Lesley Wiart

Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada

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Publications (22)41.38 Total impact

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    ABSTRACT: Low levels of physical activity are a global health concern for all children. Children with cerebral palsy have even lower physical activity levels than their typically developing peers. Low levels of physical activity, and thus an increased risk for related chronic diseases, are associated with deficits in health-related physical fitness. Recent research has provided therapists with the resources to effectively perform physical fitness testing and physical activity training in clinical settings with children who have cerebral palsy, although most testing and training data to date pertains to those who walk. Nevertheless, on the basis of the present evidence, all children with cerebral palsy should engage, to the extent they are able, in aerobic, anaerobic, and muscle-strengthening activities. Future research is required to determine the best ways to evaluate health-related physical fitness in nonambulatory children with cerebral palsy and foster long-term changes in physical activity behavior in all children with this condition.
    Journal of child neurology 05/2014; · 1.59 Impact Factor
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    ABSTRACT: Background Serial joint range of motion (ROM) measurements are an important component of assessments for children with cerebral palsy. Most research has studied ROM stability using group data. Examination of longitudinal intra-individual measures may provide more clinically relevant information about measurement variability.Objective To examine the stability of intra-individual longitudinal measurements of hip abduction (ABD), popliteal angle (POP) and ankle dorsiflexion (ADF) ROM measures of children with cerebral palsy.DesignSecondary data analysesMethods The stability patterns of individual serial measurements of ABD, POP and ADF from 85 children (mean age 3.8 years, SD 1.4 yr.) collected at baseline (T1), 3 months (T2), 6 months (T3) and 9 months (T4) were examined using T1 as the anchor and bandwidths of +/- 15(0) (ABD and POP) and +/-10(0) (ADF) as acceptable variability. Frequencies of stability categories (0(0)-5(0), 5.1(0)-10(0), 10.1(0)-15(0) and >15(0)) were calculated. Patterns of stability across the four time periods were also examined. Group means (T1-T4) were compared using repeated measures ANOVA.ResultsNo significant differences in group means except for ABD. Stability patterns revealed that 43.3% to 69.5% of joint measurements were stable with T1 measurements across all three subsequent measurements. Stability category frequencies showed that many measurements (ABD=17%, POP=29.9%, ADF=37.1%) went outside the variability bandwidths even though 39% or more of joint measurements had a change of 5(0) or less over time.LimitationsMeasurement error and true measurement variability cannot be disentangled. The results cannot be extrapolated to other joint ranges.Conclusions Individual ROM serial measurement exhibits more variability than group data. ROM data must be interpreted with caution clinically and efforts made to ensure standardization of data collection methods.
    Physical Therapy 02/2014; · 2.78 Impact Factor
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    ABSTRACT: Physical activity is important for young people's health. The emphasis over the last two decades has been on moderate to vigorous exercise when designing activity and exercise programs for children and adolescents with cerebral palsy (CP). Emerging evidence suggests that sedentary behaviour is distinctly different from a lack of moderate to vigorous physical activity, and has independent and different physiological mechanisms. The concept of concurrently increasing moderate to vigorous physical activity and replacing sedentary behaviour with light physical activity may be beneficial for children and adolescents with CP. This article is a summary of the evidence for what works and what doesn't work for improving the physical activity of children and adolescents with CP. It also discusses what we know about sedentary behaviour of children and adolescents with CP, and what research directions are needed to build foundational knowledge in this area with this population.
    Physical Therapy 10/2013; · 2.78 Impact Factor
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    ABSTRACT: ABSTRACT Secondary analysis using data from a clinical trial was performed to evaluate the stability of individual items of the Mobility and Self-Care functional skills scales of the Pediatric Evaluation of Disability Inventory (PEDI). Parents of 113 children aged 1-6 years old with cerebral palsy completed the PEDI twice by questionnaire 6 months apart. An item was classified "unstable" if the score changed from capable to unable. The number of children with more than five unstable items and the number of items with more than five children having unstable scoring patterns were calculated. Nineteen children (17%) and 13 items had unstable scoring patterns. The majority of PEDI items demonstrated stability of parent scoring. Examination of unstable items suggests that parents may need assistance in understanding the difference between "usual" and "best" performance, interpreting descriptors such as "thoroughly," and maintaining the same context reference for outdoor mobility items.
