Physical therapy in the 21st century (Part I): toward practice informed by epidemiology and the crisis of lifestyle conditions

A Model to Integrate Health Promotion and Wellness in Physical Therapist Practice: Development and Validation

BACKGROUND

Globally, physical therapy professional organizations have called for physical therapists to perform lifestyle behavior management during customary care, or health-focused care, due to increasing morbidity and mortality related to noncommunicable diseases. Given the potential for health-focused care to improve health outcomes, physical therapists should integrate health promotion into their daily clinical practice. A clinical model that illustrates necessary steps to deliver health-focused care would be helpful to educate present and future physical therapists.

OBJECTIVE

The purpose of the study was to develop and validate the Health-Focused Physical Therapy Model (HFPTM) for physical inactivity and smoking.

METHODS

The authors used a mixed method approach. The preliminary model was informed by previous research and the investigators' shared experience in health promotion and physical therapy. An interdisciplinary group of health professionals provided input into the preliminary model by way of a World Café format. Eight physical therapists with health promotion and education expertise then engaged in a Delphi process to establish content validity.

RESULTS

World Café participants indicated that: (1) physical therapists are well positioned to engage in health promotion and wellness, and (2) the model facilitates interdisciplinary collaboration and consultation. Delphi process participants reached majority consensus in 1 round. The average model content validity index (CVI) was .915 for physical inactivity and .899 for smoking. Agreement concerning the model schematic was 88% for either behavior. Investigators made few editorial changes after the Delphi process.

LIMITATIONS

Limitations of this study include using only 2 unhealthy lifestyle behaviors for testing, and performing the testing in a nonclinical setting.

CONCLUSIONS

An interdisciplinary group of health professionals believes that physical therapists should practice health-focused care and that the HFPTM is a valid model. This model could help physical therapist educators when educating physical therapist students and clinicians to practice health-focused care.

Physiotherapists' encounters with "obese" patients: Exploring how embodied approaches gain significance

BACKGROUND

Obesity is regarded as a modern lifestyle problem, causing illness, stigma, discrimination, and psychological problems. To help patients avoid these problems, physiotherapists increasingly engage in lifestyle programs specialized in weight loss.

OBJECTIVE

To explore how physiotherapists' encounters with patients diagnosed as "obese" acquire significance for their development as clinicians.

METHOD

The material draws on semi-structured interviews with eight physiotherapists. We conducted a thematic analysis inspired by van Manen's hermeneutic-phenomenological approach combined with Kvale and Brinkman's critical approach.

FINDINGS

The analysis identified the following four themes: 1) Striving to find one's own style of communication; 2) Relating to bodily discrepancies; 3) Developing clinical competence through bodily encounters; and 4) Gaining insight into the dilemmas of group-based lifestyle programs. Taken together, our findings highlight bodily encounters between patients and physiotherapists as an invaluable source of insight. Such insight can shape physiotherapists' development as clinicians inspiring them to develop their unique ways of communicating so that patients diagnosed as obese can feel empowerment rather than failure and shame. At the same time, our findings point to the need of critically reflecting on ones' own approach entering a double role of both controller and supporter. As such, our findings complicate and extend previous work on stigma and shame.

CONCLUSION

Our research leads us to conclude that more emphasis on critical thinking in physiotherapy is necessary. We suggest that this should be given more priority in research, education, as well as in clinical practice.

Physical Activity and Sedentary Behaviour of Master of Physical Therapy Students: An Exploratory Study of Facilitators and Barriers

Purpose: A full 85% of Canadians fail to meet physical activity (PA) guidelines, and 69% report being sedentary. Physical therapists are uniquely positioned to promote an active lifestyle; thus, we explored the PA and sedentary behaviour (SB) of Master of Physical Therapy (MPT) students as well as the associated facilitators and barriers. Methods: We used a mixed-methods approach, accelerometry and photovoice (a focus group discussion in which participants discussed self-selected photographs). Accelerometer data were used to quantify PA (light, moderate, and vigorous) and SB. Thematic analysis of the focus group discussion was informed by the socio-ecological model. Results: A total of 26% of participants met national PA guidelines, and mean daily sedentary time for participants was 670.7 (SD 34.4) minutes. Photovoice analysis revealed four main themes related to the facilitators of and barriers to PA and SB: (1) priorities and life balance, (2) commitment and accountability, (3) environment, and (4) MPT programming. Conclusions: A full 74% of participants did not meet the recommended PA guidelines; this is concerning given their immanent roles as health care professionals. Physical therapists are well prepared to prescribe PA to clients. Not only do MPT students need competencies in prescribing PA and exercise, but they may also need to be supported in meeting PA guidelines themselves and limiting SB throughout their studies.

A survey of physicians and physiotherapists on physical activity promotion in Nigeria

Background

Effective control of non-communicable diseases and promotion of population-wide physical activity participation require the active engagement of health professionals. Physiotherapists and physicians, as part of their practice, routinely screen and assess physical activity status, and recommend health enhancing physical activity participation for their patients. This study aims to compare Nigerian physiotherapists and physicians’ knowledge of physical activity message, role perception and confidence, perceived feasibility and barriers, and overall disposition to promoting physical activity in their practice.

Methods

A total of 153 physicians and 94 physiotherapists recruited from 10 government hospitals in five states in Northern Nigeria completed a standardized physical activity promotion questionnaire that elicited information on the knowledge of physical activity, role perception and confidence, feasibility, and barriers to physical activity promotion. Descriptive and inferential statistics were used to analyze the data.

