range of Citizen Science participatory projects.
Open Access
Research priorities of the Canadian chiropractic profession: a consensus study using a modified Delphi technique
(2017-12-12) French, Simon D; Beliveau, Peter J H; Bruno, Paul; Passmore, Steven R; Hayden, Jill A; Srbely, John; Kawchuk, Greg N
Abstract Background Research funds are limited and a healthcare profession that supports research activity should establish research priority areas. The study objective was to identify research priority areas for the Canadian chiropractic profession, and for stakeholders in the chiropractic profession to rank these in order of importance. Methods We conducted a modified Delphi consensus study between August 2015 and May 2017 to determine the views of Canadian chiropractic organisations (e.g. Canadian Chiropractic Association; provincial associations) and stakeholder groups (e.g. chiropractic educational institutions; researchers). Participants completed three online Delphi survey rounds. In Round 1, participants suggested research areas within four broad research themes: 1) Basic science; 2) Clinical; 3) Health services; and 4) Population health. In Round 2, researchers created sub-themes by categorising the areas suggested in Round 1, and participants judged the importance of the research sub-themes. We defined consensus as at least 70% of participants agreeing that a research area was “essential” or “very important”. In Round 3, results from Round 2 were presented to the participants to re-evaluate the importance of sub-themes. Finally, participants completed an online pairwise ranking activity to determine the rank order of the list of important research sub-themes. Results Fifty-seven participants, of 85 people invited, completed Round 1 (response rate 67%). Fifty-six participants completed Round 2, 55 completed Round 3, and 53 completed the ranking activity. After three Delphi rounds and the pairwise ranking activity was completed, the ranked list of research sub-themes considered important were: 1) Integration of chiropractic care into multidisciplinary settings; 2) Costs and cost-effectiveness of chiropractic care; 3) Effect of chiropractic care on reducing medical services; 4) Effects of chiropractic care; 5) Safety/side effects of chiropractic care; 6) Chiropractic care for older adults; 7) Neurophysiological mechanisms and effects of spinal manipulative therapy; 8) General mechanisms and effects of spinal manipulative therapy. Conclusions This project identified research priority areas for the Canadian chiropractic profession. The top three priority areas were all in the area of health services research: 1) Integration of chiropractic care into multidisciplinary settings; 2) Costs and cost-effectiveness of chiropractic care; 3) Effect of chiropractic care on reducing medical services.
Open Access
The Effect of Fuel Prices on the Driving Patterns of Older Adults
(Transportation Research Part F: Psychology and Behaviour, 2018) Sukhawathanakul, Paweena; Porter, Michelle M; Naglie, Gary; Marshall, Shawn; Rapoport, Mark J.; Tuokko, Holly; Vrkljan, Brenda; Gelinas, Isabelle; Mazer, Barbara; Bedard, Michel
Examining environmental factors that influence older adults’ driving patterns has important implications for understanding factors that can lead to self-regulation and cessation. The current study explored the effect of fuel prices on older adults’ driving patterns using objective data from the nationwide Candrive longitudinal study (N = 807). Fuel prices were negatively associated with driving distance and positively associated with speeding and acceleration pattern. Specifically, on occasions when fuel prices were high, older adults drove less often but were speeding and accelerating more. However, the magnitudes of the effects were small, suggesting that older adults continue to rely on their vehicles for community mobility, despite variations in fuel prices.