    Physical & Occupational Therapy in Pediatrics 08/2013; · 1.24 Impact Factor
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    ABSTRACT: Abstract Purpose: To identify facilitators and barriers frequently experienced by families of children with cerebral palsy (CP) and associated with being at the pre-intention, intention and action stages for physical activity. Method: Qualitative study involving in-depth focus group interviews with 33 ambulatory children and adolescents with CP and their parents (n = 33). These interviews were followed by questionnaires to determine stage of behavior change (i.e. pre-intention, intention and action) related to the child's participation in physical activity. Results: Families who were classified in the intention stage of behavioral change were more likely to identify environmental barriers related to the social environment and the facility or program than parents at the pre-intention stage. Families who were classified into intention and action stages were more likely to identify facilitators related to parental factors than families at the pre-intention stage. Moreover, at the action stage facilitators were related to the facility/program. Conclusions: The identified facilitators and barriers, organized according to three stages of change (pre-intention, intention and action), provide important theoretical insights into how and why children and adolescents with CP and their parents might change their physical activity behavior. Implications for rehabilitation Understanding the barriers and facilitators of physical activity for children and adolescents with CP is essential for designing effective interventions to promote participation in this group. Using the three stages of change and the identified barriers and facilitators for participation can result in tailored advice to increase physical activity behavior.
    Disability and Rehabilitation 01/2013; · 1.54 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate the interrater reliability and convergent validity of the American Academy for Cerebral Palsy and Developmental Medicine's (AACPDM) methodology for conducting systematic reviews (group design studies). Four clinicians independently rated 24 articles for the level of evidence and conduct using AACPDM methodology. Study conduct was also assessed using the Effective Public Health Practice Project scale. Raters were randomly assigned to one of two pairs to resolve discrepancies. The level of agreement between individual raters and pairs was calculated using kappa (α=0.05) and intraclass correlations (ICCs; α=0.05). Spearman's rank correlation coefficient was calculated to evaluate the relationship between raters' categorization of quality categories using the two tools. There was acceptable agreement between raters (κ=0.77; p<0.001; ICC=0.90) and between assigned pairs (κ=0.83; p<0.001; ICC=0.96) for the level of evidence ratings. There was acceptable agreement between pairs for four of the seven conduct questions (κ=0.53-0.87). ICCs (all raters) for conduct category ratings (weak, moderate, and strong) also indicated good agreement (ICC=0.76). Spearman's rho indicated a significant positive correlation for the overall quality category comparisons of the two tools (0.52; p<0.001). The AACPDM rating system has acceptable interrater reliability. Evaluation of its study quality ratings demonstrated reasonable agreement when compared with a similar tool.
    Developmental Medicine & Child Neurology 05/2012; 54(7):606-11. · 2.68 Impact Factor
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    ABSTRACT: To explore facilitators and barriers to participation in physical activity and sport in youth with cerebral palsy (CP). This was a qualitative study involving in-depth focus group interviews with 33 ambulatory youth with CP and their parents. The interviews were conducted until informational redundancy was achieved. Youth with CP and their parents reported personal and environmental facilitators and barriers to participation in physical activity. Seven major themes related to personal and environmental factors were identified. This study suggests that various personal and environmental factors play a key role in determining the extent to which youth with CP participate in physical activity. The facilitators and barriers identified provide important theoretical insights into how and why youth with CP and their parents might change their physical activity behavior.