Results

The physiotherapists and physicians were fairly knowledgeable on physical activity message (14.2 ± 2.1/20), reported minimal or little barrier to physical activity promotion (23.7 ± 3.1/30), perceived physical activity promotion as their role (13.0 ± 1.8/15), were confident in their ability to discuss and recommend physical activity promotion (7.6 ± 1.6/10) and believed promoting physical activity was feasible for them (15.6 ± 2.6/20). However, over 40% of the physiotherapists and physicians do not know the correct dosage of physical activity that could confer health benefits to patients. The physicians showed better overall disposition to physical activity promotion than the physiotherapists (P = 0.048), but more physiotherapists than the physicians believed ‘it is part of their role to suggest to patients to increase their daily physical activity’ (95.7% vs 88.2%, P = 0.043) and were more ‘confident in suggesting specific physical activity programs for their patients’ (87.2% vs 64.5%, P < 0.001).

Conclusion

Physiotherapists and physicians in Nigeria demonstrated good disposition to promoting physical activity but many of them have knowledge deficits on the correct dosage required for better health for their patients. These health professionals can serve as good advocates for physical activity promotion in Nigeria, but many of them may require knowledge update on health enhancing physical activity for effective health promotion and primary prevention of non-communicable diseases.

Electronic supplementary material

The online version of this article (doi:10.1186/s40945-017-0034-8) contains supplementary material, which is available to authorized users.

Practices of Nigerian physiotherapists with respect to lifestyle risk factor assessment and intervention: A national cross-sectional survey

BACKGROUND

Resolutions of the World Health Organization and World Confederation for Physical Therapy declare health promotion a priority for health professionals including physiotherapists.

OBJECTIVE

To describe lifestyle-related risk factor assessment and intervention practices of Nigerian physiotherapists, their perceived barriers to such practices, and education needs.

METHODS

Physiotherapists (n = 650) were invited to complete a questionnaire with 23 questions about respondent demographics, lifestyle risk factor assessment, and management practices; barriers to such practices; and related education needs. Statistical analysis was descriptive.

RESULTS

Response rate was 69% (n = 451). Less than half of respondents indicated that they "always" advised smokers to quit or heavy drinkers to reduce alcohol consumption. Most respondents viewed diet and anthropometrics as risk factors that warrant being addressed, but few respondents did so. Physical inactivity and blood pressure were the commonest risk factors reportedly assessed. Perceived barriers to health promotion practices included time, knowledge, and access to other providers. Continuing education needs identified by respondents included methods for delivering advice regarding smoking cessation, diet, and alcohol consumption.

CONCLUSIONS

Nigerian physiotherapists inconsistently assess lifestyle-related risks and intervene to address them. Continuing education is needed to address barriers to health promotion practices by meeting the perceived needs of Nigerian physiotherapists.

To Be or Not to Be a Cardiorespiratory Physiotherapist: Factors That Influence Career Choice in a Sample of Canadian Physiotherapists

Purpose: This study explored the factors that influence choosing or not choosing a career in cardiorespiratory physiotherapy (CRP) from the perspective of a group of currently practising, experienced physiotherapists in Canada. Methods: A modified Dillman approach was used to distribute a cross-sectional, self-administered, online questionnaire to all eligible members of the cardiorespiratory and orthopaedic divisions of the Canadian Physiotherapy Association. A total of 438 participants-21 CRP and 417 non-CRP therapists-completed the survey. The survey response rate was 9.4%. Results: A narrow scope of practice (61.9%) and a lack of interest in CRP subject matter (50.1%) were the most influential factors deterring the respondents from making CRP their career choice. Interest in CRP (81.0%), mentorship (76.2%), access to physical resources (76.2%), and inter-professional practice (71.4%) were the most influential factors in pursuing a career in CRP. Conclusion: Increasing the awareness of the scope of practice for CRP, exposure to positive mentors, and rich practice settings are key factors in promoting physiotherapists' specialisation in CRP.

Physical activity promotion in physiotherapy practice: a systematic scoping review of a decade of literature

Background

The health benefits of physical activity (PA) have been extensively documented. Globally PA levels are low with only a small proportion of the population reaching recommended levels. Insufficient PA is seen as a major public health problem with high cost to society. Physiotherapists work with people to manage long-term conditions and are well placed to deliver individual interventions to increase PA. Despite this, little is known about the evidence that exists in this field.

Methods

This scoping review comprises a comprehensive search of key databases using predetermined search terms. This is supplemented with a parallel search that incorporated novel social media strands. In line with current guidance, a robust screening process took place using agreed inclusion and exclusion criteria.

Results

31 studies met the inclusion criteria. The number of studies published annually increased over the decade. Ireland and USA yielded the largest number of publications with only 1 study from the UK. The target populations included physiotherapists and service users from a range of clinical populations. The studies were mainly quantitative and observational in design with a predominance of studies that scoped attitudes, perceptions, barriers and current practice.

Conclusions

This reconnaissance has shown the state of the evidence to be sparse and disparate. However, the sharp rise in published work in recent years is encouraging. The predominance of scoping studies and the clear social, economic and political drivers for change in this area highlights a need for more pragmatic, interventional studies that can inform clinical practice.

