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Jensen M, Junod C, Fatemi N, Liew K, Ulaj E, Bean CC, Nixon SA, McKay SM. Navigating the Grey Zone of Physiotherapy Assistant Autonomy in Home Care: Perspectives of Physiotherapists and Physiotherapy Assistants. Physiother Can 2022. [DOI: 10.3138/ptc-2021-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: To explore perspectives and experiences regarding the autonomy of physiotherapist assistants (PTAs) among physiotherapists and PTAs providing home care services in Ontario since the introduction of PTAs into home care rehabilitation teams. Method: For this qualitative study, we conducted semi-structured interviews with 10 physiotherapists and 5 PTAs working in home care. We analyzed interview transcripts using the DEPICT model. Results: Participants described navigating a grey zone characterized by a lack of clarity about acceptable levels of PTA autonomy. Four interrelating factors shaped the extent to which PTAs practiced with autonomy: system influences (number of physiotherapy visits, professional guidelines), patient complexity (status, comorbidities), perceived PTA competence (skills, training), and the physiotherapist–PTA relationship (trust, communication). Conclusions: New practice models in home care have impacted the role of both physiotherapists and PTAs. Home care agencies should facilitate emerging professional relationships and address autonomy-related challenges, such as trust and competence, to promote high-quality client-centred care.
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Affiliation(s)
- Meghan Jensen
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Christiane Junod
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Nilofar Fatemi
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Kieran Liew
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Endri Ulaj
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Courtney C Bean
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- VHA Home HealthCare, Toronto, Ontario, Canada
| | - Stephanie A Nixon
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- International Centre for Disability and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Sandra M McKay
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- VHA Home HealthCare, Toronto, Ontario, Canada
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Sarigiovannis P, Jowett S, Saunders B, Corp N, Bishop A. Delegation by Allied Health Professionals to Allied Health Assistants: a mixed methods systematic review. Physiotherapy 2020; 112:16-30. [PMID: 34020200 DOI: 10.1016/j.physio.2020.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Delegation by Allied Health Professionals (AHPs) to Allied Health Assistants (AHAs) was introduced in response to various challenges affecting modern health care delivery. However, the clinical and cost-effectiveness of using AHAs is relatively unexplored. OBJECTIVES The aim of this review was to synthesise the available evidence on; firstly, the clinical and cost-effectiveness of interventions delegated by AHPs to AHAs and secondly, AHPs', AHAs' and patients' attitudes and beliefs towards delegation. DATA SOURCES MEDLINE, AMED, CINAHL, Cochrane Library, PsycINFO, PEDro, OTseeker and Web of Science databases were searched from inception until January 2019 without restrictions. STUDY SELECTION Primary studies investigating the clinical and cost-effectiveness of any intervention delegated by an AHP, across the spectrum of clinical areas in relation to adult patients, as well as AHPs', AHAs' and patients' attitudes and beliefs about delegation. DATA EXTRACTION & SYNTHESIS Data were extracted by pairs of reviewers. Thematic analysis and synthesis of descriptive and analytical themes was conducted. RESULTS Thirteen publications of variable methodological quality were included. Three studies reported quantitative research and ten qualitative research. No study explored the cost-effectiveness. Only one study investigated clinical effectiveness. Training for both AHPs and AHAs and having clear processes in place were identified as important facilitators of delegation. CONCLUSION AND IMPLICATIONS OF KEY FINDINGS Delegation is not standardised across AHPs or within each profession. There are clear knowledge gaps regarding the clinical and cost-effectiveness of delegation by AHPs and patients' attitudes and preferences. Further research is needed to facilitate the standardisation of delegation. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019119557.
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Affiliation(s)
- P Sarigiovannis
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire ST5 5BG, United Kingdom; Midlands Partnership NHS Foundation Trust, Newcastle under Lyme, Staffordshire ST5 2BQ, United Kingdom.