    The Journal of pediatrics 04/2012; 161(3):488-94. · 4.02 Impact Factor
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    ABSTRACT: Evidence-based recommendations regarding which exercise tests to use in children and adolescents with cerebral palsy (CP) are lacking. This makes it very difficult for therapists and researchers to choose the appropriate exercise-related outcome measures for this group. This study aimed to identify a core set of exercise tests for children and adolescents with CP. Fifteen experts (10 physical therapists/researchers and five exercise physiologists; three from the Netherlands, two from the USA, one from the UK, five from Canada, and four from Australia) participated in a Delphi survey which took four stages to achieve a consensus. Based on the information that was collected during the survey, a core set of measures was identified for levels I to IV of the Gross Motor Function Classification System (GMFCS). For children with CP classified at GMFCS levels I and II, tests were identified for two motor skills (walking and cycling). For the subgroup of children with CP classified at GMFCS level III, the tests that were identified related to walking, cycling, and arm cranking. For children with CP classified at GMFCS level IV, the tests included in the core set were related to cycling and arm cranking. The core set will help physical therapists, exercise physiologists, and other health professionals who work with children and adolescents with CP to decide which test(s) to use in clinical practice or research. This will facilitate comparability of results across studies and clinical programmes.
    Developmental Medicine & Child Neurology 02/2011; 53(5):449-56. · 2.68 Impact Factor
  • Lesley Wiart
    Physical & Occupational Therapy in Pediatrics 11/2010; 31(1):16-8. · 1.24 Impact Factor
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    ABSTRACT: Family-centred service, functional goal setting and co-ordination of a child's move between programmes are important concepts of rehabilitation services for children with cerebral palsy identified in the literature. We examined whether these three concepts could be objectively identified in programmes providing services to children with cerebral palsy in Alberta, Canada. Programme managers (n= 37) and occupational and physical therapists (n= 54) representing 59 programmes participated in individual 1-h semi-structured interviews. Thirty-nine parents participated in eleven focus groups or two individual interviews. Evidence of family-centred values in mission statements and advisory boards was evaluated. Therapists were asked to identify three concepts of family-centred service and to complete the Measures of Process of Care for Service Providers. Therapists also identified therapy goals for children based on clinical case scenarios. The goals were coded using the components of the International Classification of Functioning Disability and Health. Programme managers and therapists discussed the processes in their programmes for goal setting and for preparing children and their families for their transition to other programmes. Parents reflected on their experiences with their child's rehabilitation related to family-centredness, goal setting and co-ordination between programmes. All respondents expressed commitment to the three concepts, but objective indicators of family-centred processes were lacking in many programmes. In most programmes, the processes to implement the three concepts were informal rather than standardized. Both families and therapists reported limited access to general information regarding community supports. Lack of formal processes for delivery of family-centred service, goal-setting and co-ordination between children's programmes may result in inequitable opportunities for families to participate in their children's rehabilitation despite attending the same programme. Standardized programme processes and policies may provide a starting point to ensure that all families have equitable opportunities to participate in their child's rehabilitation programme.
    Child Care Health and Development 11/2010; 38(1):41-7. · 1.70 Impact Factor
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    ABSTRACT: The delivery of paediatric rehabilitation services is complex due to the involvement of different service sectors and diverse models of care. Parents of children with disabilities find it challenging to navigate successfully through complicated service delivery systems. Cross-sectoral collaboration to improve continuity of care for children with disabilities and their families is viewed as ideal in public policies. The purpose of this research was to explore how ministerial cultures, processes and structures influence inter-ministerial collaboration for the purpose of enhancing continuity of care for children with disabilities and their families in a Western Canadian province. Six key informants from three government Ministries that funded paediatric rehabilitation services participated in individual, semi-structured interviews between January and May of 2007. Nineteen provincial public policy documents were reviewed. Hall's framework guided the analysis of the key informant interviews and policy documents. Influences of organisational culture, processes and structures on cross-ministerial collaboration were classified into the categories of ideas-values and beliefs that underlie policy development, interests-influence of various policy actors and institutions-structures and processes used to deliver public policy. Fundamental ideological and structural differences were apparent across the three ministries that affected the ease of inter-ministerial collaboration towards ensuring continuity of care for children with disabilities. Variations in ideas (philosophy and values) and institutions (geography and service delivery structure, relationships with regional governance, mission and function, choice of policy instruments and financial processes) are presented and implications for service delivery are explored.
