Sean Collins
Research interests
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InterestsHuman Physiology, Cardiac Rehabilitation, Exercise Physiology, Ergonomics, Occupational Health
Publications
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2.18Impact points
Mobility activities measurement for outpatient rehabilitation settings.
Archives of physical medicine and rehabilitation. 04/2011; 92(4):632-9.
To investigate the factor structure and scale properties of items underlying the mobility activities subdomains of the International Classification of Functioning, Disability and Health (ICF). A cross-sectional self-report-based psychometric study. Outpatient rehabilitation settings (N=3) in 3 urban... [more] To investigate the factor structure and scale properties of items underlying the mobility activities subdomains of the International Classification of Functioning, Disability and Health (ICF). A cross-sectional self-report-based psychometric study. Outpatient rehabilitation settings (N=3) in 3 urban areas of Spain. Convenience sample of 615 patients with musculoskeletal conditions (mean age, 38.1y) participating in an active physiotherapy program. Not applicable. A 22-item Mobility Activities Measure by using a self-report questionnaire that assessed whether patients had limitations on daily activities across major ICF categories of mobility subdomains. Factor analysis, tests of item scaling, internal consistency reliability analysis, Rasch item response theory modeling, and modified parallel analysis were used. Initial exploratory factor analysis results for each ICF subdomain produced a total of 5 distinct and interpretable factors or dimensions: changing and maintaining body position involving sitting and/or lying; changing and maintaining body position involving standing up; carrying, moving, and handling objects using the hand and shoulder; carrying, moving, and handling objects using the hand and/or forearm; and walking and moving. Dimensionality of these 5 factors was verified by using confirmatory factor analyses and scaling assumptions were met for each dimension. Rasch scaling and modified parallel analysis supported the unidimensionality. The Mobility Activities Measure is a promising new self-report measure of mobility activities as defined by the ICF. Information about Mobility Activities Measure items and dimensions from this study will be useful in the future operationalization and implementation of ICF.
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1.88Impact points
Continuity of rehabilitation services in post-acute care from the ambulatory outpatients' perspective: a qualitative study.
Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 01/2011; 43(1):58-64.
To explore ambulatory outpatient experiences and perceptions in post-acute care settings and how these experiences may have led to perceived gaps in continuity of rehabilitation care. Fifty-seven adults undergoing outpatient rehabilitation for musculoskeletal conditions/injuries, who had had more th... [more] To explore ambulatory outpatient experiences and perceptions in post-acute care settings and how these experiences may have led to perceived gaps in continuity of rehabilitation care. Fifty-seven adults undergoing outpatient rehabilitation for musculoskeletal conditions/injuries, who had had more than 10 physiotherapy treatment sessions. Qualitative study using a modified grounded theory approach. Data collection was carried out through 9 focus groups. Each group was recorded, transcribed literally and analyzed thematically. Participants described 3 main themes in continuity; relational, informational, and management continuity. Several factors that led to gaps in the 3 types of continuity were described. The relevant factors for relational continuity were: consistency of the multi-professional rehabilitation team; and an established provider-patient relationship. Factors for informational continuity were: transfer of information among providers; and accumulated knowledge regarding patients' disability experiences. Factors for management continuity included: consistency of care among rehabilitation providers; flexibility of the team in adapting care to functional changes; and involvement of the team in achieving patient collaboration. This study provides evidence of gaps in different types of continuity of care within the post-acute rehabilitation services in ambulatory settings. Outpatients often perceive their experiences of rehabilitation care as non-connected or non-coherent over time.
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Reduced vagal cardiac control variance in exhausted and high strain job subjects.
International journal of occupational medicine and environmental health. 10/2010; 23(3):267-78.
