Gender matters in physiotherapy

Mind the gap: Gender disparities in authorship in the Journal of Medical Imaging and Radiation Sciences

INTRODUCTION

Research studies tracking gender and academic publication productivity in healthcare find gender disparities in research activity, publication, and authorship. Article authorship is one of the important metrics to track when seeking to understand gender inequality in academic career advancement. Research on gender disparities in publication productivity in the field of Medical Radiation Science (MRS) is very limited thus this study analyses and explains potential gender differences in article authorship and acceptance for publication in the Journal of Medical Imaging and Radiation Sciences (JMIRS) for a 5-year period (2017-2021).

METHODS

Gender was inferred based on the author's first name or title (e.g., Mr, Mrs or Ms). For those who left the title blank or reported as 'Dr' or 'Prof,' a series of steps were taken to identify their gender. Where gender was impossible to ascribe, these authors were excluded. Descriptive and inferential statistics are reported for the study population. Descriptive and inferential statistics are used. Percentages of females are reported, and males constitute the other portion. Chi-square, slope analysis and z-tests were used to test hypotheses.

RESULTS

Results show that female authorship overall and in all categories of authorship placement (i.e., first, last and corresponding) increased over the timeframe reviewed. The percentage gain in the increase was higher than that for male authorship. However, male authorship started from a higher baseline in 2017 and has also increased year on year and overall, as well as in each placement category examined. More female authors were in the MRS sub-specialism Radiation Therapy (RT) than in the other MRS sub-specialisms. Analysis of the acceptance rate of articles with female authors shows a weak downward trend, and this may be related to higher submission and acceptance rates of articles by male authors during the same period.

CONCLUSION

Male authors are overrepresented in all categories, which raises questions about the persistence of gender disparities in JMIRS authorship and article acceptance. Positive trends in female authorship indicate progress, yet there is the persistence of the significant under-representation of women in the Medical Radiation Sciences workforce in academic publishing. Recruiting more males to address the gender imbalance in the profession should not be at the expense of females' career progression.

Sex and gender differences in upper extremity prosthesis rejection: A review of literature

Prosthesis rejection is a significant barrier to rehabilitation of persons with upper limb difference. Many individual factors can affect device rejection, including a person's sex or gender. The objective of this narrative review was to explore the reported differences between the sexes and genders in upper limb prosthesis rejection. This review considered peer-reviewed, published research studies in which the study population were adults (aged 18 and older) who had unilateral or bilateral limb difference (any level) of any etiology with current, past, or no history of prosthetic device usage. Using identified keywords, index terms, and a peer-reviewed search filter, the literature was searched in MEDLINE, Embase, and PsycInfo. The reasons for rejection, disuse, or abandonment of prosthetic devices were extracted, with the focus on reported differences between sex and genders. After searching, 29 articles were selected for full-text review and 15 were included. Only 5 of 15 articles examined differences between the sexes. Women tend to reject upper extremity prostheses more than men both before and after being fit with a device; device characteristics, such as weight and cosmesis, do not appear to be appropriately designed for women; and there may not be adequate consideration of the goals for women with limb difference(s). There is inadequate reporting of sex and gender in the literature on prosthesis rejection; future studies should report and explore these factors to determine whether the needs of the full population with limb loss are being met.

Understanding the Sociocultural Challenges and Opportunities for Affordable Wearables to Support Poststroke Upper-Limb Rehabilitation: Qualitative Study

Background

People who survive a stroke in many cases require upper-limb rehabilitation (ULR), which plays a vital role in stroke recovery practices. However, rehabilitation services in the Global South are often not affordable or easily accessible. For example, in Bangladesh, the access to and use of rehabilitation services is limited and influenced by cultural factors and patients' everyday lives. In addition, while wearable devices have been used to enhance ULR exercises to support self-directed home-based rehabilitation, this has primarily been applied in developed regions and is not common in many Global South countries due to potential costs and limited access to technology.

Objective

Our goal was to better understand physiotherapists', patients', and caregivers' experiences of rehabilitation in Bangladesh, existing rehabilitation practices, and how they differ from the rehabilitation approach in the United Kingdom. Understanding these differences and experiences would help to identify opportunities and requirements for developing affordable wearable devices that could support ULR in home settings.