    Health & Social Care in the Community 07/2010; 18(4):378-88. · 0.86 Impact Factor
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    ABSTRACT: Contemporary rehabilitation literature emphasises functional goals for children with disabilities and use of a collaborative goal-setting process grounded in principles of family centred service delivery. To explore parents' experiences with goals and goal setting. We conducted a qualitative study with 11 focus groups and two individual interviews with 39 parents of children with cerebral palsy living in western Canada. We used an inductive, thematic analysis to identify prominent themes. The analysis revealed five themes representing goals that were meaningful to parents and provided insight into parents' experiences with goal-setting processes in occupational and physical therapy: (1) movement as the means to functional success; (2) physical health and fitness are important therapy goals; (3) the importance of leading happy, fulfilling lives and being accepted by others; (4) 'We can't do it all': balancing therapy with the demands of everyday life; and (5) shifting roles and responsibilities in goal setting. The variability noted both in parents' desired role in goal setting and in goals important to parents highlights the importance of establishing trusting relationships with families so that family goals, values, individual circumstances, and desired level of participation in goal setting can be openly discussed.
    Disability and Rehabilitation 01/2010; 32(3):248-58. · 1.54 Impact Factor
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    ABSTRACT: PURPOSE: To review research regarding mechanisms of muscle contracture in cerebral palsy (CP) and the effectiveness of stretching, and to discuss current physical therapy stretching practices. Community-based recreation opportunities that encourage flexibility and fitness are explored as alternatives to traditional therapy stretching approaches. SUMMARY OF KEY POINTS: Mechanisms of muscle contracture in children with CP are unclear and clinical research evaluating the effects of stretching is inconclusive. Recent shifts in thinking about the management of children with CP suggest an increased emphasis on flexibility, fitness, and participation in activities that are meaningful to children and families. STATEMENT OF CONCLUSIONS: Additional research is needed to explore the structural changes that occur in the shortened muscles of children with CP and the effects of stretching practices used in pediatric physical therapy. RECOMMENDATIONS FOR CLINICAL PRACTICE: Physical therapists can consider innovative alternatives that integrate flexibility and fitness goals with community-based recreation programs.
    Pediatric physical therapy: the official publication of the Section on Pediatrics of the American Physical Therapy Association 02/2008; 20(2):173-8.
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    ABSTRACT: To explore therapists' goal setting and intervention with children with cerebral palsy, and to examine their acceptance of children's use of compensatory movement strategies. Interviews were conducted with 23 occupational therapists and 31 physical therapists. Goals and assumptions of relationships between intervention approaches and expected outcomes were coded using the International Classification of Functioning, Disability, and Health (ICF). Therapists' acceptance of compensatory movement strategies was rated. Thirty-three therapists identified goals representing the ICF activity component. Therapists working with younger children identified goals representing the ICF body function/structure component. Twenty-four therapists assumed that an intervention targeted at 1 ICF component would affect an outcome in a different component. Eleven therapists would not accept compensatory movement strategies. Most therapists' goals are congruent with principles encouraging functional goals. The ICF matrix developed for this study may be useful for clinical evaluation and documentation of assumed relationships among interventions and outcomes.
    Pediatric physical therapy: the official publication of the Section on Pediatrics of the American Physical Therapy Association 02/2008; 20(4):334-9.