Knowledge, Attitudes, and Current Practices of Canadian Physiotherapists in Preventing and Managing Diabetes

Purpose: To describe the knowledge, attitudes, and current practices of Canadian physiotherapists in preventing and managing diabetes. Methods: Members of the Canadian Physiotherapy Association were recruited by email to participate in a Web-based survey. The survey contained 40 items in four domains: demographics and education, attitudes and beliefs, current practices, and knowledge of diabetes. A descriptive analysis was completed for all the response variables from the survey. Results: A total of 401 physiotherapists from 10 provinces and 2 territories participated. Respondents were most confident in providing education about exercise and had decreasing confidence in providing education about managing secondary complications, weight management, blood sugar control, and nutrition, respectively. Only 32.4% of participants offered diabetes management counselling, citing lack of training. Knowledge was generally good, except for activity guidelines. Conclusions: A significant proportion of physiotherapists lack confidence in providing key aspects of care to patients with diabetes. Gaps in clinical practice and knowledge of activity guidelines were also observed. This study highlights the need to review entry-level physiotherapy training and to develop continuing educational opportunities in this area.

Weight Management Advice for Clients with Overweight or Obesity: Allied Health Professional Survey

The prevalence of obesity is increasing. The potential for allied health professionals to intervene through the provision of lifestyle advice is unknown. This study aimed to determine the knowledge, attitudes and practices of health professionals in the provision of dietary and physical activity advice for clients with overweight or obesity. Dietitians, exercise physiologists, nurses, occupational therapists, physiotherapists and psychologists (n = 296) working in New South Wales were surveyed using paper-based and online methods. The majority of health professionals (71%) believed that providing weight management advice was within their scope of practice; 81% provided physical activity advice but only 57% provided dietary advice. Other than dietitians, few had received training in client weight management during their professional qualification (14%) or continuing education (16%). Providing dietary advice was associated with: believing it was within their scope of practice (OR 3.9, 95% CI 1.9–7.9, p < 0.01), training during their entry-level qualification (OR 7.2, 3.2–16.4, p < 0.01) and having departmental guidelines (OR 4.7, 2.1–10.9, p < 0.01). Most health professionals are willing to provide lifestyle advice to clients with overweight or obesity but few have received required training. Developing guidelines and training for in client weight management may potentially impact on rising obesity levels.

Primary Care Physicians' Action Plans for Responding to Results of Screening Tests Based on the Concept of Quaternary Prevention

Since noncommunicable diseases (NCDs) are generally controllable rather than curable, more emphasis is placed on prevention than on treatment. For the early detection of diseases, primary care physicians (PCPs), as well as general practitioners and family physicians, should interpret screening results accurately and provide screenees with appropriate information about prevention and treatment, including potential harms. The concept of quaternary prevention (QP), which was introduced by Jamoulle and Roland in 1995, has been applied to screening results. This article summarizes situations that PCPs encounter during screening tests according to the concept of QP, and suggests measures to face such situations. It is suggested that screening tests be customized to fit individual characteristics instead of being performed based on general guidelines. Since screening tests should not be carried out in some circumstances, further studies based on the concept of prevention levels proposed by Jamoulle and Roland are required for the development of strategies to prevent NCDs, including cancers. Thus, applying the concept of QP helps PCPs gain better insights into screening tests aimed at preventing NCDs and also helps improve the doctor-patient relationship by helping screenees understand medical uncertainties.

Physical Therapists' Role in Health Promotion as Perceived by the Patient: Descriptive Survey

BACKGROUND

The importance of health professionals discussing health behaviors with patients is emphasized in Healthy People 2020, the national health objectives established by the US Department of Health and Human Services. Many physical therapists do not routinely discuss health behaviors with their patients. One reason may be uncertainty about how these discussions might be perceived by patients.

OBJECTIVE

The primary purpose of this study was to determine patients' opinions regarding physical therapists discussing the topics of physical activity, smoking, fruit and vegetable consumption, and maintaining a healthy weight during clinical visits. A secondary purpose was to determine whether patients believe that physical therapists should be role models for these behaviors.

DESIGN

This was a descriptive cross-sectional survey.

METHODS

Patients were surveyed at 8 outpatient clinics in Michigan and Minnesota. A written questionnaire collected information about the participants' health behaviors, their opinions about physical therapists discussing their health behaviors during clinical visits, and their opinions about physical therapists role-modeling healthy behaviors.

RESULTS

The survey response rate was 45.6%. A total of 230 patients participated. Most participants agreed that physical therapists should speak to them about physical activity (91.3%), maintaining a healthy weight (73%), and abstaining from smoking (51.3%). Fewer participants agreed that physical therapists should advise them about fruit and vegetable consumption (32.1%). The majority of participants agreed that physical therapists should be role models for engaging in regular physical activity (83.4%), maintaining a healthy weight (71.7%), and abstaining from smoking (63.9%).

LIMITATIONS

Limitations of this study include the potential for response bias and limited generalizability.

CONCLUSIONS

Most participants believed it is appropriate for physical therapists to speak with them about and be role models for the behaviors of physical activity, maintaining a healthy weight, and abstaining from smoking. Physical therapists have the opportunity to support the goals of Healthy People 2020 by discussing health behaviors with their patients.

Promoting Physical Activity and Exercise in Daily Practice: Current Practices, Barriers, and Training Needs of Physiotherapists in Eastern Nigeria

PURPOSE

To investigate current practices, barriers, and training needs for the promotion of physical activity (PA) in physiotherapy practices in eastern Nigeria.