Methods

We conducted an exploratory study with 14 participants representing key stakeholder groups. We interviewed physiotherapists and patients in Bangladesh to understand their approaches, rehabilitation experiences and challenges, and technology use in this context. We also interviewed UK physiotherapists to explore the similarities and differences between the 2 countries and identify specific contextual and design requirements for low-cost wearables for ULR. Overall, we remotely interviewed 8 physiotherapists (4 in the United Kingdom, 4 in Bangladesh), 3 ULR patients in Bangladesh, and 3 caregivers in Bangladesh. Participants were recruited through formal communications and personal contacts. Each interview was conducted via videoconference, except for 2 interviews, and audio was recorded with consent. A total of 10 hours of discussions were transcribed. The results were analyzed using thematic analysis.

Results

We identified several sociocultural factors that affect ULR and should be taken into account when developing technologies for the home: the important role of family, who may influence the treatment based on social and cultural perceptions; the impact of gender norms and their influence on attitudes toward rehabilitation and physiotherapists; and differences in approach to rehabilitation between the United Kingdom and Bangladesh, with Bangladeshi physiotherapists focusing on individual movements that are necessary to build strength in the affected parts and their British counterparts favoring a more holistic approach. We propose practical considerations and design recommendations for developing ULR devices for low-resource settings.

Conclusions

Our work shows that while it is possible to build a low-cost wearable device, the difficulty lies in addressing sociotechnical challenges. When developing new health technologies, it is imperative to not only understand how well they could fit into patients', caregivers', and physiotherapists' everyday lives, but also how they may influence any potential tensions concerning culture, religion, and the characteristics of the local health care system.

Knee osteoarthritis patients assessed during walking for ankle inversion movement discrimination sensitivity

Background: Knee osteoarthritis (KOA) is a common musculoskeletal condition that affects dynamic balance control and increases the risk of falling during walking. However, the mechanisms underlying this are still unclear. Diminished ankle proprioception during walking has been found to be related to fear of falling in older adults, with a gender difference in incidence of falling. This study aimed to determine 1) whether ankle inversion proprioceptive acuity during walking is impaired in patients with KOA; and 2) whether there is any difference between genders. Methods: Thirty-two patients with KOA (F:M = 17:15, Median age = 52.5, BMI = 22.3 ± 3.0) and 34 healthy controls without KOA (HC) (F:M = 17:17; median age = 49.0, BMI = 22.5 ± 2.7) were recruited. In patients with KOA, ankle inversion proprioceptive acuity was measured on the affected side using the ankle inversion discrimination apparatus for walking (AIDAW), whilst HC were assessed on a randomly selected side. Two-way (2*2) analysis of variance (ANOVA) was performed to determine the main effects and interaction between gender and KOA condition. Results: Two-way ANOVA showed a significant KOA main effect (F = 26.6, p < 0.001, ƞp 2 = 0.3) whereby AIDAW scores during walking for individuals with KOA were significantly lower than those without KOA (KOA vs. HC: 0.746 ± 0.057 vs. 0.807 ± 0.035). There was neither a gender main effect nor interaction (both p > 0.05). Conclusion: Individuals with KOA demonstrated lower ankle proprioception scores during walking compared to their healthy counterparts, with a similar level of impairment in ankle proprioceptive acuity between male and female patients. A low score may contribute to an increased risk of falling in the KOA population. The current findings suggest the need for global concern about lower limb proprioception in the clinical management of KOA.

Patients' and therapists' perspective of integrating home and family work roles into rehabilitation following distal radius fracture

PURPOSE

To explore distal radius fracture (DRF) patients' and hand therapist/occupational therapist/physiotherapists' perceptions of integrating home and family work roles (HFWR) into rehabilitation.

METHODS

Eighteen patients and eleven therapists completed a semi-structured telephone interview three months after DRF. Reflexive thematic analysis of the interviews and triangulation of patients' and therapists' themes was performed.

RESULTS

The patient interview yielded five themes: the experience of rehabilitation; predetermined expectations of rehabilitation; incorporating HFWR into therapy sessions; varying patient needs for addressing HFWR; and determination to return to valued activities drives behavioral choices. The therapists' interview yielded five themes: The challenges in integrating HFWR into rehabilitation; HFWR addressed when brought up by a patient; working context and referral sources influence the rehabilitation plan; rehabilitation is not explicitly tailored according to sex and gender; and utilizing HFWR as a rehabilitation strategy is perceived beneficial.

CONCLUSIONS

Patients have predetermined rehabilitation expectations primarily focused on mobility and strengthening exercises. Therapists and patients agree that adapting home and family work roles is beneficial but was not a major focus for either therapists' or patients' expectations during therapy. An unfavourable environment, patient budget constraints, and limited time were identified as challenges to integrating family roles.