This paper has two primary objectives. First, the paper proposes methodological strategies for analyzing multiscale vagal cardiac control based on the Stress Disequilibrium Theory (SDT) using high frequency power of heart rate variability (HFP) and short term variance of HFP. Second, the paper provi... [more] This paper has two primary objectives. First, the paper proposes methodological strategies for analyzing multiscale vagal cardiac control based on the Stress Disequilibrium Theory (SDT) using high frequency power of heart rate variability (HFP) and short term variance of HFP. Second, the paper provides evidence of reduced vagal cardiac control range and variability in high strain job and exhausted subjects. Job Strain was measured using the Job Content Questionnaire, 8/day diary reports, and a nationally standardized occupational code linkage in 36 healthy mid-aged males with varying strain jobs. Subjects were Holter-monitored for 48 hours, including a work and rest day. Subjects responded to questions on a daily diary as well as on the Job Content Questionnaire to test for exhaustion as a dichotomous state variable. Vagal cardiac control was measured by components of electrocardiograph: heart rate variability based measures of high frequency power (HFP). We assessed range of vagal cardiac control using extreme value analysis (data in upper tail); and short term vagal variability using Poincaré plots of HFP. Comparisons were made between high (N = 10) and low job strain (N = 22) jobs. Furthermore, subjects categorized as exhausted (N = 4) were separately analyzed. Exhausted subjects displayed a reduced range of vagal cardiac control on the workday; and both high strain and exhausted subjects displayed reduced short-term variance in vagal cardiac control. A repeated measures ANOVA controlling for age confirms reductions in variance of cardiac vagal activity in high job strain subjects (0.01), with further reductions in subjects reporting exhaustion (p = 0.001). This analysis supports the hypothesis that (a) job strain is associated with reductions in cardiac vagal - or system level - variance; and (b) that reduced system variability may be a characteristic of exhaustion.
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Description of a large-scale study design to assess work-stress-disease associations for cardiovascular disease.
International journal of occupational medicine and environmental health. 01/2010; 23(3):293-312.
We claim that a new level of studies is needed to answer a series of important questions about the expanding global chronic disease burden for cardiovascular disease (CVD) and for related conditions such as diabetes, metabolic syndrome, and obesity. These require a new study design structure, relate... [more] We claim that a new level of studies is needed to answer a series of important questions about the expanding global chronic disease burden for cardiovascular disease (CVD) and for related conditions such as diabetes, metabolic syndrome, and obesity. These require a new study design structure, related to a new level of theory that goes beyond the current single-factor, a-theoretic epidemiological studies. This new platform for the design of large-scale Work/Stress/Disease studies would assess CVD-related disease mechanisms in a more general and dynamic form, based on the use of new tools for measuring autonomic functions in an occupational stress context and a new theory of disease causation. A sample outline is presented for such a study, based on Stress-Disequilibrium Theory (SDT) hypotheses, building on analytic tools developed for the assessment of stress-related exhaustion effects and chronic disease risks from Heart Rate Variability (HRV) research studies. The goal is to assess the associations between social organizational risks, particularly at work, and hypertension, metabolic syndrome, and diabetes II. The study design is multi-stage, spanning across several levels of disease-related de-regulation, and addressing co-morbidity of the conditions themselves. The study design is meant to span across a broad social population at all levels and would probably be multi-site, involving several countries, to yield the larger sample increased power for finding associations for work - physiological effects.
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2.18Impact points
Self-management of chronic neck and low back pain and relevance of information provided during clinical encounters: an observational study.
Archives of physical medicine and rehabilitation. 10/2009; 90(10):1734-9.
Escolar-Reina P, Medina-Mirapeix F, Gascón-Cánovas JJ, Montilla-Herrador J, Valera-Garrido JF, Collins SM. Self-management of chronic neck and low back pain and relevance of information provided during clinical encounters: an observational study. OBJECTIVE: To assess the relative influence of inform... [more] Escolar-Reina P, Medina-Mirapeix F, Gascón-Cánovas JJ, Montilla-Herrador J, Valera-Garrido JF, Collins SM. Self-management of chronic neck and low back pain and relevance of information provided during clinical encounters: an observational study. OBJECTIVE: To assess the relative influence of information provided during physical therapy on a patient's adherence to self-management strategies in relation to other predictors of adherence (patient and pain characteristics, use of self-management strategies before intervention). DESIGN: A longitudinal observational study of the relationship between the information provided during physical therapy and adherence to self-management strategies. SETTING: Data came from a clinical-based population in 8 primary health care centers. PARTICIPANTS: Patients (N=184) with chronic neck or low back pain (77% under the age of 59y) were surveyed at the beginning and 1 month after completion of physical therapy. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Specific and overall adherence to 2 types of strategies: (1) nonpharmacologic pain management strategies, and (2) neck/back care in activities of daily life. RESULTS: Adherence to strategies of nonpharmacologic self-management of pain was more probable when patients received information explaining the effectiveness of the self-management strategies (adjusted odds ratio [AOR]=10.1; P<.05) and information about their illness (AOR=3.4; P<.05) during clinical encounters. Information provided by the physical therapist did not have any influence on the adherence to neck/back care in activity of daily life (P>.05). CONCLUSIONS: Information provided during clinical encounters is associated with adherence to different kinds of self-management strategies. While further study is required, it is suggested that more attention be given to clinical practice strategies for improving adherence to self-management of chronic pain.
