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Mastwyk S, Taylor NF, Lowe A, Dalton C, Peiris CL. "You don't know what you don't know": Knowledge, attitudes, and current practice of physiotherapists in recognising and managing metabolic syndrome, a mixed methods study. Physiotherapy 2024; 124:75-84. [PMID: 38875840 DOI: 10.1016/j.physio.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 12/11/2023] [Accepted: 01/24/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVES To determine the knowledge, attitudes, and current practice of primary care physiotherapists in recognising and managing clients with metabolic syndrome. DESIGN Mixed-methods research design comprising an online survey and focus groups. PARTICIPANTS Australian and English physiotherapists (n = 183) working in a primary care setting responded to the survey. Twelve physiotherapists participated in focus groups. RESULTS Metabolic syndrome was not on physiotherapists radar. They did not screen for metabolic syndrome nor provide management for it in primary care. Although most physiotherapists had some awareness of metabolic syndrome, they were not knowledgeable. Physiotherapists reported a need to focus on their clients' presenting condition, and there was uncertainty on whether metabolic syndrome management was within their scope of practice. Despite this, physiotherapists felt they had an important role to play in exercise and physical activity prescription for chronic disease management and were keen to further their knowledge and skills related to metabolic syndrome. Survey responses and focus group data were convergent. CONCLUSION Physiotherapists working in primary care settings are well-placed to identify metabolic risk factors in their clients and provide physical activity interventions to enhance management but currently lack knowledge to embed this in clinical practice. Training and resources are required to enable physiotherapists to identify and manage metabolic syndrome within their practice. CONTRIBUTION OF PAPER.
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Affiliation(s)
- Sally Mastwyk
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Australia; Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK.
| | - Nicholas F Taylor
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Australia; Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia.
| | - Anna Lowe
- National Centre for Sports & Exercise Medicine, Sheffield Hallam University, Sheffield, UK.
| | - Caroline Dalton
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK.
| | - Casey L Peiris
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Australia; Allied Health, The Royal Melbourne Hospital, Parkville, Australia.
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Fernandez M, de Luca K, Moore C, French SD, Ferreira P, Swain M. Insights into physical activity promotion among Australian chiropractors: a cross-sectional survey. Chiropr Man Therap 2024; 32:22. [PMID: 38877559 PMCID: PMC11179190 DOI: 10.1186/s12998-024-00543-2] [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: 01/30/2024] [Accepted: 05/24/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Despite the well-known benefits of physical activity, physical inactivity is presently a global health pandemic. Allied healthcare providers, such as chiropractors, knowingly recognise the importance of physical activity and are prepared to routinely discuss and/or counsel patients on this topic; however, little is known about Australian chiropractors in the physical activity setting. Our aim was to explore and identify factors associated with physical activity promotion among Australian chiropractors, including their knowledge of the physical activity and sedentary behaviour guidelines and their own levels of physical activity. METHODS From February to May 2021, a convenience sample of Australian chiropractors completed an online survey. Items assessed by Likert scale included: physical activity promotion frequency, with the type, quantity, barriers, perceptions, and feasibility. We asked questions about their familiarity with, and knowledge of, Australian Physical Activity and Sedentary Behaviour Guidelines, chiropractors' own physical activity, and whether the chiropractors met activity guidelines. Survey responses were descriptively reported. Univariable logistic regression models explored factors explaining frequent physical activity promotion. RESULTS Of 217 respondents, 64% reported that they frequently (≥ 70%) recommended a more physically active lifestyle. Only 15% often performed pre-exercise screening, 73% frequently prescribed resistance exercise, 19% reported time as the most frequent barrier, while 37% reported being not at all familiar with the guidelines. Univariable logistic regression models found male chiropractors were more likely to promote physical activity, [odds ratio (OR) = 2.33; 95% confidence interval (CI): 1.32-4.12)], while chiropractors who frequently treat children 0-3 years (OR = 0.5; 95% CI: 0.28-0.87), children 4-18 years (OR = 0.42; 95% CI: 0.21-0.86), and pregnant women (OR = 0.5; 95% CI: 0.26-0.94) were less likely. Chiropractors were more likely to promote physical activity if they were familiar with the activity guidelines (OR = 2.9; 95% CI: 1.32-6.41), were confident promoting (OR = 11.6; 95% CI: 1.37-98.71) and prescribing physical activity programs (OR = 4.5; 95% CI: 2.03-9.99). CONCLUSION Most chiropractors confidently and regularly integrate physical activity into practice. Yet, despite acknowledging its importance, one third of chiropractors reported poor knowledge of the Physical Activity and Sedentary Behaviour Guidelines. Identifying barriers to the awareness, and implementation of physical activity guidelines should be further explored within chiropractic clinical settings.
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Affiliation(s)
- Matthew Fernandez
- Discipline of Chiropractic, Faculty, School of Health, Medical and Applied Sciences, Central Queensland University, Brisbane, Australia.
| | - Katie de Luca
- Discipline of Chiropractic, Faculty, School of Health, Medical and Applied Sciences, Central Queensland University, Brisbane, Australia
| | - Craig Moore
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Simon D French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Paulo Ferreira
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Michael Swain
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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Shallwani SM, Thomas R, Poitras S, Toupin-April K, Sheill G, King J. Canadian oncology physiotherapists' perspectives of physical activity in people with advanced cancer: a mixed-methods study. Physiother Theory Pract 2024; 40:1281-1299. [PMID: 36305676 DOI: 10.1080/09593985.2022.2138663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/06/2022] [Accepted: 10/06/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Individuals with advanced cancer can benefit from physical activity (PA), but face barriers to PA participation. Physiotherapists can be well-positioned to support this patient population. OBJECTIVE Our objective was to describe the perspectives, practices, knowledge, and skills of oncology physiotherapists related to PA in people with advanced cancer. METHODS In this mixed-methods study, we recruited Canadian physiotherapists with current or recent clinical experience with advanced cancer. Phase I consisted of an online survey about views toward PA in advanced cancer and activity-related recommendations and concerns for two case scenarios. Phase II involved individual, semi-structured interviews about perspectives related to working with advanced cancer. RESULTS Sixty-two physiotherapists participated in the survey, of which 13 participated in interviews. Most respondents (> 85%) agreed or strongly agreed PA is important and safe for individuals with advanced cancer. Case responses highlighted cancer-related considerations (e.g. bone metastases) tailored activity recommendations, and patient-centered, interprofessional care. Interview themes included: 1) situating PA within individually meaningful goals; 2) tailored strategies to promote PA; 3) overarching roles in functional optimization and symptom management; and 4) generalized lack of awareness regarding physiotherapy. CONCLUSION Our findings indicate Canadian oncology physiotherapists describe knowledge of the safety and importance of PA, as well as key considerations in advanced cancer. Moreover, they highlight the importance of a patient-centered approach to support this population, particularly in facilitating safe and meaningful PA, as well as optimizing function and alleviating symptom burden. Further efforts are needed to investigate the development and integration of physiotherapy within cancer care.
