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Chala MB, Vader K, Bisson EJ, Doulas T, Duggan S, Desmeules F, Perreault K, Donnelly C, Abebe A, McClintock C, Tawiah A, Miller J. Identifying competencies for an advanced practice physiotherapy role within an interprofessional chronic pain clinic. Musculoskelet Sci Pract 2024; 72:102965. [PMID: 38701666 DOI: 10.1016/j.msksp.2024.102965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/16/2024] [Accepted: 04/25/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Advanced practice physiotherapy (APP) models of care have shown success in access, safety, satisfaction, and care quality for musculoskeletal pain conditions in various settings. Yet, there is a gap in defining competencies for physiotherapists to be the initial point of contact for people with chronic pain. This study aims to identify and agree upon the competencies necessary for a physiotherapist to fulfill the role of an APP in an interprofessional chronic pain clinic. METHODS Three focus groups were conducted using a Nominal Group Technique and a modified Delphi process. Consensus on the competency, defined as agreement by ≥ 75% of participants, was sought. RESULTS Twenty-three experts (17 healthcare providers and six individuals with chronic pain) participated in the focus group discussions. Twenty completed the follow-up Delphi surveys. Ten essential competencies for an APP role in interprofessional chronic pain clinics were identified and achieved consensus: 1) use an evidence-based approach to practice; 2) communicate effectively with the patient; 3) perform a comprehensive assessment; 4) determine pain-related diagnoses; 5) develop therapeutic relationships; 6) provide appropriate care; 7) support patients through transitions in care; 8) collaborate with members of the interprofessional team; 9) advocate for the needs of the patients; and 10) use a reflective approach to practice. CONCLUSION This study identified ten competencies essential for physiotherapists to fulfill an APP role within interprofessional chronic pain clinics. These competencies serve as a foundation for informing a training program and future research evaluating the effectiveness of the APP model in this setting.
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Affiliation(s)
- Mulugeta Bayisa Chala
- The Gray Centre for Mobility and Activity, Parkwood Institute, St. Joseph's Health Care London, London, ON, Canada.
| | - Kyle Vader
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Etienne J Bisson
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada; Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada; Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Tom Doulas
- Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Scott Duggan
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada; Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - François Desmeules
- School of Rehabilitation, Université de Montreal, Montreal, Quebec, Canada
| | - Kadija Perreault
- École des Sciences de la Réadaptation, Université Laval, Québec City, Québec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale, Québec City, Québec, Canada
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Abey Abebe
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Chad McClintock
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Andrews Tawiah
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
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Lovasi O, Gaál P, Frank K, Lám J. Acute Pain Services and pain-related patient-reported outcomes in Hungarian hospitals. Perioper Med (Lond) 2024; 13:18. [PMID: 38475942 DOI: 10.1186/s13741-024-00373-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Postoperative pain management is an important part of surgical care, where Acute Pain Service offers added value in terms of patient outcomes and costs. The technology, however, has hardly been adopted in Hungary, with only two hospitals operating Acute Pain Service and whose performance has not been evaluated yet. This research compared pain management outcomes of surgical, orthopedic, and traumatology patients in Hungarian hospitals with and without Acute Pain Service. METHODS We recruited 348 patients, 120 in the APS group and 228 in the control group, whose experience was surveyed with an adapted version of the American Pain Society Patient Outcome Questionnaire. The questionnaire covered pain intensity, pain interference with physical and emotional functions, side effects, patient satisfaction, information received, and participation in treatment decisions. The differences were analyzed by Fisher's exact test and Mann-Whitney U test. RESULTS The APS group showed better results with lower pain intensity scores regarding worst postoperative pain (χ2 = 18.919, p = 0.0043). They reported less pain interference with activities in bed (χ2 = 21.978, p = 0.0006) and out of bed (χ2 = 14.341, p = 0.0129). Furthermore, patients in the APS group experienced fewer pain-management-related side effects, like nausea (χ2 = 15.240, p = 0.0101), drowsiness (χ2 = 26.965, p = 0.0001), and dizziness (χ2 = 13.980, p = 0.0124). However, patient information (χ2 = 3.480, p = 0.0945) and patient satisfaction (χ2 = 5.781, p = 0.2127) did not differ significantly between the two groups. CONCLUSIONS Our findings confirm earlier international evidence on the benefits of Acute Pain Service in postoperative pain management and support the wider adoption of the technology in Hungarian hospitals. Nevertheless, close attention should be paid to patient information and involvement as better outcomes alone do not necessarily increase patient satisfaction.