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    Lesley Wiart, Susan Burwash
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    ABSTRACT: With the current emphasis on accountability for outcomes and the need for objective evaluation of efficacy of interventions, physiotherapists are increasingly using evidence from research as a source of information to support clinical decision making. The concept of evidence- based practice has been adopted widely in physiotherapy with much work devoted to encouraging the transfer of research results into clinical practice. Under the definition developed by Sackett et al (2000) - a group of clinical epidemiologists - evidence-based practice requires the integration of three components: patient values, clinical expertise, and best evidence from research. Best evidence from research is defined as 'clinically relevant research… (about the) accuracy and precision of diagnostic tests, the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens.' Increased focus on using evidence from research as a source of information for clinical practice has led to the development of hierarchies for evaluating research rigour (Guyatt and Rennie 2002, Higgins and Green 2005, Butler et al 1999). Evidence hierarchies are most often based on criteria for rigour developed for quantitative research designs. Design is ranked according to the extent that the study is internally valid or free from sources of bias, with large randomised controlled trials providing the highest level of evidence and physiologic studies and unsystematic clinical observations providing weaker evidence. Qualitative research is excluded from most prominent hierarchies because qualitative and quantitative research have different underlying philosophies, methods, and criteria for judging quality. However, it should not be inferred from this exclusion that rigorous qualitative research is a less valuable form of evidence or that research employing qualitative methods cannot be used to inform clinical practice. In fact, the Cochrane Qualitative Research Methods Group is exploring whether and how studies using qualitative methods can be included in systematic reviews. As clinicians, we know that implementation of interventions in real-world situations requires knowledge about patients' values and experiences, contextual variables that influence how interventions are delivered, and the difficult-to- quantify human aspects of clinical practice - what Guyatt et al (2000) refer to as the broad perspective offered by the humanities and social sciences. Since selection of research methods should be based on their 'best fit' with the research questions, qualitative methods (used alone or in a mixed- method design) provide a systematic approach to producing knowledge about the behaviours, values, and experiences of patients, their families, and clinicians. Qualitative research can provide clinically-relevant information about patient values and experiences. In the reality of clinical practice, knowing why patients choose not to participate in an intervention is as important as knowing about its efficacy. Efficacious interventions will have limited therapeutic value if patients cannot or do not follow recommendations. It is likely that myriad factors, including some that may not be readily apparent, contribute to patients' decisions about whether to adhere to recommendations. Qualitative methods offer the possibility to explore human experiences in unique sociocultural contexts from the perspective of the participants, offering insights into patients' values and experiences. Qualitative research methods were used in a study aimed at reduction of disparity between the effectiveness (ie, the ability to produce an effect under real-world conditions) and efficacy (ie, the ability to produce an effect under ideal conditions) of interventions for childhood asthma. Hyland and Stahl (2004) collected quantitative and qualitative data to explore the unmet needs of parents of children with asthma to ascertain how their perceptions of management compared with those of service providers. Data from focus groups with parents indicated that they were concerned about the use of steroids, specifically the possibility of addiction and growth inhibition, and therefore they were not giving the medications as advised. This information has clear implications for education about asthma management, and could be used to stimulate discussion among parents of children with asthma and health care service providers about the risks of poorly-controlled asthma and the potential for adverse effects of medications. A similar approach could be used to explore the perceptions and experiences of patients and their families about physiotherapy interventions. The emphasis on objective measurement of outcomes in physiotherapy has led to the proliferation of outcome measures. Qualitative research can be used to determine which outcomes and how much change in those outcomes are significant to patients. Are the changes we consider 'clinically significant' meaningful to patients and families? Are the outcome measures used to evaluate 'subjective' phenomena such as quality of life capturing the essence of what those concepts mean to our patients? In a recent study, Young et al (2007) used qualitative methods to explore the meaning of quality of life in children with cerebral palsy. Their data were compared against the concepts represented in the KIDSCREEN, a standardised screening instrument for children's quality of life. The children discussed concepts that were included in the KIDSCREEN (social relationships, self and body, and recreational activities and resources). However, there were a number of concepts that
    The Australian journal of physiotherapy 02/2007; 53(4):215-6. · 3.48 Impact Factor
  • Lesley Wiart, Johanna Darrah
    Developmental Medicine & Child Neurology 01/2007; 41(10):716-718. · 2.68 Impact Factor
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    ABSTRACT: This qualitative study focused on the experiences of six 20- to 23-year-old persons with cerebral palsy and their parents during the transition to adulthood and explored perceived changes in their relationship. Using semi-structured interviews, three interrelated themes emerged: (a) perceptions of readiness for increased autonomy, (b) opportunities for the young adults to make independent decisions and learn from life experiences, and (c) shifting parental roles. The youths' autonomy related to parental perceptions of their readiness and push for autonomy, the parent's personal beliefs and readiness to support the changing relationship, and the parents' needs for separation from the child. In some families of youths requiring ongoing support for personal care, finances were a barrier to altering relationships with their child.