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Affiliation(s)
- Shirin M Shallwani
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
- McGill Lymphedema Research Program, McGill University Health Centre, Montreal, QC, Canada
| | - Roanne Thomas
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Stéphane Poitras
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Karine Toupin-April
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Institut du savoir Montfort, Ottawa, ON, Canada
| | - Grainne Sheill
- Department of Physiotherapy, Trinity College Dublin, University of Dublin, College Green, Ireland
- Department of Physiotherapy, Dublin Trinity Centre for Health Sciences, Dublin, Ireland
| | - Judy King
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
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Kennedy W, Curtin C, Bowling A. Access to physical activity promotion for people with neurological conditions: Are physical therapists leading the way? Disabil Health J 2024; 17:101517. [PMID: 37673784 DOI: 10.1016/j.dhjo.2023.101517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/26/2023] [Accepted: 08/05/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND People with neurological conditions (NCs) engage in physical activity (PA) at a lower rate than those without disabilities. Physical therapists (PTs) are positioned to provide PA promotion; however, less is known about the consistency of promoting PA for their patients with NC. OBJECTIVE The objective of this study was to investigate the frequency of PA promotion of PTs who treat patients with NC, the factors associated with PA promotion, and the types of PA promotion used. METHODS An online survey that assessed the aspects of PA promotion frequency and behaviors was delivered to a sample of licensed PTs recruited in the United States between February and April of 2022. Descriptive statistics and the equality of proportions test were used to analyze the data. RESULTS Out of 76 participants who reported working with patients with NC, 34 (45%) reported always promoting PA. Of the 38 participants reporting a caseload of over 50% NC, 17 (45%) reported always promoting PA. Seven factors had a significant correlation with the frequency of PA promotion, and participants reported providing education about PA with their patients (99%). CONCLUSIONS PTs who work with patients with NC are not consistently promoting PA for their patients. There are opportunities for PTs to learn and apply PA promotion in practice for people with disabilities. The lack of PA promotion by PT may be contributing to the health disparities experienced by people with disabilities particularly those with NC.
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Affiliation(s)
- Winston Kennedy
- Northeastern University, 360 Huntington Ave, Boston, MA 02115, USA; Merrimack College, 315 Turnpike St, North Andover, MA 01845, USA; University of Massachusetts Chan Medical School, 55 N Lake Ave, Worcester, MA 01655, USA.
| | - Carol Curtin
- University of Massachusetts Chan Medical School, 55 N Lake Ave, Worcester, MA 01655, USA.
| | - April Bowling
- Merrimack College, 315 Turnpike St, North Andover, MA 01845, USA.
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Purcell K, Taylor J, West K, Haynes A, Hassett L, Sherrington C. Promotion of physical activity by health professionals in a sample of six public hospitals: A cross sectional study. Health Promot J Austr 2024; 35:176-187. [PMID: 37039303 DOI: 10.1002/hpja.730] [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: 08/08/2022] [Revised: 01/18/2023] [Accepted: 04/03/2023] [Indexed: 04/12/2023] Open
Abstract
ISSUE ADDRESSED Despite strong evidence of physical and mental health benefits from physical activity, participation is low. Physical activity promotion by health professionals can effectively increase physical activity participation. This study aimed to explore the frequency of physical activity promotion by health professionals in public hospitals with a focus on community-based structured exercise; and facilitators and barriers to such promotion. METHODS We surveyed health professionals (n = 100) from physiotherapy, rheumatology and rehabilitation departments at six public hospitals in Sydney, Australia. RESULTS Most common respondent characteristics were physiotherapist (84%), female (68%), aged 25-34 years (45%) and treating older adults (45%). Almost all health professionals (94%) considered themselves physical activity role-models. Half (53%) reported promoting physical activity frequently/often to their clients. Those working with children with a physical disability (23%) were more likely to promote physical activity (Relative Risk 1.69, 95% CI 1.13-2.51, p = .03), than those working with adults or older adults. Half the physiotherapists (52%) reported providing tailored advice about increasing physical activity frequently/often, but only 20% provided advice about structured physical activity. Barriers reported by physiotherapists were lack of time (51%) and client's access to transport (61%). CONCLUSION Only half the health professionals surveyed offered tailored physical activity advice to clients, and advice on structured physical activity was less common. SO WHAT?: Some promotion of physical activity by health professionals is occurring in hospital settings but more work is needed to embed this within clinical care.
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Affiliation(s)
- Kate Purcell
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jennifer Taylor
- Central Clinical School and Department of Anaesthetics, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kerry West
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Physiotherapy Department, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Abby Haynes
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Leanne Hassett
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Cathie Sherrington
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Freene N, McPhail SM, Tyack Z, Kunstler B, Niyonsenga T, Keegan R, Gallagher R, Abhayaratna W, Verdicchio C, Davey R. Very brief intervention for physical activity behaviour change in cardiac rehabilitation: protocol for the 'Measure It!' effectiveness-implementation hybrid trial. BMJ Open 2023; 13:e072630. [PMID: 37945300 PMCID: PMC10649619 DOI: 10.1136/bmjopen-2023-072630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/13/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Physical inactivity is a risk factor for repeat cardiac events and all-cause mortality in coronary heart disease (CHD). Cardiac rehabilitation, a secondary prevention programme, aims to increase physical activity levels in this population from a reported low baseline. This trial will investigate the effectiveness and implementation of a very brief physical activity intervention, comparing different frequencies of physical activity measurement by cardiac rehabilitation clinicians. The Measure It! intervention (<5 min) includes a self-report and objective measure of physical activity (steps) plus very brief physical activity advice. METHODS AND ANALYSIS This type 1 hybrid effectiveness-implementation study will use a two-arm multicentre assessor-blind randomised trial design. Insufficiently active (<150 min of moderate-to-vigorous physical activity per week) cardiac rehabilitation attendees with CHD (18+ years) will be recruited from five phase II cardiac rehabilitation centres (n=190). Patients will be randomised (1:1) to five physical activity measurements or two physical activity measurements in total over 24 weeks. The primary effectiveness outcome is accelerometer daily minutes of moderate-to-vigorous intensity physical activity at 24 weeks. Secondary effectiveness outcomes include body mass index, waist circumference and quality-of-life. An understanding of multilevel contextual factors that influence implementation, and antecedent outcomes to implementation of the intervention (eg, feasibility and acceptability), will be obtained using semistructured interviews and other data sources. Linear mixed-effects models will be used to analyse effectiveness outcomes. Qualitative data will be thematically analysed inductively and deductively using framework analysis, with the framework guided by the Consolidated Framework for Implementation Research and Theoretical Domains Framework. ETHICS AND DISSEMINATION The study has ethical approval (University of Canberra (ID 11836), Calvary Bruce Public Hospital (ID 14-2022) and the Greater Western Area (ID 2022/ETH01381) Human Research Ethics Committees). Results will be disseminated in multiple formats for consumer, public and clinical audiences. TRIAL REGISTRATION NUMBER ACTRN12622001187730p.
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Affiliation(s)
- Nicole Freene
- Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
- Health Research Institute, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Digital Health and Informatics, Metro South Health Service District, Brisbane, Queensland, Australia
| | - Zephanie Tyack
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Breanne Kunstler
- Behaviour Works Australia, Monash Sustainable Development Institute, Monash University, Clayton, Victoria, Australia
| | - Theophile Niyonsenga
- Health Research Institute, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Richard Keegan
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Robyn Gallagher
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Walter Abhayaratna
- School of Medicine and Psychology, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christian Verdicchio
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Rachel Davey
- Health Research Institute, University of Canberra, Canberra, Australian Capital Territory, Australia
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Parchment A, Lawrence W, Rahman E, Townsend N, Wainwright E, Wainwright D. 'Making every contact count' with patients with musculoskeletal conditions: a qualitative exploration of acceptability to physiotherapists. BMC Health Serv Res 2023; 23:1125. [PMID: 37858090 PMCID: PMC10588214 DOI: 10.1186/s12913-023-10126-1] [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: 11/18/2022] [Accepted: 10/06/2023] [Indexed: 10/21/2023] Open
Abstract
AIM To qualitatively explore physiotherapists' experiences and acceptability of implementing 'Making Every Contact Count Healthy Conversation Skills' (MECC HCS) in routine practice with patients with musculoskeletal (MSK) conditions. METHODS This article reports the second phase of a mixed method, sequential explanatory study. Physiotherapists trained in and delivering MECC HCS in their practice were invited to take part in semi-structured interviews. We hoped to develop a rich, in-depth understanding of their use and perceptions of the brief intervention and to contextualise findings from the first phase of the study. Qualitative data were analysed using Reflexive Thematic Analysis. RESULTS Physiotherapists valued MECC HCS as being integral to their practice, promoting a person-centred approach to supporting behaviour change and enhancing self-management in patients with MSK conditions and pain. It was believed that this brief intervention could reduce workload pressure for physiotherapists and have significant wider benefits for health services. Time limitations associated with appointments did, however, pose as a challenge to MECC HCS delivery, and it was felt that more organisational-level support was needed to sustain it. CONCLUSIONS These findings support our quantitative data, collected in the first phase of this study. MECC HCS is a highly acceptable brief intervention that can be delivered in physiotherapy care to support behaviour change in patients with MSK conditions. Future roll-out may be optimised within organisations by providing regular refresher training and adopting a MECC champion.