| | - S Jowett
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire ST5 5BG, United Kingdom; Health Economics Unit, Institute of Applied Health Research, IOEM Building, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - B Saunders
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire ST5 5BG, United Kingdom
| | - N Corp
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire ST5 5BG, United Kingdom
| | - A Bishop
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire ST5 5BG, United Kingdom
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Sørvoll M, Obstfelder A, Normann B, Øberg GK. How physiotherapists supervise to enhance practical skills in dedicated aides of toddlers with cerebral palsy: A qualitative observational study. Physiother Theory Pract 2018; 35:427-436. [PMID: 29558237 DOI: 10.1080/09593985.2018.1453003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Physiotherapy from an early age is considered important for children with cerebral palsy (CP). In preschool, dedicated aides are responsible for the daily follow-up and training under the supervision of a physiotherapist (PT). Knowledge is sparse regarding what is created and achieved in clinical practice involving triads (i.e. the PT, aide, and child) with respect to the enhancement of practical skills in dedicated aides. The study purpose was to explore form and content in supervision. METHODS Nonparticipating observations were performed on a purposive sample of seven triads, including seven PTs, seven dedicated aides, and seven preschool toddlers with CP with function level III-IV of the Gross Motor Function Classification System. Each triad was video-recorded once. Data consisted of 371 minutes of video recordings analyzed using content analysis and enactive theory on participatory sense-making. RESULTS From the analysis, three supervision approaches emerged: (1) the Cognitive Supervision approach; (2) the Joint Action Supervision approach; and (3) the Embodied Supervision approach. Each approach gives rise to different types of sense-making processes, ranging from merely reflective ways of knowing through verbal and visual conveyance to mutual embodied ways of knowing through joint actions and physical interplay. To make use of all approaches, PTs require incorporated handling skills and action competence. CONCLUSION Supervision is an emergent process where knowledge is transformed through interactions and shared sense-making processes. IMPLICATIONS Clinicians should be aware of the context-dependent and interactional factors that drive the supervision process.
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Affiliation(s)
- Marit Sørvoll
- a Department of Health and Care sciences , UIT - The Artic University of Norway , Tromsø , Norway
| | - Aud Obstfelder
- a Department of Health and Care sciences , UIT - The Artic University of Norway , Tromsø , Norway.,b Centre of Care research , NTNU - Norwegian University of Science and Technology , Gjøvik , Norway
| | - Britt Normann
- a Department of Health and Care sciences , UIT - The Artic University of Norway , Tromsø , Norway.,c Department of Physiotherapy , Nordland Hospital Trust , Bodø , Norway
| | - Gunn Kristin Øberg
- a Department of Health and Care sciences , UIT - The Artic University of Norway , Tromsø , Norway
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Rycroft-Malone J, Burton CR, Williams L, Edwards S, Fisher D, Hall B, McCormack B, Nutley S, Seddon D, Williams R. Improving skills and care standards in the support workforce for older people: a realist synthesis of workforce development interventions. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04120] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundSupport workers make up the majority of the workforce in health and social care services for older people. There is evidence to suggest that support workers are not deployed as effectively as possible, are often undervalued, and that there are gaps in understanding support worker roles across different care settings. In the context of a population that is growing older, having a skilled and knowledgeable workforce is an imperative. Workforce development includes the support required to equip those providing care to older people with the right skills, knowledge and behaviours to deliver safe and high-quality services.ObjectiveThe review answered the question ‘how can workforce development interventions improve the skills and the care standards of support workers within older people’s health and social care services?’.DesignA realist synthesis was conducted. In realist synthesis, contingent relationships are expressed as context–mechanism–outcomes (CMOs), to show how particular contexts or conditions trigger mechanisms to generate outcomes. The review was conducted in four iterative stages over 18 months: (1) development of a theoretical framework and initial programme theory; (2) retrieval, review and synthesis of evidence relating to interventions designed to develop the support workforce, guided by the programme theories; (3) ‘testing out’ the synthesis findings to refine the programme theories and establish their practical relevance/potential for implementation; and (4) forming recommendations about how to improve current workforce development interventions to ensure high standards in the care of older people.ParticipantsTwelve stakeholders were involved in workshops to inform programme theory development, and 10 managers, directors for training/development and experienced support workers were interviewed in phase 4 of the study to evaluate the findings and inform knowledge mobilisation.ResultsEight CMO configurations emerged from the review process, which provide a programme theory about ‘what works’ in developing the older person’s support workforce. The findings indicate that the design and delivery of workforce development should consider and include a number of starting points. These include personal factors about the support worker, the specific requirements of workforce development and the fit with broader organisational strategy and goals.Conclusions and recommendationsThe review has resulted in an explanatory account of how the design and delivery of workforce development interventions work to improve the skills and care standards of support workers in older people’s health and social care services. Implications for the practice of designing and delivering older person’s support workforce development interventions are directly related to the eight CMO configuration of the programme theory. Our recommendations for future research relate both to aspects of research methods and to a number of research questions to further evaluate and explicate our programme theory.LimitationsWe found that reports of studies evaluating workforce development interventions tended to lack detail about the interventions that were being evaluated. We found a lack of specificity in reports about what were the perceived and actual intended impacts from the workforce development initiatives being implemented and/or evaluated.Study registrationThis study is registered as PROSPRERO CRD42013006283.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Jo Rycroft-Malone