Open Access
Exercise in Pregnancy and Children’s Cardiometabolic Risk Factors: a Systematic Review and Meta-Analysis
(2018-08-02) Guillemette, Laetitia; Hay, Jacqueline L; Kehler, D. S; Hamm, Naomi C; Oldfield, Christopher; McGavock, Jonathan M; Duhamel, Todd A
Abstract Background Maternal metabolic health during the prenatal period is an established determinant of cardiometabolic disease risk. Many studies have focused on poor offspring outcomes after exposure to poor maternal health, while few have systematically appraised the evidence surrounding the role of maternal exercise in decreasing this risk. The aim of this study is to characterize and quantify the specific impact of prenatal exercise on children’s cardiometabolic health markers, at birth and in childhood. Methods A systematic review of Scopus, MEDLINE, EMBASE, CENTRAL, CINAHL, and SPORTDiscus up to December 2017 was conducted. Randomized controlled trials (RCTs) and prospective cohort studies of prenatal aerobic exercise and/or resistance training reporting eligible offspring outcomes were included. Four reviewers independently identified eligible citations and extracted study-level data. The primary outcome was birth weight; secondary outcomes, specified a priori, included large-for-gestational age status, fat and lean mass, dyslipidemia, dysglycemia, and blood pressure. We included 73 of the 9804 citations initially identified. Data from RCTs was pooled using random effects models. Statistical heterogeneity was quantified using the I2 test. Analyses were done between June and December 2017 and the search was updated in December 2017. Results Fifteen observational studies (n = 290,951 children) and 39 RCTs (n = 6875 children) were included. Observational studies were highly heterogeneous and had discrepant conclusions, but globally showed no clinically relevant effect of exercise on offspring outcomes. Meta-analyzed RCTs indicated that prenatal exercise did not significantly impact birth weight (mean difference [MD] − 22.1 g, 95% confidence interval [CI] − 51.5 to 7.3 g, n = 6766) or large-for-gestational age status (risk ratio 0.85, 95% CI 0.51 to 1.44, n = 937) compared to no exercise. Sub-group analyses showed that prenatal exercise reduced birth weight according to timing (starting after 20 weeks of gestation, MD − 84.3 g, 95% CI − 142.2, − 26.4 g, n = 1124), type of exercise (aerobic only, MD − 58.7 g, 95% CI − 109.7, − 7.8 g; n = 2058), pre-pregnancy activity status (previously inactive, MD − 34.8 g, 95% CI − 69.0, − 0.5 g; n = 2829), and exercise intensity (light to moderate intensity only, MD − 45.5 g, 95% CI − 82.4, − 8.6 g; n = 2651). Fat mass percentage at birth was not altered by prenatal exercise (0.19%, 95% CI − 0.27, 0.65%; n = 130); however, only two studies reported this outcome. Other outcomes were too scarcely reported to be meta-analyzed. Conclusions Prenatal exercise does not causally impact birth weight, fat mass, or large-for-gestational-age status in a clinically relevant way. Longer follow up of offspring exposed to prenatal exercise is needed along with measures of relevant metabolic variables (e.g., fat and lean mass). Protocol Registration Protocol registration number: CRD42015029163 .
Open Access
Naturalistic Driving Patterns of Older Adults Before and After Cataract Surgery
(Canadian Journal of Ophthalmology, 2018-10) Porter, Michelle M; Cull, Andrew W.
Background. Cataract surgery can have many benefits for older adults, including enabling continued driving. However, it is not known how objectively measured driving patterns change after cataract surgery. Objective. The purpose of this study was to examine how participants from the Winnipeg site of Candrive (a longitudinal study of older drivers in Canada) drove before and after cataract surgery. Methods. An in-vehicle device monitored all trips taken at 1 second intervals allowing for the analysis of distances driven, number of trips, time of trips, speeding, excessive braking/accelerating, as well as the types of roadways. Hypotheses. It was hypothesized that after cataract surgery participants would drive further. Secondarily it was also hypothesized that participants would make more trips, drive further from home on different roadway types, drive in the dark more, speed more, and have fewer episodes of hard brakes and accelerations. Results. Over the four years of data collection, there were 16 cases of participants having cataract surgery, whereby there was also suitable driving data for analyses. Participants drove 28% further distances after surgery (p = 0.022). They also had drove further from home, more on primary roads (p < 0.05), and had fewer episodes of hard braking per distance travelled (p < 0.001). No other variables significantly changed. Conclusions. This study suggests that older drivers changed some of their driving patterns after cataract surgery. Future studies could explore the effects of increased driving exposure, in conjunction with potentially safer driving behaviors, on overall driving safety after cataract surgery.