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Affiliation(s)
- Amelia Parchment
- Department for Health, University of Bath, Bath, BA2 7AY, England, UK.
- NIHR Applied Research Collaboration- Greater Manchester, University of Manchester, Manchester, M13 9PL, England.
| | - Wendy Lawrence
- Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, England, UK
| | - Em Rahman
- Public Health Workforce Development, Southern House, Health Education England, Winchester, SO21 2RU, England, UK
| | - Nick Townsend
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, BS8 1TZ, England, UK
| | - Elaine Wainwright
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - David Wainwright
- Department for Health, University of Bath, Bath, BA2 7AY, England, UK
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Pellegrini CA, Brown D, DeVivo KE, Lee J, Wilcox S. Promoting physical activity via physical therapist following knee replacement: A pilot randomized controlled trial. PM R 2023; 15:965-975. [PMID: 36106651 PMCID: PMC11210327 DOI: 10.1002/pmrj.12895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/13/2022] [Accepted: 08/19/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Outpatient physical therapy may be an opportune time to promote aerobic physical activity after knee replacement; however, it is unknown if it is feasible to integrate a physical activity intervention within standard physical therapy. OBJECTIVE To examine the feasibility and acceptability of a physical activity intervention delivered within outpatient physical therapy for adults after knee replacement. METHODS As part of a cluster randomized trial, adults with knee replacement starting outpatient physical therapy were recruited across four physical therapy sites. Sites were randomized and physical therapists delivered either an enhanced physical activity intervention or a control condition. The enhanced physical activity intervention consisted of standard postoperative physical therapy plus goal setting, problem-solving, and use of motivational interviewing techniques to promote 150 minutes/week of aerobic moderate intensity physical activity. The control group received standard postoperative physical therapy only. Feasibility and acceptability were determined based on recruitment and retention rates at 12 weeks after surgery. Outcomes including objectively measured physical activity, pain, and self-reported function were examined at the baseline postoperative visit and 12 weeks later. RESULTS Thirty-three percent of candidates screened were randomized (n = 45) and retention at 12 weeks after surgery was 91% (no difference by condition). Moderate-intensity activity increased, pain decreased, and self-reported function improved, but there were no statistically significant group differences between baseline and 12 weeks. CONCLUSION Implementing a physical activity intervention within outpatient physical therapy for adults after knee replacement is feasible; however, in this pilot study, changes were not observed in moderate intensity physical activity as compared to standard postoperative physical therapy. Future studies are needed to explore additional low-cost strategies and the optimal time to promote physical activity after knee replacement.
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Affiliation(s)
- Christine A Pellegrini
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Debbie Brown
- Prisma Health Orthopedics, Columbia, South Carolina, USA
| | - Katherine E DeVivo
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Jungwha Lee
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sara Wilcox
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Burke S, Hopkins N, Divine A, Ebenso B, Allsop M. Physical activity service provision in hospice care: A national mixed-methods study. Palliat Support Care 2023:1-9. [PMID: 37365803 DOI: 10.1017/s1478951523000822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
BACKGROUND Physical activity (PA) interventions help people with advanced incurable diseases to manage symptoms and improve their quality of life. However, little is known about the extent to which PA is currently delivered in hospice care in England. OBJECTIVES To determine the extent of and intervention features of PA service provision in hospice care in England alongside barriers and facilitators to their delivery. METHODS An embedded mixed-methods design using (1) a nationwide online survey of 70 adult hospices in England and (2) focus groups and individual interviews with health professionals from 18 hospices. Analysis of the data involved applying descriptive statistics to the numeric items and thematic analysis to the open-ended questions. Quantitative and qualitative data were collected and analyzed separately. RESULTS The majority of responding hospices (n = 47/70, 67%) promoted PA in routine care. Sessions were most often delivered by a physiotherapist (n = 40/47, 85%) using a personalized approach (n = 41/47, 87%) and included resistance/thera bands, Tai Chi/Chi Qong, circuit exercises, and yoga. The following qualitative findings were revealed: (1) variation among hospices in their capacity to deliver PA, (2) a desire to embed a hospice culture of PA, and (3) a need for an organizational commitment to PA service provision. SIGNIFICANCE OF RESULTS While many hospices in England deliver PA, there is considerable variation in its delivery across sites. Funding and policy action may be needed to support hospices to initiate or scale up services and address inequity in access to high-quality interventions.
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Affiliation(s)
- Shaunna Burke
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Natalie Hopkins
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Alison Divine
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Bassey Ebenso
- Leeds Institute of Health Sciences, School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Matthew Allsop
- Leeds Institute of Health Sciences, School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Stead A, Vishnubala D, Marino KR, Iqbal A, Pringle A, Nykjaer C. UK physiotherapists delivering physical activity advice: what are the challenges and possible solutions? A qualitative study. BMJ Open 2023; 13:e069372. [PMID: 37116991 PMCID: PMC10151243 DOI: 10.1136/bmjopen-2022-069372] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVES Despite the known health benefits of physical activity (PA), PA levels are in decline. Healthcare professionals, including physiotherapists, have been identified as ideal conduits to promote PA, yet their knowledge and awareness of PA guidelines are poor. The aims of this study were to explore current knowledge of PA guidelines among UK physiotherapists and identify barriers and possible solutions to delivering PA advice. DESIGN A qualitative approach using semistructured interviews that took place between March and May 2021. Data were analysed with a thematic approach using Braun and Clarke's six steps. SETTING Various inpatient and outpatient clinical settings across six UK regions. PARTICIPANTS Eighteen UK-based physiotherapists managing National Health Service patients were recruited through volunteer sampling in March 2021. RESULTS Five themes and 16 subthemes (shown in parenthesis) were identified as barriers and solutions to delivering PA advice: physiotherapist intrinsic barriers (knowledge, fear/confidence); a lack of emphasis and priority given to PA (time constraints, minimal educational and staff training); patient barriers (compliance, expectations and fear of doing PA); increasing awareness of the PA guidelines (staff training, signposting awareness, use of social media and television campaigns); and optimising delivery (use of visual resources, good communication and approaches involving being individualised and gradual for patients with chronic conditions). CONCLUSIONS In this study, physiotherapist participants seemed to have limited awareness of the PA guidelines despite recent updates and were faced with similar barriers to those previously reported in the literature. The solutions suggested could guide strategies to support physiotherapists being able to deliver PA advice. Further research is needed to evaluate the efficiency of any implemented solutions supporting the delivery of PA advice.