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Affiliation(s)
- Orsolya Lovasi
- School of PhD Studies, Semmelweis University, Üllői Út 26, 1085, Budapest, Hungary.
| | - Péter Gaál
- Health Services Management Training Center, Semmelweis University, Budapest, Hungary
- Department of Applied Social Sciences, Sapientia Hungarian University of Transylvania, Targu Mures, Romania
| | - Krisztián Frank
- Szekszárd District Office of the Government Office of Tolna County, Szekszárd, Hungary
| | - Judit Lám
- Health Services Management Training Center, Semmelweis University, Budapest, Hungary
- NEVES Society for Patient Safety, Budapest, Hungary
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Kaloty K, Rudecki J, Craine V, Moyes A, Armstrong R, Baxter M, Hunter J, Mustafa N, Grant G, Vader K, Bosma R. Virtual care exercise interventions in multidisciplinary chronic pain clinics: a qualitative study of perspectives of adults living with chronic pain. Disabil Rehabil 2023; 45:2976-2983. [PMID: 36073755 DOI: 10.1080/09638288.2022.2117864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/04/2022] [Accepted: 08/20/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Chronic pain affects 1 in 4 Canadians and is a leading contributor of disability. Although virtual care has become more prevalent, it is unclear how adults living with chronic pain perceive virtual delivery of exercise interventions within multidisciplinary chronic pain clinics (MCPC). This study explores the perspectives of adults living with chronic pain regarding their perceived barriers and facilitators and recommendations when implementing virtual care exercise interventions within MCPCs. METHODS We conducted an interpretive description qualitative study based on semi-structured interviews with adults (age ≥18 years) living with chronic pain from a MCPC in Toronto, Canada, between March 1 and April 30, 2021. RESULTS We completed fifteen (N = 15) interviews of adults living with chronic pain. We identified eight themes that addressed the study objectives: 1) virtual care supplements in-person care, 2) virtual care improves accessibility, 3) impact of technology on participation, 4) navigating the home environment, 5) impact of pain on participation, 6) impact of supervision and feedback, 7) the need for tailored care, and 8) the need for preparation and additional support. CONCLUSION Our results reveal that adults living with chronic pain view virtual care exercise interventions positively however, the implementation of these interventions must be carefully considered within MCPCs. Specifically, virtual care was considered an excellent adjunct to in-person care but should not replace it completely.Implications for RehabilitationChronic pain is a leading contributor of disability.Exercise interventions are recommended component of comprehensive pain management.Virtual delivery of exercise interventions are becoming more prevalent.Adults living with chronic pain view virtual care exercise interventions positively as they can supplement in-person care and improve access to this type of care.
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Affiliation(s)
- Kiren Kaloty
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Julia Rudecki
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Vanessa Craine
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Alexander Moyes
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Robert Armstrong
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Megan Baxter
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Judith Hunter
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Nida Mustafa
- Toronto Academic Pain Medicine Institute (TAPMI), Women's College Hospital, Toronto, Canada
| | - Gillian Grant
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Toronto Academic Pain Medicine Institute (TAPMI), Women's College Hospital, Toronto, Canada
| | - Kyle Vader
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Rachael Bosma
- Toronto Academic Pain Medicine Institute (TAPMI), Women's College Hospital, Toronto, Canada
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Janssen SM, Connelly DM, Gillis H. Physiotherapists’ Perspectives on Type 2 Diabetes Management and as a Primary Condition for Referral to Physiotherapy Services: A Qualitative Descriptive Study. Physiother Can 2022. [DOI: 10.3138/ptc-2022-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Purpose: We explored the current and potential role of physiotherapists in the management of people with type 2 diabetes (T2D) and T2D as a primary condition for physiotherapy referral. Method: We conducted a qualitative descriptive study. Participants were physiotherapists practicing in community and outpatient settings across Canada. One-on-one telephone interviews were completed to explore provision of physiotherapy care for people with T2D, including current practices and readiness of physiotherapists to provide direct care. We employed thematic analysis for generation of themes from interviews. Results: We interviewed 21 participants from eight provinces and territories. Three themes were generated from the data: current approach to T2D management; challenges for physiotherapy integration; and merits of physiotherapy and needed evolution. Participants described that physiotherapists are not part of the healthcare team for T2D management. There is a gap in medical management of T2D that physiotherapy would fill, that is, education and prescription for exercise participation. Conclusions: Our findings support a gap in the management of T2D in Canadian healthcare, particularly in reference to physiotherapy. Further, our findings support the need for greater inclusion of physiotherapists for lifestyle counseling with an emphasis on physical activity and exercise for patients at risk of and with T2D to maximize health and improve/maintain function. Studies focusing on accessibility and funding of physiotherapy services are needed to validate these findings.