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Occupational factors, fatigue, and cardiovascular disease.
Cardiopulmonary physical therapy journal. 06/2009; 20(2):28-31.
Purpose: Briefly identify the epidemiological evidence, propose pertinent mechanisms, and discuss physical therapy practice as well as research implications of a causal association between occupational factors and cardiovascular disease. Summary of Key Points: There is evidence that occupational met... [more] Purpose: Briefly identify the epidemiological evidence, propose pertinent mechanisms, and discuss physical therapy practice as well as research implications of a causal association between occupational factors and cardiovascular disease. Summary of Key Points: There is evidence that occupational metabolic demands and work organizations characterized by reduced worker control are associated with increased risk of cardiovascular disease. It is biologically plausible that these two factors interact to create a preclinical, intermediate state of fatigue (burnout) that is a critical component in the causal path from occupational factors to CVD. Physical therapists are uniquely qualified to contribute to an understanding of these mechanisms and their resultant implications for work organization, rehabilitation, and health promotion. Statement of Recommendations: Physical therapists engaged in ergonomic job analysis should consider work related metabolic demands, worker control, and fatigue in their assessment of risk for injury and illness, in recommendations for return to work, and in the prescription of health promotion leisure time physical activity.
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1.88Impact points
Personal characteristics influencing patients' adherence to home exercise during chronic pain: a qualitative study.
Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 05/2009; 41(5):347-52.
OBJECTIVE: To identify the beliefs and perceptions of patients with chronic neck and low back pain that influence adherence to home exercise during exacerbation and/or remission of pain. DESIGN: Qualitative study using a focus group technique. SUBJECTS: Thirty-four patients (23 women, age range 26-7... [more] OBJECTIVE: To identify the beliefs and perceptions of patients with chronic neck and low back pain that influence adherence to home exercise during exacerbation and/or remission of pain. DESIGN: Qualitative study using a focus group technique. SUBJECTS: Thirty-four patients (23 women, age range 26-70 years) with chronic neck or low back pain who had participated in a home exercise programme. METHODS: Seven focus groups were formed. Participants were sampled purposefully from all patients with chronic neck or low back pain who attended for physiotherapy at 4 primary healthcare centres. Patients were interviewed about how they perceived their adherence to a home exercise programme during chronic pain. Data were analysed using a phenomenographic method. RESULTS: Several themes about patients' beliefs and perceptions were identified as factors related to adherence. These factors change when pain or disabilities appear, decrease or disappear for an extended period. Beliefs about illness and treatment are more likely when pain is present and when pain disappears for an extended period. However, patients consider perceptions about barriers, social support and physical environment when pain decreases. CONCLUSION: These findings may represent an important potential for improving the adherence of patients with chronic pain to home exercise programmes.
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1.13Impact points
Is physical therapy more beneficial than unsupervised home exercise in treatment of post surgical knee disorders? A systematic review.
The Knee. 11/2008;
Physical therapy is common following a knee surgery. With rising healthcare costs there is debate as to the appropriateness of outpatient physical therapy following such interventions. Many of the existing controlled trials have concluded that there is no benefit to subjects that receive supervised ... [more] Physical therapy is common following a knee surgery. With rising healthcare costs there is debate as to the appropriateness of outpatient physical therapy following such interventions. Many of the existing controlled trials have concluded that there is no benefit to subjects that receive supervised physical therapy when compared to subjects that perform their exercises at home. The purpose of this systematic review was to consider the existing evidence regarding benefit following knee surgery and evaluate the quality, internal and external validity of such evidence. Ten studies, all randomized control trials, were found to be applicable to our review. Using the PEDro scale all studies were considered at least moderate in quality. Many of the studies had designs that biased the home exercise group, providing supervision similar to that provided by outpatient physical therapy. In select young and healthy population with few co morbidities supervised physical therapy is no more beneficial than a home exercise program following relatively simple knee surgical procedures (arthroscopic meniscetomy). However there is a lack of evidence regarding older populations with co morbidities or for more complicated knee surgical procedures (ACL reconstruction, Total Knee Arthoplasty) prohibiting a conclusion at this time for these populations and/or these procedures.