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Affiliation(s)
- Alexandra Stead
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Dane Vishnubala
- School of Biomedical Sciences, University of Leeds, Leeds, UK
- Hull York Medical School, Hull, UK
| | | | - Adil Iqbal
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Andy Pringle
- Clinical Exercise and Rehabilitation Research Centre, School of Human Sciences, University of Derby, Derby, UK
| | - Camilla Nykjaer
- School of Biomedical Sciences, University of Leeds, Leeds, UK
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Job S, Heales L, Obst S. Tides of Change-Barriers and Facilitators to Beach Accessibility for Older People and People with Disability: An Australian Community Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095651. [PMID: 37174170 PMCID: PMC10178453 DOI: 10.3390/ijerph20095651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/06/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023]
Abstract
The beach is Australia's most popular recreational destination with participation in beach-based activities associated with a wide range of health and wellbeing benefits. Unfortunately, access to beach environments is not possible for many older people and people with a disability. The purpose of this study was to investigate the barriers and facilitators of beach accessibility using a framework that recognises the complex interconnections between blue space, accessibility, physical activity, and health and wellbeing. A 39-item anonymous online cross-sectional survey was developed and administered to explore the perspectives of older people and people with a disability regarding beach accessibility. In total, 350 people completed the survey (69% female, age range 2-90 years (mean = 52)). Disability was reported by 88% of respondents, with 77% requiring a community mobility aid. Two-thirds (68%) of respondents were unable to visit the beach as often as they wanted, with 45% unable to visit at all. The most frequently reported barriers to beach access included difficulty moving on soft sand (87%), no specialised mobility equipment (75%), and inaccessible lead-up pathways (81%). If beach access was improved, respondents reported they would visit the beach more often (85%), for longer (83%), and have an improved experience (91%). The most frequently reported facilitators to beach access were the presence of accessible lead-up pathways (90%), sand walkways (89%), and parking (87%). Older people and people with disability have limited beach access, primarily due to a lack of accessible equipment, excluding them from the wide range of health benefits associated with visiting the beach.
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Affiliation(s)
- Sasha Job
- School of Health, Medical and Applied Sciences, College of Health Sciences, Central Queensland University, Bundaberg, QLD 4670, Australia
| | - Luke Heales
- School of Health, Medical and Applied Sciences, College of Health Sciences, Central Queensland University, Rockhampton, QLD 4701, Australia
| | - Steven Obst
- School of Health, Medical and Applied Sciences, College of Health Sciences, Central Queensland University, Bundaberg, QLD 4670, Australia
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Fernandez M, Young A, Milton K, Pinhiero M, de Luca K, Ferreira P, Hebert J. Physical activity promotion in chiropractic: a systematic review of clinician-based surveys. Chiropr Man Therap 2022; 30:55. [PMID: 36514061 PMCID: PMC9749165 DOI: 10.1186/s12998-022-00467-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Physical inactivity is a global health pandemic. Allied healthcare providers, including chiropractors, are well placed to integrate individual physical activity (PA) promotion into routine care. A previous systematic review identified that approximately 90% of chiropractors held a positive opinion towards healthier patient lifestyles; however, the extent to which chiropractors promote PA to their patients within routine care is unclear. This systematic review aimed to describe chiropractors' attitudes towards and current practice in advising, counselling, discussing, supporting, or recommending PA to patients. METHODS Five databases were searched from inception to December 2021 for cross-sectional surveys that explored PA promotion by chiropractors in practice. We assessed the risk of bias of the included studies with the 'Risk of Bias in Cross-Sectional Surveys of Attitudes and Practices' tool. Descriptive data were extracted, grouping similar survey questions and responses into emerging categories. Chiropractors' views regarding the perceived importance and/or their preparedness to counsel and provide PA or exercise information are reported. RESULTS From 661 studies, 15 met the selection criteria. Surveys included 7999 chiropractors primarily from the USA, UK, Australia, and Sweden. All studies were rated as moderate-to-high risk of bias, with methodological weaknesses characterised by inconsistent reporting of missing data, non-representative samples, low response rates (i.e., less than 60%), and unknown validity of survey instruments. Chiropractors frequently recognised the importance of PA promotion, as demonstrated by the proportion of respondents reporting that they: (1) support the importance of providing PA or exercise information and counselling (64% to 100%); (2) are prepared to provide PA or exercise information and/or counselling to patients (91% to 92%,); (3) frequently obtain PA or exercise information from patients (87% to 97%,); 4) frequently discuss PA or exercise and/or provide PA or exercise information to patients (68% to 99%); and 5) frequently provide PA counselling to patients (50% to 81%.). CONCLUSION A large majority of practising chiropractors actively engage with PA promotion. However, the results should be interpreted with caution owing to the moderate-to-high risk of bias of the included studies. Forthcoming research initiatives should explore unbiased surveys, further PA education and training as well as capitalising on chiropractors' own PA participation.
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Affiliation(s)
- Matthew Fernandez
- School of Health, Medical and Applied Sciences, Central Queensland University, Brisbane, Australia.
| | - Anika Young
- grid.1004.50000 0001 2158 5405Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Karen Milton
- grid.8273.e0000 0001 1092 7967Norwich Medical School, University of East Anglia, Norwich, UK
| | - Marina Pinhiero
- grid.1013.30000 0004 1936 834XInstitute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia ,grid.1013.30000 0004 1936 834XSchool of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Katie de Luca
- grid.1023.00000 0001 2193 0854School of Health, Medical and Applied Sciences, Central Queensland University, Brisbane, Australia
| | - Paulo Ferreira
- grid.1013.30000 0004 1936 834XSydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Jeffrey Hebert
- grid.266820.80000 0004 0402 6152Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
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13
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Hartley SE, Ryad H, Yeowell G. Future-proofing the Profession: Physiotherapists' perceptions of their current and emerging role. Physiotherapy 2022; 119:72-79. [PMID: 36940489 DOI: 10.1016/j.physio.2022.11.007] [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: 03/08/2022] [Revised: 11/15/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES As healthcare systems continue to modernise, physiotherapists are required to transform their practice to remain contemporary and meet future population needs. The study aims to gain an insight into physiotherapists' perceptions of their current and emerging future role. The intention is to develop an understanding of the physiotherapist's role and how it can continue to evolve to support populations' needs in more sustainable and innovative ways. DESIGN A qualitative design using semi-structured interviews was undertaken informed by Gadamerian hermeneutic philosophy. PARTICIPANTS Participants were gained from a postgraduate physiotherapy programme in Northwest England that recruits physiotherapists from across the UK; via the research teams' professional networks and using snowball sampling. Interviews were digitally recorded and transcribed verbatim. Thematic analysis was undertaken. Ethical approval and informed consent was obtained. RESULTS 23 participants (15 female). 4 themes were identified: 'An underpinning philosophy of practice' that promotes holistic care and supports patient wellbeing. An 'evolving role broadening the scope of practice' with many 'agents of change shaping the profession'. When 'preparing the future workforce and their transition into practice', graduates were seen as more adaptable and resilient. However, more affiliation between the university and placement providers to enhance learning environments is needed. CONCLUSIONS Physiotherapists need to re-evaluate their role so a clear vision for the future can be co-created to ensure they remain contemporary and continue to optimise their potential. An emerging role that re-envisages a holistic approach that incorporates health promotion as fundamental to this role could support physiotherapists' transformation in practice. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Sandra Elaine Hartley
- Department of Health Professions, Brooks Building, Birley Campus, Manchester Metropolitan University, 53 Bonsall Street, Manchester M15 6GX, England, UK.
| | - Hanane Ryad
- Department of Health Professions, Brooks Building, Birley Campus, Manchester Metropolitan University, 53 Bonsall Street, Manchester M15 6GX, England, UK.
| | - Gillian Yeowell
- Department of Health Professions, Brooks Building, Birley Campus, Manchester Metropolitan University, 53 Bonsall Street, Manchester M15 6GX, England, UK.