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Affiliation(s)
- Sarah M. Janssen
- From the: Health and Rehabilitation Sciences Graduate Program, Western University, London, Ontario, Canada
| | | | - Heather Gillis
- School of Physical Therapy, Western University, London, Ontario, Canada
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Augeard N, Bostick G, Miller J, Walton D, Tousignant-Laflamme Y, Hudon A, Bussières A, Cooper L, McNiven N, Thomas A, Singer L, Fishman SM, Bement MH, Hush JM, Sluka KA, Watt-Watson J, Carlesso LC, Dufour S, Fletcher R, Harman K, Hunter J, Ngomo S, Pearson N, Perreault K, Shay B, Stilwell P, Tupper S, Wideman TH. Development of a national pain management competency profile to guide entry-level physiotherapy education in Canada. Can J Pain 2022; 6:1-11. [PMID: 35036823 PMCID: PMC8757473 DOI: 10.1080/24740527.2021.2004103] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND National strategies from North America call for substantive improvements in entry-level pain management education to help reduce the burden of chronic pain. Past work has generated a valuable set of interprofessional pain management competencies to guide the education of future health professionals. However, there has been very limited work that has explored the development of such competencies for individual professions in different regions. Developing profession-specific competencies tailored to the local context is a necessary first step to integrate them within local regulatory systems. Our group is working toward this goal within the context of entry-level physiotherapy (PT) programs across Canada. AIMS This study aimed to create a consensus-based competency profile for pain management, specific to the Canadian PT context. METHODS A modified Delphi design was used to achieve consensus across Canadian university-based and clinical pain educators. RESULTS Representatives from 14 entry-level PT programs (93% of Canadian programs) and six clinical educators were recruited. After two rounds, a total of 15 competencies reached the predetermined endorsement threshold (75%). Most participants (85%) reported being "very satisfied" with the process. CONCLUSIONS This process achieved consensus on a novel pain management competency profile specific to the Canadian PT context. The resulting profile delineates the necessary abilities required by physiotherapists to manage pain upon entry to practice. Participants were very satisfied with the process. This study also contributes to the emerging literature on integrated research in pain management by profiling research methodology that can be used to inform related work in other health professions and regions.
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Affiliation(s)
- Nathan Augeard
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Geoff Bostick
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - David Walton
- School of Physical Therapy, Western University, London, Ontario, Canada
| | | | - Anne Hudon
- School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Lynn Cooper
- Canadian Injured Workers Alliance, Thunder Bay, Ontario, Canada
| | - Nicol McNiven
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Aliki Thomas
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Lesley Singer
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Scott M. Fishman
- Davis School of Medicine, University of California, Sacramento, California, USA
| | - Marie H. Bement
- Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin, USA
| | - Julia M. Hush
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - Kathleen A. Sluka
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA
| | - Judy Watt-Watson
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Lisa C. Carlesso
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sinead Dufour
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Roland Fletcher
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine Harman
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Judith Hunter
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Suzy Ngomo
- Department of Health Science, Université du Québec à Chicoutimi, Chicoutimi, Quebec, Canada
| | - Neil Pearson
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kadija Perreault
- Department of Rehabilitation Science, Faculty of Medicine, Université Laval, Québec City, Quebec, Canada
| | - Barbara Shay
- Department of Physical Therapy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Peter Stilwell
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Susan Tupper
- School of Rehabilitation Sciences, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Timothy H. Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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Vrzic A, Vader K, Law M, Miller J. Implementing a Virtual Care Clinical Placement for a Physiotherapy Student in a Hospital-Based Chronic Pain Programme. Physiother Can 2021. [DOI: 10.3138/ptc-2020-0098] [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: The aim of this case report was to determine the experiences and outcomes of implementing a part-time virtual care clinical placement for a physiotherapy student in a hospital-based chronic pain programme. Client Description: Three participants were involved in this clinical placement: an entry-level physiotherapy student, a physiotherapy clinical instructor, and an academic coordinator of clinical education from a Master of Science in Physical Therapy (MScPT) programme. Intervention:We implemented a part-time 40-hour virtual care clinical placement (10 hr/wk for 4 wk) in a publicly funded chronic pain programme at Kingston Health Sciences Centre for an MScPT student from Queen’s University in Kingston, Ontario. Measures and Outcome:The student’s performance was evaluated by the clinical instructor using learning goals and the Canadian Physiotherapy Assessment of Clinical Performance. The participants also provided reflections on their experiences in their respective roles. The student achieved the learning goals and demonstrated competency at the level required for a senior-level placement. Overall reflections on the virtual care clinical placement were positive, with a few key challenges. Implications: Novel clinical placement opportunities can help prepare physiotherapy students for emerging practice experiences. This case report provides insight into one such experience.
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Affiliation(s)
- Ana Vrzic
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Kyle Vader
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
- Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Melanie Law
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
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