METHODS

A total of 141 fully licensed physiotherapists in southeast Nigeria were invited to participate in a cross-sectional survey consisting of 23 questions in five key sections, focusing mainly on risk-factor management practices of physiotherapists.

RESULTS

A total of 103 questionnaires were returned. Respondents ranged in age from 25 to 54 years and reported a mean of 11 (SD 10) years of clinical experience. Respondents reported that they regularly assess and advise their clients on PA but rarely give written prescriptions. Although they are confident in assessing and advising their clients on PA and consider including PA intervention as a priority in daily practice, lack of time and lack of access to materials were reported as barriers to effective PA intervention.

CONCLUSION

Findings showed the potential for physiotherapists to address physical inactivity and highlighted several barriers. Strategies are needed to improve contact time with clients and make material promoting PA available to practising physiotherapists.

Promotion of healthy nutrition in clinical practice: A cross-sectional survey of practices and barriers among physiotherapists in southeast Nigeria

Background:

Healthy diet counselling is an important concept in health promotion. Physiotherapists are well positioned to initiate or support healthy nutrition in addition to physical activity counselling, in routine patient consultation.

Objective:

To determine the practices about and barriers to diet counselling practices among physiotherapists in Southeast Nigeria.

Methods:

In this cross-sectional survey, a total of 140 questionnaires were distributed among physiotherapists.

Results:

Overall, 103 physiotherapists responded. Physiotherapists are confident and consider the incorporation of dietary counselling very important and of high priority in their daily clinical work. They, however, assessed and counselled on dietary status opportunistically in patients. Notwithstanding, physiotherapists believed that the diet counselling they give could be effective in helping patients change their unhealthy dieting practices. Patients were also amenable to physiotherapists advocating on diet issues as part of their consultation. Several barriers to incorporating diet counselling into physiotherapy practice were identified, including lack of access to a dietician/health promotion staff/counsellors, lack of proper patient education materials, lack of expertise in relation to dietary risk factors’ assessment and management, and uncertainty about what dietary services to provide.

Conclusion:

Although physiotherapists consider it important to incorporate diet counselling in their daily clinical practice, development and implementation of strategies to improve physiotherapists’ diet counselling knowledge, competence, skills, and practice are warranted.

A comparison of work-related physical activity levels between inpatient and outpatient physical therapists: an observational cohort trial

Background

Physical therapists (PTs) work in a variety of healthcare settings with varied levels of physical activity demands placed on them. The purpose of this study is to compare the physical activity (PA) levels between PTs in inpatient versus outpatient environments for one work week using a cross-sectional design.

Methods

Sixty-one PTs (30 inpatient, 31 outpatient) wore a tri-axial accelerometer and inclinometer for one work-week. The number steps-per-day, PA intensities, energy expenditures and postural positions adopted during the work day were recorded.

Result

Significantly longer amounts of time spent sitting was found for inpatient PTs regardless of the significantly higher number of steps-per-day. Outpatient PTs had a higher number of breaks from sedentary activity with those breaks being longer than the inpatient PTs. The percentage of time spent performing moderate-vigorous PA approached significance implying more time was spent performing these types of activities for outpatient PTs. The energy expenditures between the two groups of PTs were not different.

Conclusion

This study compared the differences in physical activity levels between physical therapists who worked at inpatient versus outpatient environment as little is known about their activity levels. Inpatient physical therapists took more steps per day than outpatient physical therapists but the outpatient physical therapists were less sedentary and took more frequent and longer breaks from sedentary activities. The energy expenditures were similar between both types of therapists and this may be reflective of the gender and bodyweight differences between the groups that equalizes the energy expenditures. The findings of this study suggests that there are differences in the physical activity demands between inpatient and outpatient physical therapists. The results of this study may serve dual purposes: (1) employers may be able to more accurately describe the expected physical activity demands to future employees; (2) individuals tasked with preparing PTs to physically manage their work environment can outline training programs that are diverse based on the specific work environment of PTs.

Electronic supplementary material

The online version of this article (doi:10.1186/s13104-016-2119-y) contains supplementary material, which is available to authorized users.

Promoting Health and Wellness: Implications for Physical Therapist Practice

The leading cause of morbidity and mortality in the United States is chronic, or noncommunicable, diseases. The impact of chronic diseases on health and wellness can be significantly altered by individual health and behavior choices or modifications. Furthermore, the burden of chronic disease goes beyond health and the health care system and may influence an individual's wellness. The purposes of this article are: (1) to provide a basis for understanding the terms "health" and "wellness," (2) to identify the knowledge and skills physical therapists need to address behaviors that promote health and wellness and treat and protect against chronic disease, and (3) to discuss barriers and opportunities associated with integrating the promotion of health and wellness into physical therapist practice.

Assessment of health promotion content in undergraduate physiotherapy curricula

Background

The integration of health promotion in the treatment of patients should be included in all academic curricula in primary training of health professionals. However, the extent to which health promotion is included in the various curricula at undergraduate level is not known.

Objective

To assess the extent to which health promotion content is integrated in undergraduate physiotherapy training programmes in South Africa.

Method

This was a qualitative and descriptive study, using in-depth interviews with representatives of physiotherapy academic departments.

Results

All universities have some content of health promotion, with the weighting varying between 12% and 40%. Health promotion is taught at various levels of study, and health promotion training blocks are in both urban and rural settings and include communities, schools and old-age homes. The theories of advocacy, enabling and mediation are covered, but there is limited practical training on these elements. There are limited human resources trained in health promotion, as well as a lack of clear processes of developing and reviewing teaching and training materials.