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14
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Pellerine LP, O’Brien MW, Shields CA, Crowell SJ, Strang R, Fowles JR. Health Care Providers’ Perspectives on Promoting Physical Activity and Exercise in Health Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159466. [PMID: 35954823 PMCID: PMC9368367 DOI: 10.3390/ijerph19159466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 11/16/2022]
Abstract
Health care providers (HCPs) are entrusted with providing credible health-related information to their patients/clients. Patients/clients who receive physical activity and exercise (PAE) advice from an HCP typically increase their PAE level. However, most HCPs infrequently discuss PAE or prescribe PAE, due to the many challenges (e.g., time, low confidence) they face during regular patient care. The purpose of this study was to ascertain HCPs’ perspectives of what could be done to promote PAE in health care. HCPs (n = 341) across Nova Scotia completed an online self-reflection survey regarding their current PAE practices and ideas to promote PAE. The sample consisted of 114 physicians, 114 exercise professionals, 65 dietitians, and 48 nurses. Quantitative textual analysis (frequency of theme ÷ number of respondents) was performed to identify common themes to promote PAE in health care. In the pooled sample, the primary theme cited was to increase the availability of community programs (24.1% of respondents), followed by more educational opportunities for providers (22.5%), greater promotion of PAE from HCPs (17.1%), reducing financial barriers experienced by patients/clients (16.3%), and increasing availability of qualified exercise professionals (15.0%). Altogether, increased PAE education and greater availability of affordable community PAE programs incorporating qualified exercise professionals, would reduce barriers preventing routine PAE promotion and support the promotion of PAE in Nova Scotia.
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Affiliation(s)
- Liam P. Pellerine
- Division of Kinesiology, Dalhousie University, Halifax, NS B3H 4R2, Canada; (L.P.P.); (M.W.O.)
| | - Myles W. O’Brien
- Division of Kinesiology, Dalhousie University, Halifax, NS B3H 4R2, Canada; (L.P.P.); (M.W.O.)
| | - Chris A. Shields
- Centre of Lifestyle Studies, School of Kinesiology, Acadia University, Wolfville, NS B4P 2K5, Canada;
| | | | - Robert Strang
- Department of Health and Wellness, Government of Nova Scotia, Halifax, NS B3J 1V9, Canada;
| | - Jonathon R. Fowles
- Centre of Lifestyle Studies, School of Kinesiology, Acadia University, Wolfville, NS B4P 2K5, Canada;
- Nova Scotia Health Authority, Halifax, NS B3H 1V8, Canada;
- Correspondence:
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15
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Wingood M, Peters DM, Shea JL, Gell NM. Addressing Physical Activity among Adults 50+: An Ethnographic Study of Physical Therapists. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2022. [DOI: 10.1080/02703181.2022.2095074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Mariana Wingood
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, USA
| | - Denise M. Peters
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, USA
| | - Jeanne L. Shea
- Department of Anthropology, University of Vermont, Burlington, USA
| | - Nancy M. Gell
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, USA
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16
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Bello B, Hartley SE, Yeowell G. Nigerian physiotherapists’ knowledge, current practice and perceptions of their role for promoting physical activity: A cross-sectional survey. PLoS One 2022; 17:e0266765. [PMID: 35536853 PMCID: PMC9089902 DOI: 10.1371/journal.pone.0266765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/25/2022] [Indexed: 12/03/2022] Open
Abstract
Background Nigeria has the highest rates of physical inactivity in Africa. As physical inactivity is a leading global risk factor for non-communicable diseases (NCD), physical activity promotion is a strategy for their mitigation. Physiotherapists are already ideally situated to undertake this role and can assist in the reversal of NCD. Gaining insight into how physiotherapists in Nigeria perceive their role in relation to physical activity promotion is needed to ensure this undertaking will be effective. This national survey aimed to investigate Nigerian physiotherapists’ knowledge and current practice for promoting physical activity across Nigeria and perceptions of their role related to this. Methods Following ethical approval, a cross-sectional, online questionnaire survey design was employed to investigate the aim. 330 qualified physiotherapists, working across Nigeria were recruited. Internal consistency of the survey was examined using Cronbach’s alpha. Descriptive statistics were used to analyse closed questions. Thematic content analysis was used to analyse open-ended questions. Chi-square inferential statistic was used to investigate the association between variables with alpha interpreted at a level of 0.05. Results The internal consistency of the questionnaire survey was good overall (Cronbach Alpha α = 0.71). 330 physiotherapists participated. 99.4% agreed that discussing the benefits of a physically active lifestyle with patients is part of their role. However, over 60% did not feel confident in suggesting specific physical activity programs for their patients. 59.7% were aware of one or more physical activity guideline. However, only 49.1% were incorporating it into their practice. 85.5% felt that developing a physical activity guideline specifically for Nigeria would promote physical activity. 63.3% of respondents did not use any resource in promoting physical activity. An association was found between the physiotherapist’s awareness of physical activity guidelines and male sex (χ2 = 8.95, df = 2, p = 0.01). Conclusion Whilst most physiotherapists had a positive perception of their role in promoting physical activity, translating this into practice would seem to be challenging. A systems approach to physical activity health promotion is recommended with the need for a commitment by the Nigerian Government to the development and implementation of national guidelines. Incorporating more training in physiotherapy education could foster more confidence in the delivery of these guidelines. Greater use of resources and working with community organisations could help to optimise physical activity uptake in Nigeria.
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Affiliation(s)
- Bashir Bello
- Department of Physiotherapy, Faculty of Allied Health Sciences, Bayero University Kano, Kano, Nigeria
| | - Sandra Elaine Hartley
- Department of Health Professions, Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom
| | - Gillian Yeowell
- Department of Health Professions, Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom
- * E-mail:
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17
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Rethorn ZD, Covington JK, Cook CE, Bezner JR. Identifying Factors That Influence Physical Activity Promotion in Outpatient Physical Therapist Practice Using the Theoretical Domains Framework. J Geriatr Phys Ther 2022; 45:190-196. [PMID: 35470309 DOI: 10.1519/jpt.0000000000000353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Physical activity (PA) promotion is not routine practice for physical therapists. Understanding the PA promotion beliefs of physical therapists may offer targets for behavior change interventions to improve PA promotion. The purpose of this study was to explore outpatient US physical therapists' beliefs about PA promotion and determine which Theoretical Domains Framework (TDF) domains can inform implementation efforts. METHODS We used a descriptive qualitative research design. A TDF-based interview guide was developed to identify beliefs about PA promotion. Twenty-six outpatient US physical therapists (13 regular PA promoters and 13 irregular PA promoters) completed semistructured interviews. Directed content analysis identified specific beliefs by grouping similar belief statements. Specific beliefs were mapped to TDF domains. RESULTS AND DISCUSSION Five TDF domains were identified as likely relevant to changing physical therapists' PA promotion behaviors. Key beliefs within those domains included conflicting comments about PA guidelines being evidence based, a lack of confidence to promote PA due to perceived deficits in communication skills, and time constraints as key barriers. Beliefs about improving PA promotion included incorporating screening for baseline PA and continuing education targeting confidence and communication. CONCLUSIONS We identified key beliefs that influence outpatient US physical therapists' PA promotion. These beliefs identify targets for behavior change interventions to improve PA promotion rates among outpatient US physical therapists including incorporating baseline screening for PA and the development of continuing education training programs.