Critical physiotherapy: a ten-year retrospective

Critical physiotherapy has been a rapidly expanding field over the last decade and could now justifiably be called a professional sub-discipline. In this paper we define three different but somewhat interconnected critical positions that have emerged over the last decade that share a critique of physiotherapy's historical approach to health and illness, while also diverging in the possibilities for new forms of practice and thinking. These three positions broadly align with three distinctive philosophies: approaches that emphasize lived experience, social theory, and a range of philosophies increasingly referred to as the "posts". In this paper we discuss the origins of these approaches, exploring the ways they critique contemporary physiotherapy thinking and practice. We offer an overview of the key principles of each approach and, for each in turn, suggest readings from key authors. We conclude each section by discussing the limits of these various approaches, but also indicate ways in which they might inform future thinking and practice. We end the paper by arguing that the various approaches that now fall under the rubric of critical physiotherapy represent some of the most exciting and opportune ways we might (re)think the future for the physiotherapy profession and the physical therapies more generally.

Gender diversity in therapeutic radiography: A mixed methods exploration of the gender influences impacting on male students' career choices

INTRODUCTION

A significant gender imbalance exists in therapeutic radiography, with male radiographers contributing to less than one fifth of the UK registered workforce. This research aimed to explore male student recruitment experiences to identify gender-sensitive strategies to employ within future recruitment drives.

METHODS

An exploratory mixed methods design commenced with therapeutic radiography student focus groups, analysed via descriptive thematic analysis. The focus group themes informed an online questionnaire survey targeting enrolled male therapeutic radiography students in the UK. Both phases explored students' experiences of their career choice and the impact, if any, their gender had on this selection.

RESULTS

Three focus groups (n = 9) yielded four major themes: the invisible profession; career choices; gender influences; gender-sensitive approaches. Survey responses (n = 38) represented 9 UK institutions, a 25% estimated response rate. Over half (55%) had little or no awareness of the career at entry, with many discovering the profession 'by accident'. Many had never seen recruitment materials; 40% (n = 15) stated they were not designed to appeal to male applicants, with 18% (n = 7) suggesting they reflected more stereotypical female traits.

CONCLUSION

Targeting gender imbalances is always controversial but doing nothing will maintain the status quo and perpetuate an unrepresentative workforce. Earlier awareness-raising of therapeutic radiography is essential, with promotional imagery suitable for different audiences and focusing equally on care and technology. Recruitment language should embrace 'leadership' attributes as well as 'caring' attributes. Supported by male role models, outreach events should emphasise the profession in terms of a sustainable, fulfilling and rewarding career.

IMPLICATIONS FOR PRACTICE

The findings have provided detailed recommendations on which to focus a specific recruitment and marketing strategy to encourage male applicants to consider a career in therapeutic radiography.

Gender Difference in the Relationship of Physical Activity and Subjective Happiness Among Chinese University Students

Background: Gender makes a difference in health and physical activity (PA). This research aimed to identify the gender difference in the relationship of PA and subjective happiness among Chinese university students.

Methods: A cross-sectional survey was conducted in Shanghai Jiao Tong University from July 7 to 17 in 2021, using an anonymous online self-report questionnaire. The questionnaire included the Chinese version of the International Physical Activity Questionnaire-Short Form (IPAQ-SF), the Subjective Happiness Scale (SHS), the Depression Anxiety Stress Scale-21(DASS-21). The demographic and health-related factors were also reported. Linear regression was carried out to identify the relationship of PA and subjective happiness.

Findings: In total, 1,512 students (1,108 males and 404 females) from three comprehensive schools completed the survey. The SHS score was 17.20 ± 3.44, and it was 17.00 ± 3.23 in males, and 17.75 ± 3.93 in females, respectively (p < 0.001). There was no gender difference in vigorous, moderate PA, or walk min/week, while female students had longer sedentary behavior hours/day than males. Male students scored higher in each subscale of DASS-21. After controlling for confounders, vigorous PA min/week (β = 0.002, p = 0.002) and sedentary behavior hours/day (β = 0.168, p = 0.005) were significantly positively associated with happiness in male students. In contrast, walk min/week (2= 0.002, p = 0.005) was significantly positively associated with happiness in female students.

Interpretation: This research demonstrated a significant gender difference in the association between PA and happiness. Policymakers and college management should pay more attention to PA programs to promote students’ happiness and mental health status.