Conclusion

There is lack of consensus on the weighting of health promotion, the level at which it is taught and how it is evaluated across universities. Challenges to integrate health promotion in physiotherapy curricula include lack of frequent curricula reviews, inadequate training of lecturers and lack of conducive practical sites.

The physiotherapy profession needs to reach a consensus on minimum standards for integration of health promotion in undergraduate training, and the physiotherapy professional board has the potential to provide the required leadership.

Physical Therapy Entry-level Education and Post-professional Training in Saudi Arabia: A Comparison of Perceptions of Physical Therapists from Five Regions

[Purpose] The goal of this study was to examine potential differences in physical therapists’ perceptions of content areas for the new entry-level Doctor of Physical Therapy (DPT) curricula and specialties for post-graduate residency and fellowship programs among five geographical regions in Saudi Arabia. [Subjects and Methods] All physical therapists in Saudi Arabia were invited to participate in this cross-sectional study, which was conducted via a web-based survey. The first domain queried the importance of introducing 10 content areas into future DPT curricula. The second domain concerned the importance of developing residency and fellowship programs in nine subspecialties. Descriptive statistics were generated, and an analysis of variance with a post hoc Tukey’s HSD test was used to evaluate the significance of differences in the physical therapists’ perceptions across the geographical regions. [Results] In total, 148 participants responded to the survey. Significant differences were found among respondents in different geographical regions for 4 of the 10 skills and 3 of the 9 subspecialties. [Conclusion] Understating the variations between the five regions would be helpful in developing a new model for future DPT and post-professional programs that addresses potentially unique needs perfectly. Future research is needed to confirm the findings in a wide range of stakeholders.

Tobacco cessation counseling training in US entry-level physical therapist education curricula: prevalence, content, and associated factors

BACKGROUND

The US Public Health Service (USPHS) recommends tobacco cessation counseling (TCC) training for all health care professionals. Within physical therapist practice, smoking can have adverse effects on treatment outcomes in all body systems. In addition, people with physical disabilities have a higher smoking prevalence than the general population, creating a strong need for tobacco cessation among physical therapy clientele. Therefore, TCC training is an important component of entry-level physical therapist education.

OBJECTIVE

The aims of this study were: (1) to determine need for TCC training within entry-level physical therapist education and (2) to identify potential barriers to implementation of USPHS guidelines in the academic environment.

DESIGN

A descriptive cross-sectional survey was conducted.

METHODS

Directors or academic coordinators of clinical education from entry-level physical therapist programs (N=204) were surveyed using an online instrument designed specifically for this study. Data regarding program and faculty characteristics, tobacco-related training content, and faculty opinions toward TCC in both physical therapist practice and education were analyzed descriptively.

RESULTS

The response rate was 71%. A majority (60%) of programs indicated inclusion of tobacco-related training, most commonly 1 to 2 hours in duration, and of these programs, 40% trained students in the implementation of USPHS clinical guidelines for TCC.

LIMITATIONS

Data analyses were constrained by limited or missing data in some areas. A single faculty member completed the survey for each program.

CONCLUSIONS

There is a need for TCC training in entry-level physical therapist education. Inclusion may be facilitated by addressing perceived barriers toward TCC as a component of physical therapist practice and promoting the relevance of TCC as it relates to intended outcomes of physical therapy interventions.

Perceptions of physiotherapists about their role in health promotion at an acute hospital: a qualitative study

OBJECTIVE

To investigate the perceptions of physiotherapists about their role in health promotion in an acute inpatient setting.

DESIGN

Qualitative design using focus groups within a constructivist framework. Focus groups were recorded, transcribed verbatim and analysed using a constant comparative method.

SETTING

An acute National Health Service (NHS) hospital trust.

PARTICIPANTS

Three focus groups were conducted with a total of 22 physiotherapists who were recruited purposively from the medical and surgical unit of the study hospital.

FINDINGS

Participants generally perceived health promotion to be within their scope of practice, particularly in relation to the promotion of physical activity and smoking cessation. Whilst some facilitators to engaging in health promotion were discussed, a large number of barriers to routine engagement in health promotion were identified. These included time constraints, the focus of acute settings on discharge, and scepticism of effectiveness.

CONCLUSION

Pre- and postregistration physiotherapy education as well as mandatory training in NHS trusts should be reviewed to equip the workforce to engage in this crucial area of health care.

Addition of motivational interventions to exercise and traditional physiotherapy: a review and meta-analysis

BACKGROUND

Incontestable epidemiological trends indicate that, for the foreseeable future, mortality and morbidity will be dominated by an escalation in chronic lifestyle-related diseases. International guidelines recommend the implementation of evidence-based approaches to bring about health behaviour changes. Motivational interventions to increase adherence and physical activity are not part of traditional physiotherapy for any condition.

OBJECTIVE

To evaluate the evidence for the effectiveness of adding motivational interventions to traditional physiotherapy to increase physical activity and short- and long-term adherence to exercise prescriptions.

DATA SOURCES

A literature search of PubMed, EMBASE, Scopus, CINAHL, PsychINFO, AMED and Allied Health Evidence database using keywords and subject headings.

STUDY SELECTION

Only randomised controlled trials comparing two or more arms, with one arm focused on motivational interventions influencing exercise and one control arm, were included. The search identified 493 titles, of which 14 studies (comprising 1504 participants) were included.