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Affiliation(s)
- Zachary D Rethorn
- Rocky Mountain University of Health Professions, Provo, Utah.,Doctor of Physical Therapy Division, Duke University, Durham, North Carolina
| | - J Kyle Covington
- Doctor of Physical Therapy Division, Duke University, Durham, North Carolina
| | - Chad E Cook
- Doctor of Physical Therapy Division, Duke University, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Janet R Bezner
- Department of Physical Therapy, Texas State University, Round Rock
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18
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Hassett L, Jennings M, Brady B, Pinheiro M, Haynes A, Sidhu B, Christie L, Dennis S, Pearce A, Howard K, Greaves C, Sherrington C. Brief physical activity counselling by physiotherapists (BEHAVIOUR): protocol for an effectiveness-implementation hybrid type II cluster randomised controlled trial. Implement Sci Commun 2022; 3:39. [PMID: 35395933 PMCID: PMC8991667 DOI: 10.1186/s43058-022-00291-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/28/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Physical inactivity is a leading risk factor for chronic disease. Brief physical activity counselling delivered within healthcare systems has been shown to increase physical activity levels; however, implementation efforts have mostly targeted primary healthcare and uptake has been sub-optimal. The Brief Physical Activity Counselling by Physiotherapists (BEHAVIOUR) trial aims to address this evidence-practice gap by evaluating (i) the effectiveness of a multi-faceted implementation strategy, relative to usual practice for improving the proportion of patients receiving brief physical activity counselling as part of their routine hospital-based physiotherapy care and (ii) effectiveness of brief physical activity counselling embedded in routine physiotherapy care, relative to routine physiotherapy care, at improving physical activity levels among patients receiving physiotherapy care. METHODS Effectiveness-implementation hybrid type II cluster randomised controlled trial with embedded economic evaluation, qualitative study and culturally adapted patient-level outcome measures. The trial will be conducted across five hospitals in a local health district in Sydney, Australia, with a lower socioeconomic and culturally diverse population. The evidence-based intervention is brief physical activity counselling informed by the 5As counselling model and behavioural theory, embedded into routine physiotherapy care. The multi-faceted strategy to support the implementation of the counselling intervention was developed with key stakeholders guided by the Consolidated Framework for Implementation Research and the Capabilities, Opportunities, Motivation-Behaviour (COM-B) theoretical model, and consists of clinician education and training, creating a learning collaborative, tailored strategies to address community referral barriers, team facilitation, and audit and feedback. Thirty teams of physiotherapists will be randomised to receive the multi-faceted implementation strategy immediately or after a 9-month delay. Each physiotherapy team will recruit an average of 10 patients (n=300) to collect effectiveness outcomes at baseline and 6 months. The primary effectiveness outcome is self-reported planned physical activity using the Incidental and Planned Exercise Questionnaire, and the primary implementation outcome is reach (proportion of eligible new physiotherapy patients who receive brief physical activity counselling). Secondary effectiveness and implementation outcomes will also be collected. DISCUSSION This project focuses on physiotherapists as health professionals with the requisite skills and patterns of practice to tackle the increasing burden of chronic disease in a high-risk population. TRIAL REGISTRATION ANZCTR, ACTRN12621000194864 . Registered on 23 February 2021.
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Affiliation(s)
- Leanne Hassett
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia. .,Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia. .,Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia.
| | - Matthew Jennings
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia
| | - Bernadette Brady
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia
| | - Marina Pinheiro
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Abby Haynes
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Balwinder Sidhu
- Multicultural Health Unit, South Western Sydney Local Health District, Sydney, Australia
| | - Lauren Christie
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia.,St Vincent's Health Network Sydney & Nursing Research Institute, Australian Catholic University, Sydney, Australia
| | - Sarah Dennis
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Ingham Institute, South Western Sydney Local Health District, Sydney, Australia
| | - Alison Pearce
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Rethorn ZD, Covington JK, Cook CE, Bezner JR. Physical Therapists' Knowledge, Skills, Beliefs, and Organizations Impact Physical Activity Promotion: A Systematic Review and Meta-Analysis. Phys Ther 2022; 102:6481178. [PMID: 34972862 DOI: 10.1093/ptj/pzab291] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/02/2021] [Accepted: 12/03/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this study was to characterize factors that influence physical therapists' physical activity (PA) promotion practices and map these factors to the Theoretical Domains Framework (TDF) to inform future implementation efforts. METHODS Six databases (MEDLINE, EMBASE, Scopus, CINAHL, PsychInfo, and Web of Science) were searched from inception to March 11, 2021. Studies were included if they reported physical therapists' PA promotion practices and factors influencing these practices. Study quality was assessed with a modified Newcastle-Ottawa Scale and the Critical Appraisal Skills Programme checklist. Studies were excluded if they did not separate physical therapist PA promotion practices and influencing factors from other health professionals. RESULTS The search yielded 12,835 references and 27 included studies. Twenty studies were included in a meta-analysis of proportions, whereas 15 studies were included in a meta-analysis of correlations. Very-low to moderate-quality evidence suggests that factors at the individual and organizational levels have very small to moderate associations with PA promotion practices. CONCLUSION Efforts to improve PA promotion by physical therapists should consider incorporating combinations of individual and organizational factors. Limitations to the body of evidence highlight the need for future research. IMPACT With PA projected to decrease in the general population by an additional 20% by 2050, PA promotion is urgently needed to maximize physical therapists' impact on the health of society. This study identifies factors that may prove useful for guiding the development of strategies to encourage greater engagement in PA promotion by physical therapists.
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Affiliation(s)
- Zachary D Rethorn
- Rocky Mountain University of Health Professions, Provo, Utah, USA.,Doctor of Physical Therapy Division, Duke University, Durham, North Carolina, USA
| | - J Kyle Covington
- Doctor of Physical Therapy Division, Duke University, Durham, North Carolina, USA
| | - Chad E Cook
- Doctor of Physical Therapy Division, Duke University, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Janet R Bezner
- Department of Physical Therapy, Texas State University, Round Rock, Texas, USA
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20
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Tuna H, Bozan O, Elibol N, Unver B. Are the physical activity habits of Turkish physiotherapists associated with their physical activity promotion and counseling? Physiother Theory Pract 2022; 38:189-200. [PMID: 32096415 DOI: 10.1080/09593985.2020.1729909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Physiotherapists (PTs) must be role models and convincing promoters of physical activity (PA). Objective: This cross-sectional study aimed to determine whether Turkish PTs' PA promotion and counseling practices are associated with their own PA habits. Method: An open-access survey was distributed to 2,619 PTs via e-mail to collect information about the PTs' PA habits; their knowledge, role perception, confidence, perceived barriers and feasibility in PA promotion; and their counseling practices. During the year that the survey was online, 421 (16.1%) PTs responded. The PTs were divided into two groups: physically active PTs (engaged in at least one type of PA) and inactive PTs. Chi-square test of independence was used for data analysis. Results: Knowledge of PA did not differ between the groups (p>0.05). Physically active PTs had higher role perception (except in one item) and greater confidence in PA promotion than inactive PTs (p<0.05). Except for one barrier, engagement in PA was not associated with perceived barriers or feasibility in PA promotion (p>0.05). Significantly more physically active PTs suggested PA to 10 or more patients/month [25.2% (n=40), vs. 13.5% (n=26); p=0.005] and suggested at least one type of PA [78.7% (n=137) vs. 59.2% (n=141); p=0.000]. PTs who engaged in vigorous-intensity PA and strength training were significantly more likely to suggest these types of PA than PTs who did not [44.1% (n=15) vs. 10.4% (20); p=0.000 and 91.1% (n=113) vs. 83.2% (n=154); p=0.047, respectively]. Conclusion: This study demonstrated that physically active PTs had higher role perception and confidence, and more actively promoted PA in their counseling practice.