    Physical & Occupational Therapy in Pediatrics 02/2005; 25(3):19-36. · 1.24 Impact Factor
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    ABSTRACT: Physical therapists and occupational therapists frequently assist parents with the exploration and use of powered wheelchairs for their children with physical disabilities. The purpose of this study was to explore parents' experiences and perceptions of their children's experiences with the receipt and use of powered mobility. Qualitative methods were used to gain insight into the experiences of five mothers of children with physical disabilities who use powered wheelchairs. Information was collected during individual interviews with the mothers. Data analyses revealed five higher-level themes identified across the participants. Results of this study suggest that mothers initially perceive powered mobility as a "last resort" mobility option. The perceived effects of their children's use of powered mobility were significant and included increased personal control, independence, and opportunities to participate in age appropriate, meaningful activities. The mothers perceived that increased independence positively affected others' attitudes toward their children and allowed their children to develop more "legitimate" relationships with their peers.
    Physical & Occupational Therapy in Pediatrics 02/2004; 24(4):3-21. · 1.24 Impact Factor
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    ABSTRACT: The purpose of this study was to evaluate the use of powered mobility by young individuals with physical disabilities. The four study objectives were to: (a) describe the characteristics of children and adolescents who received powered wheelchairs at eighteen years of age or younger, (b) evaluate the longitudinal use or disuse of powered mobility by these participants, (c) describe the extent and locations of powered mobility use, and (d) explore environmental (i.e., physical, social and attitudinal) barriers and facilitators to successful powered mobility use with the participants and their families. Sixty-six families shared information during a structured telephone interview. The results of this study confirm that younger children are now receiving powered wheelchairs. The results also suggest that powered mobility is reserved for children with the most severe disabilities. Physical and occupational therapists can work collaboratively with more families to explore powered mobility as one of an array of early movement options.
    Physical & Occupational Therapy in Pediatrics 02/2003; 23(2):59-75. · 1.24 Impact Factor
  • Lesley Wiart, J Darrah
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    ABSTRACT: PURPOSE: Over the past decade, the emergence of a new philosophical framework has influenced approaches to service delivery in paediatric rehabilitation. Traditional approaches focused on the attainment of typical movement patterns as the ultimate goal of intervention. By contrast, contemporary approaches to intervention encourage children with physical disabilities to use their most efficient movement strategies to explore their environment and participate in meaningful activities. Methods/Results: Factors that facilitated this change in approaches to intervention are explored and include: the disability movement; the evolution of models of disablement; the shift from a medical model to a family-centred model of health care service provision; the emergence of a new theory to explain motor development and increased availability and quality of assistive technology. CONCLUSION: The clinical implications of this philosophical shift for the use of powered mobility with children with physical disabilities are explored. A collaborative approach to working with families throughout the process of selecting mobility options for their children is discussed.
    Disability and Rehabilitation 07/2002; 24(9):492-8. · 1.54 Impact Factor