DATA EXTRACTION

The principal investigator extracted data that were reviewed independently by another author. Methodological quality was assessed independently by two authors using the Cochrane Risk of Bias tool and the PEDro scale. Outcomes were measured at the level of impairment, activity limitation and participation restriction. The standardised mean difference between the control and intervention groups at follow-up time points was used as the mode of analysis. I2≤50% was used as the cut-off point for acceptable heterogeneity, above which a random effects model was applied.

RESULTS

Exercise attendance was measured in six studies (n=378), and the results indicate that there was no significant difference in exercise attendance between the groups (Random effects model, standardised mean difference 0.33, 95% confidence interval -0.03 to 0.68, I2 62%). Perceived self-efficacy results were pooled from six studies (n=722), and a significant difference was found between the groups in favour of the interventions (Fixed effects model, standardised mean difference 0.71, 95% confidence interval 0.55 to 0.87, I2 41%). The results for levels of activity limitation were pooled (n=550), and a significant difference was found between the groups in favour of the interventions (REM, standardised mean difference -0.37, 95% confidence interval -0.65 to -0.08, I(2) 61%).

LIMITATIONS

The majority of the included studies were of medium quality, and four studies were of low quality. Data were pooled from a wide variety of different populations and settings, increasing the assortment of study characteristics.

CONCLUSIONS

Motivational interventions can help adherence to exercise, have a positive effect on long-term exercise behaviour, improve self-efficacy and reduce levels of activity limitation. The optimal theory choice and the most beneficial length and type of intervention have not been defined, although all interventions showed benefits. There is a need to determine how practising physiotherapists currently optimise adherence, and their current levels of knowledge about motivational interventions.

IMPLICATIONS OF KEY FINDINGS

The results indicate that motivational interventions are successful for increasing healthy physical activity behaviour. Physiotherapists are ideally placed to take on this role, and motivational interventions must become part of physiotherapy practice.

The effectiveness of physical therapist-administered group-based exercise on fall prevention: a systematic review of randomized controlled trials

BACKGROUND

Falls are a verified cause of morbidity and mortality in adults older than 65 years. Exercise under the direction of a physical therapist has been shown to reduce the risk of falls in older adults; however, it is not clear whether physical therapist-directed group-based exercise could produce similar results.

PURPOSE

The purpose of this systematic review was to summarize the evidence on the effectiveness of physical therapist-administered group-based exercise when compared with various controls for falls prevention and improvement of quality of life.

METHODS

A computerized search of PubMed and CINAHL was performed. An exhaustive hand search was also performed of the references of all full-text articles. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for this review. Studies were included if they met the following criteria: (1) comparison of group-based exercise led by a physical therapist to a control group; (2) ambulatory elderly men or women, aged 65 years or older; (3) subjects in the community or institutional setting; (4) the use of 1 or more outcome measures related to functional balance and/or quality of life; (5) randomized controlled or clinical trials; and (6) published in English, between December 1, 2001, and June 7, 2012. The PEDro scale was used to assess the quality of each study included in this review.

RESULTS

The computerized search strategy and hand search revealed 213 potential articles, 10 of which met the inclusion criteria. After assessment with the PEDro scale, 8 of these were considered high-quality studies (score > 6/10). Seven studies compared group-based exercise to a nonexercise control group, while 3 studies compared group-based exercise with a physical therapist-prescribed home exercise program. Outcomes measured include fall rate, balance, physical performance, health-related quality of life, and fear of falling.

DISCUSSION

When group-based exercise was compared with no intervention, group-based exercise was found to be more effective in decreasing fall frequency, increase balance, and improve quality of life. When compared with a physical therapist-prescribed home exercise program, the group-based exercise results were not statistically different but showed improvements in some quality of life and physical functioning measures. There is also some evidence to suggest that group-based exercise promotes greater patient satisfaction and exercise adherence.

CONCLUSION

There is preliminary evidence to suggest that the group-based exercise is effective for falls prevention, quality-of-life enhancement, and balance improvements in the older adults comparable with traditional home exercise programs.

From clinical expert to guide: experiences from coaching people with rheumatoid arthritis to increased physical activity

BACKGROUND

Physical activity levels in people with rheumatoid arthritis are lower than what are recommended for a healthful lifestyle. To support physical activity, health care professionals may use behavioral change techniques based on a biopsychosocial perspective. Investigating the implementation process may be relevant for understanding how these techniques translate to practice.

OBJECTIVES

The study objective was to explore the experiences of physical therapists using behavioral change techniques to coach people with rheumatoid arthritis to health-enhancing physical activity in a 2-year trial, the Physical Activity in Rheumatoid Arthritis 2010 study.

DESIGN

This was an exploratory study with qualitative content analysis.

METHODS

Semistructured interviews were conducted with all 12 physical therapists in the study. They were asked about their experiences with an educational program and with their delivery of a health-enhancing physical activity intervention. Codes, subcategories, categories, and an overarching theme were derived from the transcribed interviews by use of qualitative content analysis.

RESULTS

The overarching theme (from clinical expert to guide) was based on 3 main categories: challenges in the coaching role, growing into the coaching role, and coach education and support. Early in the process, the physical therapists encountered challenges that needed to be addressed for a smoother transition into their coaching role. Assisted by education and support, they gradually adopted practices that facilitated their use of behavioral change techniques and promoted growth into the role of coach.