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Affiliation(s)
- Hulya Tuna
- School of Physiotherapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | | | - Nuray Elibol
- Department of Physiotherapy and Rehabilitation, Ege University Faculty of Health Sciences, Izmir, Turkey
| | - Bayram Unver
- School of Physiotherapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
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21
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Aubry C, Nüesch C, Fiebig O, Stoll TM, Köhler M, Barth A, Mündermann A. Accelerometry-based physical activity, disability and quality of life before and after lumbar decompression surgery from a physiotherapeutic perspective: An observational cohort study. NORTH AMERICAN SPINE SOCIETY JOURNAL 2021; 8:100087. [PMID: 35141652 PMCID: PMC8819940 DOI: 10.1016/j.xnsj.2021.100087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The effect of lumbar decompression on physical activity (PA) measures (measured as number of steps/day and as moderate to vigorous PA (MVPA)) is poorly understood. The aim of the current study was to compare PA in patients before and after lumbar decompression and to determine the association between change in steps/day and MVPA with change in disability, health-related quality of life (HRQOL) and pain. METHODS Patients undergoing lumbar decompression surgery were recruited. Steps/day and MVPA MVPA were recorded with an accelerometer. Oswestry Disability Index (ODI), HRQOL (Short Form 36 questionnaire (SF-36)) and pain levels (visual analogue scale (VAS)) were collected prior to surgery and six and twelve weeks postoperatively. Steps/day were compared to the lower bound of steps/day in healthy persons (7,000 steps per day), and the relationship between changes in steps/day, MVPA, ODI, SF-36, and VAS were calculated. RESULTS Twenty-six patients aged 37 to 75 years met inclusion criteria and were included in the study. Lumbar decompressions were performed for stenosis and/or disc herniation. Preoperatively, patients took an average 5,073±2,621 (mean±standard deviation) steps/day. At 6 weeks postoperatively, patients took 6,131±2,343 steps/day. At 12 weeks postoperatively, patients took 5,683±2,128 steps/day. Postoperative MVPA minutes per week increased compared to preoperative MVPA (preoperative: 94.6±122.9; 6 weeks: 173.9±181.9; 12 weeks: 145.7±132.8). From preoperative to 12 weeks postoperative, change in steps correlated with MVPA (R=0.775; P<0.001), but not with ODI (R=0.069; P=0.739), SF-36 (R=0.138; P=0.371), VAS in the back (R=0.230; P=0.259) or VAS in the leg (R=-0.123; P=0.550). CONCLUSIONS During the first 12 postoperative weeks, daily steps did not reach the lower bound of normal step activity of 7,000 steps/day, however postoperative steps/day were higher than before surgery. Steps/day and MVPA appear to be independent of ODI and SF-36 and represent additional outcome parameters in patients undergoing lumbar decompression surgery and should be considered e.g., by physiotherapists especially from 6 to 12 weeks postoperatively. LEVEL OF EVIDENCE 2, prospective cohort study.
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Affiliation(s)
- Caroline Aubry
- Department of Physiotherapy, Bethesda Hospital AG, Basel, Switzerland
- Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Winterthur, Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Oliver Fiebig
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Neurosurgical and Orthopaedic Spine Surgery, Bethesda Hospital AG, 4052 Basel, Switzerland
| | - Thomas M. Stoll
- Department of Neurosurgical and Orthopaedic Spine Surgery, Bethesda Hospital AG, 4052 Basel, Switzerland
| | - Markus Köhler
- Department of Neurosurgical and Orthopaedic Spine Surgery, Bethesda Hospital AG, 4052 Basel, Switzerland
| | - Alain Barth
- Department of Neurosurgical and Orthopaedic Spine Surgery, Bethesda Hospital AG, 4052 Basel, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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22
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Roidl A, Gabriel A, Beckmann J. Ergebnisse einer deutschlandweiten Umfrage über Beratung zu lebensstilbezogener Verhaltensänderung (BzlV) in der physiotherapeutischen Versorgung – eine Querschnittstudie. PHYSIOSCIENCE 2021. [DOI: 10.1055/a-1384-0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Zusammenfassung
Hintergrund Es ist unklar, in welchem Umfang Beratung zu lebensstilbezogener Verhaltensänderung (BzlV) in Deutschland bereits in die physiotherapeutische Arbeit integriert ist und ob Physiotherapeut*innen die erforderlichen Kompetenzen aufweisen.
Ziel Erfassung der Einstellung von Physiotherapeut*innen zur Gesundheitsförderung sowie zu Praxis, Kompetenzen und möglichen Barrieren für die Umsetzung von BzlV.
Methode Mittels Online-Umfrage wurden in Deutschland tätige Physiotherapeut*innen zu ihren allgemeinen Einstellungen zur Gesundheitsförderung sowie zu Praxis, Kompetenzen und möglichen Barrieren für die Umsetzung von BzlV befragt. Neben einer deskriptiven Analyse der Angaben wurden Unterschiede zwischen akademisch und nicht akademisch ausgebildeten Physiotherapeut*innen mithilfe des Mann-Whitney-U-Tests ermittelt.
Ergebnisse 511 Physiotherapeut*innen nahmen an der Umfrage teil, davon konnten 413 Fragebögen in die deskriptive Analyse eingeschlossen werden (Alter: 36,4 (± 10,88 SD) Jahre; w/m: 281/132). 92,7 % der Befragten hielten Gesundheitsförderung für einen fundamentalen Bestandteil der physiotherapeutischen Arbeit und 93,4 % stimmten zu, dass die Förderung eines gesunden Lebensstils zur Arbeit von Physiotherapeut*innen gehöre. Die Befragten erhoben (a) und berieten (b) am häufigsten zum Risikofaktor körperliche Inaktivität (a: 89,8 %; b: 91,3 %) und gaben an, über geringe bis mittlere Kompetenzen für die Beratung zur Verhaltensänderung zu verfügen. Akademisch ausgebildete Physiotherapeut*innen schätzten ihre Kompetenzen besser als nicht akademisch ausgebildete Physiotherapeut*innen (W = 8253,5, p = 0,001, r = 0,182) ein. Als häufigste Barrieren bei der Umsetzung von BzlV wurden strukturelle Ursachen, wie Zeitmangel (64,9 %) und fehlende Vergütung (70,5 %), genannt.
Schlussfolgerung Physiotherapeut*innen haben überwiegend eine positive Einstellung zur Gesundheitsförderung und erachten BzlV als sehr wichtig. Derzeit bestehen aber noch viele Barrieren, die Physiotherapeut*innen an der Umsetzung hindern. Damit diese in Deutschland dennoch einen Beitrag zur Gesundheitsförderung leisten können, sollten Rahmenbedingen und Ausbildungsinhalte angepasst werden.
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Affiliation(s)
- Anna Roidl
- Technische Universität München, Fakultät für Sport- und Gesundheitswissenschaften, München, Deutschland
- Klinik und Poliklinik für Kinder- und Jugendmedizin der Universität Regensburg, KinderUniKlinik Ostbayern (KUNO), Abteilung für Neonatologie, Barmherzige Brüder Klinik St. Hedwig, Regensburg, Deutschland
| | - Anna Gabriel
- Technische Universität München, Professur für Konservative und Rehabilitative Orthopädie, München, Deutschland
| | - Jürgen Beckmann
- Technische Universität München, Fakultät für Sport- und Gesundheitswissenschaften, München, Deutschland
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23
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Haynes A, Sherrington C, Ramsay E, Kirkham C, Manning S, Wallbank G, Hassett L, Tiedemann A. "Sharing Success with Someone": Building therapeutic alliance in physiotherapist-delivered physical activity coaching for healthy aging. Physiother Theory Pract 2021; 38:2771-2787. [PMID: 34324406 DOI: 10.1080/09593985.2021.1946872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Therapeutic alliance, a goal-orientated partnership between clients and practitioners, can enhance program engagement and adherence, and improve treatment outcomes and satisfaction. OBJECTIVES To develop an empirical model that describes how therapeutic alliances can be operationalized in clinical and research settings and use this in our evaluation of the Coaching for Healthy Ageing (CHAnGE) trial. METHODS Secondary analysis of interviews with participants in the CHAnGE trial (n = 32) and a focus group with the physiotherapists who delivered health coaching in that trial (n = 3). Analysis was inductive (thematic) and deductive (using a therapeutic alliance model derived from a literature review and informed by earlier analyses). RESULTS Data from participants and physiotherapists indicated that health coaching in CHAnGE built effective therapeutic alliances (i.e. it facilitated collaborative decision-making and trusting person-centered relationships) which were underpinned by professional skills and structural supports. Components of the intervention that strengthened therapeutic alliance were health coaching training, home visits, the coaching format, and provision of free activity monitors. CONCLUSION This study identifies key concepts and practical 'building blocks' of therapeutic alliance, showing how these were operationalized within an intervention. This may help those in clinical and research settings to recognize the importance and characteristics of therapeutic alliance and put it into practice.