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1.88Impact points
Reliability and validity of patient reports for physical therapy quality assessment: an empirical analysis regarding the use of exercises for neck pain in Spain.
Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 12/2006; 38(6):354-9.
OBJECTIVE: To determine usefulness and reliability of patient reports as a data source on the use of exercises for neck pain in primary healthcare. DESIGN: Survey research. SUBJECTS: A total of 176 patients with mechanical neck pain, surveyed about their physical therapy experience. METHOD: A questi... [more] OBJECTIVE: To determine usefulness and reliability of patient reports as a data source on the use of exercises for neck pain in primary healthcare. DESIGN: Survey research. SUBJECTS: A total of 176 patients with mechanical neck pain, surveyed about their physical therapy experience. METHOD: A questionnaire was constructed on the selection of exercises, instructions for carrying them out and follow-up provided by the physical therapist. The same items reported by the surveyed patients were also reviewed in the physical therapy record. We analysed the reliability and validity of the questionnaire, and used the valid information from the survey to estimate a total of 8 indicators on the quality of care provided. RESULTS: Sensitivity of the items was high (>75%), suggesting that most of the recorded information could be provided by patients, and specificity was quite low, suggesting that they also provide relevant information that was not recorded. These results, particularly low specificity, were not homogeneous among items. Estimates for the indicators demonstrate room for improvement. CONCLUSION: Patient reports could be useful as a complement to other sources of information for physical therapy quality assessment, and they can be reliable and valid substitutes for recorded data about specific aspects of the care provided.
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1.72Impact points
Job strain and autonomic indices of cardiovascular disease risk.
American journal of industrial medicine. 10/2005; 48(3):182-93.
BACKGROUND: Despite the epidemiological evidence linking job strain to cardiovascular disease, more insight is needed into the etiologic mechanisms. This, in turn, would help to more precisely identify risk. METHODS: We measured Job Strain using the Job Content Questionnaire, 8/day diary reports, an... [more] BACKGROUND: Despite the epidemiological evidence linking job strain to cardiovascular disease, more insight is needed into the etiologic mechanisms. This, in turn, would help to more precisely identify risk. METHODS: We measured Job Strain using the Job Content Questionnaire, 8/day diary reports, and nationally standardized occupational code linkage, as well as autonomic regulation utilizing heart rate variability including spectral-derived components and QT interval variability in 36 healthy mid-aged males with varying strain jobs. The subjects wore Holter-monitors for 48 hr; this included a work and rest day. RESULTS: Job strain (P = 0.02) and low decision latitude (P = 0.004) were associated with a reduction in cardiac vagal control (HFP) persisting throughout the 48 hr. Job strain was also associated with elevations in sympathetic control during working hours (P = 0.003). CONCLUSIONS: The disturbed cardiovascular regulatory pattern associated with job strain may help explain the increased risk of cardiovascular diseases linked with occupational exposure.
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Emerging methods for the physiological assessment of occupational stress.
Work (Reading, Mass.). 02/2001; 17(3):209-219.
Occupational stress is implicated as an etiology for a variety of diseases. Many of the etiological theories surrounding these associations incriminate some deviation of autonomic nervous system activity. New methods of analyzing cardiovascular data obtained from a Holter monitor provide a window in... [more] Occupational stress is implicated as an etiology for a variety of diseases. Many of the etiological theories surrounding these associations incriminate some deviation of autonomic nervous system activity. New methods of analyzing cardiovascular data obtained from a Holter monitor provide a window into a worker's autonomic nervous system throughout the day, in many cases for two days. These methods allow a variety of comparisons, for example, between workers of varying job stress levels, between work days and rest days, day and night, and between high stress and low stress periods. Identifying altered autonomic nervous system activity patterns throughout the day may: 1. provide insight into the etiology of stress related pathologies; 2. allow quantification of exposure; 3. investigate possible interaction effects of different exposures; 4. lead to monitoring methods capable of identifying whether an employee's job stress is increasing his or her risk for disease.
Following (2)
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Rebecca Gore
University of Massachusetts - Lowell -
Marco Ferrario
Università degli Studi dell'Insubria