CONCLUSIONS

Adapting to a new role is a challenging process for health care professionals; it requires relevant education and support. The experiences identified in the present study may inform future educational programs targeting the skills of health care professionals in promoting various health-related behaviors.

Assessment and management of risk factors for the prevention of lifestyle-related disease: a cross-sectional survey of current activities, barriers and perceived training needs of primary care physiotherapists in the Republic of Ireland

OBJECTIVE

To provide a snapshot of current activities, barriers and perceived training needs for the assessment and management of behavioural risk factors in physiotherapy practice in primary care settings in the Republic of Ireland.

DESIGN

Cross-sectional survey of primary care physiotherapists.

METHOD

Two hundred and twenty primary care physiotherapists were invited to participate. Each received a questionnaire, consisting of 23 questions, within five key sections. Its main focus was the risk factor management practices of physiotherapists. Descriptive statistics and frequencies were used to analyse the data.

RESULTS

A response rate of 74% (163/220) was achieved. Level of physical activity was the most common risk factor assessed at initial and follow-up visits (78%, 127/163), followed by dietary status (55%, 90/163). Few respondents included smoking status and alcohol consumption in their assessment; however, the majority considered them as risk factors that should be addressed. The main reasons why smoking status and alcohol consumption were not assessed were lack of time, limited knowledge and expertise, not traditionally viewed as the physiotherapist's role, and patient's lack of interest in changing their unhealthy behaviour.

CONCLUSION

The findings highlight an untapped potential in relation to physiotherapists addressing lifestyle-related risk factors. A number of strategies are required to improve the systematic assessment and management of these risk factors.

Introduction to Special Issue: A Review of the International Classification of Functioning, Disability and Health and Physical Therapy over the Years

BACKGROUND AND PURPOSE

The International Classification of Functioning, Disability and Health (ICF) of the World Health Organization was developed as a common framework to understand health and to describe the impact of health condition on functioning. The purpose of this paper is to summarize the literature on the use of the ICF in physical therapy practice and research.

METHODS

We performed a scoping-narrative review and searched for relevant English language articles from 2001 to 2012 in multiple databases that included MEDLINE, PsycINFO, PubMed and Physiotherapy Evidence Database. Our keywords for the search consisted of ['physical therapy' OR 'physiotherapy'] AND ['ICF']. All types of articles were considered.

RESULTS

We found 268 articles; out of which, 79 were reviewed. The years with most publications were 2011 (n = 16), 2008 (n = 15) and 2010 and 2012 (both with n = 13). Publications mostly came from the United States with 27% of the articles. The journal Physical Therapy leads with almost a third of ICF-related physical therapy publications. The ICF has been mostly used in studies of musculoskeletal and neuromuscular conditions. We found a wide array of application of the ICF in research, clinical practice and teaching (classroom and clinical education). Emerging topics included using the ICF in resource allocation and prevention and wellness.

CONCLUSION

The use of the ICF in physical therapy practice and research is promising and continues to evolve. With recent developments in ICF-based measurement and integration in assessment tools for use in the clinics, research and teaching, the need to show the added value of using the ICF in practice and research remains.

Teaching evidence based practice in physical therapy in a developing country: a national survey of Philippine schools

BACKGROUND

Early education on the foundations of evidence based practice (EBP) is advocated as a potent intervention toward enhancing EBP uptake among physical therapists. Little is known about the extent to which EBP is integrated in educational curricula in developing countries where the benefits of EBP are more acutely needed. This study sought to describe EBP education in Philippine physical therapy schools, including the challenges encountered by educators in teaching EBP.

METHODS

A national survey of higher education institutions offering an undergraduate degree program in physical therapy was conducted from August 2011 through January 2012. A 35-item questionnaire was developed to gather data on whether or not EBP was taught, specific EBP content covered and courses in which content was covered, teaching and evaluation methods, and challenges in teaching EBP. Data were analyzed descriptively.

RESULTS

The study had a response rate of 55.7% (34/61). Majority of the participating educational institutions (82%, 28/34) reported teaching EBP by incorporating EBP content in the professional courses. Among those that did not teach EBP, inadequate educator competence was the leading barrier. Courses commonly used to teach EBP were those on research (78.6%, 22/28), therapy planning (71.4%, 20/28), treatment skills (57.1-64.3%, 16-18/28), and undergraduate thesis (60.7%, 17/28). Various EBP contents were covered, with statistical concepts more frequently taught compared with critical EBP content. Lectures and journal reports were the usual teaching methods (96.4%, 27/28 and 89.3%, 25/28, respectively) while written examinations, completion of an undergraduate thesis, and oral reports (82.1%, 23/28, 78.6%, 22/28, and 78.6%, 22/28, respectively) were often used in evaluation. Students' inadequate knowledge of statistics and lack of curricular structure for EBP were identified as leading challenges to teaching (75%, 21/28 and 50%, 14/28, respectively).

CONCLUSIONS

Many physical therapy faculties across the Philippines are incorporating EBP content in teaching. However, there is arbitrary and fragmented coverage of EBP content and inadequate emphasis on clinically oriented teaching-learning and assessment methods. These findings suggest the need to design appropriate entry-level educational programs on EBP. Effective 'educating the educators' strategies are urgently needed and can have far-reaching positive repercussions on EBP uptake in physical therapist practice.