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Christopher R Burton
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Lynne Williams
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Stephen Edwards
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Denise Fisher
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Beth Hall
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Brendan McCormack
- Division of Nursing, School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Sandra Nutley
- School of Management, University of St Andrews, St Andrews, UK
| | - Diane Seddon
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Roger Williams
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
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Le Cornu KA, Halliday DA, Swift L, Ferris LA, Gatiss GA. The current and future role of the dietetic support worker. J Hum Nutr Diet 2010; 23:230-7. [DOI: 10.1111/j.1365-277x.2010.01055.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Parry RH, Lincoln NB, Vass CD. Effect of severity of arm impairment on response to additional physiotherapy early after stroke. Clin Rehabil 1999; 13:187-98. [PMID: 10392645 DOI: 10.1177/026921559901300302] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate effect of initial severity of arm impairment on response to additional physiotherapy for the arm after stroke. DESIGN In this controlled trial, patients were randomized into one of three groups: routine physiotherapy (RPT) patients received no additional physiotherapy; qualified physiotherapy (QPT) patients received additional treatment from a qualified physiotherapist; assistant physiotherapy (APT) patients received additional treatment from a trained supervised assistant. Comparisons between the whole groups found no significant differences and have been reported elsewhere. In a post hoc analysis, the groups were subdivided according to severity of initial arm impairment. The subgroups were then compared. SETTING A general hospital with acute and rehabilitation facilities for stroke patients. SUBJECTS Patients (n = 282) between one and five weeks after stroke. INTERVENTIONS Ten hours additional physiotherapy were given over a five-week period. The treatment approach reflected current usual British practice. 'Blind' outcome assessment was performed after intervention, and at three and six months after stroke. MAIN OUTCOME MEASURES Rivermead Motor Assessment Arm Scale, Action Research Arm Test. RESULTS In more severe patients, no benefits of additional treatment were detected. In less severe patients, significant benefits were found in those who completed treatment with the trained assistant. However, a considerable number of patients did not complete the additional treatment. The content of treatment differed between the QPT and APT groups. Treatment of less severe APT patients emphasized repetitive supervised practice of movements and functional tasks. No significant effects of additional treatment were found in terms of shoulder pain or spasticity. CONCLUSIONS Regardless of whether additional physiotherapy was given or not, patients with severe arm impairment improved very little in arm function. Enabling adaptation to loss of arm function may be an appropriate rehabilitation strategy for some patients. Trends in the data confirm findings of some previous studies that intensive treatment for patients with some motor recovery of the upper limb is effective. Following patient assessment and treatment planning by a qualified physiotherapist, it may be appropriate for guidance of repetitive practice of motor and functional tasks to be delegated to trained and closely supervised assistant staff.
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Affiliation(s)
- R H Parry
- Division of Stroke Medicine, University of Nottingham, Nottingham City Hospital, UK.
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Lincoln NB, Parry RH, Vass CD. Randomized, controlled trial to evaluate increased intensity of physiotherapy treatment of arm function after stroke. Stroke 1999; 30:573-9. [PMID: 10066854 DOI: 10.1161/01.str.30.3.573] [Citation(s) in RCA: 155] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Many patients have impaired arm function after stroke, for which they receive physiotherapy. The aim of the study was to determine whether increasing the amount of physiotherapy early after stroke improved the recovery of arm function and to compare the effects of this therapy when administered by a qualified therapist or a trained, supervised assistant. The physiotherapy followed a typical British approach, which is Bobath derived. Ten hours of additional therapy were given over a 5-week period. METHODS The study design was a single-blind, randomized, controlled trial. Stroke patients were recruited from those admitted to the hospital in the 5 weeks after stroke. They were randomly allocated to routine physiotherapy, additional treatment by a qualified physiotherapist, or additional treatment by a physiotherapy assistant. Outcome was assessed after 5 weeks of treatment and at 3 and 6 months after stroke on measures of arm function and of independence in activities of daily living. RESULTS There were 282 patients recruited to the study. The median initial Barthel score was 6.5, and the median age of the patients was 73 years. The median initial Rivermead Motor Assessment Arm score was 1. There were no significant differences between the groups at randomization or on any of the outcome measures. Only half of the patients allocated to the 2 additional-therapy groups completed the program. CONCLUSIONS This increase in the amount of physiotherapy for arm impairment with a typical British approach given early after stroke did not significantly improve the recovery of arm function in the patients studied. A number of other studies of interventions aimed at rehabilitation of arm function have reported positive results. Such findings may have been due to the content of these interventions, to the greater intensity of the interventions, or to the selection of patients to whom the treatments were applied.
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Affiliation(s)
- N B Lincoln
- School of Psychology, University of Nottingham, Division of Stroke Medicine, Nottingham City Hospital, Nottingham, UK.
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Affiliation(s)
- Liz Saunders
- Derby City General Hospital, Derby DE22 3NE and part-time research student at Loughborough University
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