Research evidence uptake in a developing country: a survey of attitudes, education and self-efficacy, engagement, and barriers among physical therapists in the Philippines

RATIONALE AND OBJECTIVE

Use of evidence from systematic research is critical in evidence-based physical therapy, yet this has not been described well in developing countries where its purported benefits are most needed. This study explored research evidence uptake among physical therapists in the Philippines.

METHOD

A probability survey of practitioners in tertiary hospitals in the Philippines' National Capital Region was conducted.

RESULTS

Of the 188 questionnaires distributed, 152 were returned for an 81% response rate. Positive attitudes were consistently reported (78-93%), although education and self-efficacy related to key dimensions such as searching, appraising and integrating evidence were varied (53-82%). Less than 50% reported using research evidence routinely in five of six dimensions of clinical practice, except in selecting treatments (53%). Textbooks, own observations and expert opinion were consistently relied upon (74-96%) while average-month approximations of engagement in relevant activities such as searching, reading, appraising and applying research literature were low (10-18%). Participants faced a number of barriers such as lack of time, resources, skills, access to research literature, supporting administrative policies, in-service training and authority in decision making.

CONCLUSIONS

The low research evidence uptake and heavy reliance on potentially biased evidence sources strongly indicate the need for effective professional education for practitioners to address current barriers as well as early intensive undergraduate education for students to ensure adequate preparation on being effective research evidence consumers. Given the profile of Filipino physical therapists, alternatives to 'from scratch' evidence searching and appraisal are required if widespread uptake is envisaged.

Benchmarking curriculum content in entry-level health professional education with special reference to health promotion practice in physical therapy: a multi-institutional international study

Health promotion (HP) warrants being a clinical competency for health professionals given the global burden of lifestyle-related conditions; these are largely preventable with lifestyle behavior change. Physical therapists have a practice pattern conducive to HP, including lifestyle behavior change. The extent to which HP content is included in entry-level physical therapy (PT) curricula, and how it is taught however, is unknown. The aim of this study was to benchmark lifestyle behavior HP content within entry-level curricula of international PT programs. The sampling frame included 258 accredited PT academic programs spanning six countries. An internet-based survey was used to assess HP curricular content. Descriptive questions for HP topics (smoking cessation, nutrition, weight control, alcohol consumption, exercise, and stress management) included hours allotted and instructional methods used. Chi square tests examined differences between the proportion of programs in the United States (US) and other countries (combined) for HP topics, and among HP topics regarding instructional methods. The response rate was 48 %. Most programs (>80 %) included all HP topics except alcohol consumption (65.5 % of programs). Instructional methods used were primarily theory-based; few programs (range 2.6-24.1 %) combined theory, practical and attainment of clinical competency for all HP topics (exercise prescription notwithstanding). Proportionally, more US programs included alcohol and nutrition than other countries combined. Overall, HP lifestyle behavior topics were included to varying extent; however, instructional methods used and hours allotted per topic varied across PT curricula. Universal standards of HP practice as a clinical competency are warranted within the profession.

How do patients, politicians, physiotherapists and other health professionals view physiotherapy research in Switzerland? A qualitative study

Background

Since 2002, the professional education for Swiss physiotherapists has been upgraded to a tertiary educational level. With this change, the need for research related to professional practice has become more salient. The elaboration of research priorities is seen as a possible way to determine the profession's needs, to help coordinate research collaborations and to address expectations regarding physiotherapy. There is still limited evidence about stakeholders' views with regard to physiotherapy research. The objective of this study was to investigate key stakeholders' opinions about research in physiotherapy in Switzerland.

Methods

Focus groups with patients, health professionals, researchers and representatives of public health organizations were conducted, and semi-structured interviews were conducted with politicians, health insurers and medical doctors from three linguistic regions in Switzerland. An interview guide was elaborated. Data were transcribed and analysed using inductive content analysis (Atlas-ti 6®).

Results

Eighteen focus groups and 23 interviews/written commentaries included 134 participants with various research experiences and from different settings. Fourteen categories were defined reflecting three themes: identity, interdisciplinarity and visibility. Stakeholders had positive views about the profession and perceived physiotherapists' important role now and in the future. Yet, they also felt that physiotherapy was not sufficiently recognized in society and not visible enough. A stronger professional identity would be key to enhancing interdisciplinary work.

Conclusions

Results of this qualitative study provide insights into key aspects for moving the physiotherapy profession forward. Identity is at the heart of physiotherapy, not necessarily in terms of research priorities but in the definition of domains of competence and future positioning. Identity is also tightly connected to Interdisciplinarity as this might threaten the existence of the profession. Stakeholders outside the profession insist on the importance of visibility. The results of this study can help stakeholders reflect on the future of physiotherapy and elaborate research priorities. © 2013 The Authors. Physiotherapy Research International published by John Wiley & Sons Ltd.

[Child health promotion: a physiotherapeutic approach]

This article seeks to analyze the state-of-the-art physiotherapeutic actions geared to children, with a focus on health promotion, in the available literature. Thus, by questioning ideas present in the production of knowledge, the intention is to contribute with input for the formulation of principles for physiotherapy to promote actions of comprehensive health care for children. In terms of methodology, the study consisted of a bibliographical review of a qualitative nature, focusing on articles available in national and international virtual libraries and databases. Four pivotal themes that permeate the discussion were singled out, namely: physiotherapy from the perspective of promoting the health of children; bodily practices at different levels of care; physiotherapy for children on a community basis; and cooperation between sectors. The discussions of the literature consulted made it possible to establish parameters for the development of physiotherapy geared to children from a health promotion standpoint.