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Affiliation(s)
- Abby Haynes
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Level 10N King George V Building Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Level 10N King George V Building Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Elisabeth Ramsay
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Level 10N King George V Building Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Catherine Kirkham
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Level 10N King George V Building Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Shona Manning
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Level 10N King George V Building Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia.,Christian Homes Tasmania Inc, Kingston, TAS, Australia
| | - Geraldine Wallbank
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Level 10N King George V Building Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Leanne Hassett
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Level 10N King George V Building Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia.,School of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
| | - Anne Tiedemann
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Level 10N King George V Building Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
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Rethorn ZD, Covington JK, Cook CE, Bezner JR. Physical Activity Promotion Attitudes and Practices Among Outpatient Physical Therapists: Results of a National Survey. J Geriatr Phys Ther 2021; 44:25-34. [PMID: 33347041 DOI: 10.1519/jpt.0000000000000289] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Physical activity (PA) promotion delivered by physical therapists is effective. However, little is known about how much PA promotion is integrated into outpatient US physical therapist practice. The purpose of this study was to determine the current PA promotion practices and factors that influence those practices among outpatient US physical therapists. METHODS A sample of outpatient US physical therapists from the Academy of Orthopaedic Physical Therapy and American Physical Therapy Association (APTA) Geriatrics completed an adaptive online survey that included questions related to PA promotion practices and factors that influence those practices. We dichotomized levels of PA promotion as regular and irregular. Multivariable logistic regression was used to determine what factors predicted regular PA promotion. RESULTS AND DISCUSSION A total of 522 individuals participated and 393 surveys were included in the analyses (75.3%). Most participants (58.5%) irregularly promoted PA and few reported always screening for patients' PA levels (12.7%). The strongest predictor of regularly promoting PA was screening for baseline PA (odds ratio = 5.07, 95% confidence interval = 2.23, 11.57). Physical therapists' own PA levels compared favorably to the US adult population and other health professionals and predicted PA promotion. Other factors related to capability, opportunity, and environment were predictors of PA promotion. Perceived lack of financial support from insurance companies, lack of support from clinical employers, and a perception of competing priorities were barriers to PA promotion. Despite being a public health priority, the majority of physical therapists surveyed infrequently screen for baseline PA and irregularly promote PA. Perceived financial barriers, lack of organizational support, and prioritizing other patient problems hinder PA promotion in the outpatient setting. CONCLUSION Despite guidance from national and international governing bodies, US outpatient physical therapists do not regularly promote PA to patients and perceive financial constraints and competing priorities as key barriers. Professional and patient stakeholders should be involved in designing pathways to improve PA promotion practices among outpatient US physical therapists.
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Affiliation(s)
- Zachary D Rethorn
- Rocky Mountain University of Health Professions, Provo, Utah
- Doctor of Physical Therapy Division, Duke University, Durham, North Carolina
| | - J Kyle Covington
- Doctor of Physical Therapy Division, Duke University, Durham, North Carolina
| | - Chad E Cook
- Doctor of Physical Therapy Division, Duke University, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Janet R Bezner
- Department of Physical Therapy, Texas State University, Round Rock
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25
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Zhu S, Sherrington C, Jennings M, Brady B, Pinheiro M, Dennis S, Christie LJ, Sidhu B, Haynes A, Greaves C, Hassett L. Current Practice of Physical Activity Counselling within Physiotherapy Usual Care and Influences on Its Use: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4762. [PMID: 33947018 PMCID: PMC8125383 DOI: 10.3390/ijerph18094762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 12/03/2022]
Abstract
Physical activity counselling has demonstrated effectiveness at increasing physical activity when delivered in healthcare, but is not routinely practised. This study aimed to determine (1) current use of physical activity counselling by physiotherapists working within publicly funded hospitals; and (2) influences on this behaviour. A cross-sectional survey of physiotherapists was conducted across five hospitals within a local health district in Sydney, Australia. The survey investigated physiotherapists' frequency of incorporating 15 different elements of physical activity counselling into their usual healthcare interactions, and 53 potential influences on their behaviour framed by the COM-B (Capability, Opportunity, Motivation-Behaviour) model. The sample comprised 84 physiotherapists (79% female, 48% <5 years of experience). Physiotherapists reported using on average five (SD:3) elements of physical activity counselling with at least 50% of their patients who could be more active. A total of 70% of physiotherapists raised or discussed overall physical activity, but less than 10% measured physical activity or contacted community physical activity providers. Physiotherapists reported on average 25 (SD:9) barriers influencing their use of physical activity counselling. The most common barriers were related to "opportunity", with 57% indicating difficulty locating suitable community physical activity opportunities and >90% indicating their patients lacked financial and transport opportunities. These findings confirm that physical activity counselling is not routinely incorporated in physiotherapy practice and help to identify implementation strategies to build clinicians' opportunities and capabilities to deliver physical activity counselling.
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Affiliation(s)
- Shiyi Zhu
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (S.Z.); (B.B.); (M.P.); (S.D.)
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, NSW 2050, Australia; (C.S.); (A.H.)
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Matthew Jennings
- South Western Sydney Local Health District, Sydney, NSW 2170, Australia; (M.J.); (L.J.C.); (B.S.)
| | - Bernadette Brady
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (S.Z.); (B.B.); (M.P.); (S.D.)
- South Western Sydney Local Health District, Sydney, NSW 2170, Australia; (M.J.); (L.J.C.); (B.S.)
| | - Marina Pinheiro
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (S.Z.); (B.B.); (M.P.); (S.D.)
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, NSW 2050, Australia; (C.S.); (A.H.)
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Sarah Dennis
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (S.Z.); (B.B.); (M.P.); (S.D.)
- South Western Sydney Local Health District, Sydney, NSW 2170, Australia; (M.J.); (L.J.C.); (B.S.)
- Ingham Institute for Applied Medical Research, South Western Sydney Local Health District, Sydney, NSW 2170, Australia
| | - Lauren J. Christie
- South Western Sydney Local Health District, Sydney, NSW 2170, Australia; (M.J.); (L.J.C.); (B.S.)
- Ingham Institute for Applied Medical Research, South Western Sydney Local Health District, Sydney, NSW 2170, Australia
- Allied Health Research Unit & Nursing Research Institute (NRI), St Vincent’s Health Network Sydney, Sydney, NSW 2010, Australia
| | - Balwinder Sidhu
- South Western Sydney Local Health District, Sydney, NSW 2170, Australia; (M.J.); (L.J.C.); (B.S.)
| | - Abby Haynes
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, NSW 2050, Australia; (C.S.); (A.H.)
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Colin Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK;
| | - Leanne Hassett
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (S.Z.); (B.B.); (M.P.); (S.D.)
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, NSW 2050, Australia; (C.S.); (A.H.)
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Ingham Institute for Applied Medical Research, South Western Sydney Local Health District, Sydney, NSW 2170, Australia
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26
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West K, Purcell K, Haynes A, Taylor J, Hassett L, Sherrington C. "People Associate Us with Movement so It's an Awesome Opportunity": Perspectives from Physiotherapists on Promoting Physical Activity, Exercise and Sport. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062963. [PMID: 33799347 PMCID: PMC8000875 DOI: 10.3390/ijerph18062963] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 11/16/2022]
Abstract
Insufficient physical activity (PA) is a critical public health issue especially in the context of COVID-related deconditioning. Health professionals are well placed to promote community-based PA but there is little supporting implementation research. We aimed to explore physiotherapists' knowledge, views, attitudes and experiences regarding the promotion of physical activity, exercise and sport within daily clinical practice in order to guide development of strategies to support implementation of PA promotion by physiotherapists, in particular those treating older people, and adults and children with a disability. We conducted interviews and focus groups with 39 physiotherapists. Two researchers coded transcripts with an iterative coding approach. Analysis returned five main themes: putting principles into practice; working with conflicting priorities; multiple client barriers; connections build confidence; and the battle for information. The physiotherapists accepted their legitimate role in PA promotion. Limited clinical and administrative time and acute treatment priorities often superseded PA promotion but the lack of updated information regarding suitable community-based PA opportunities and lack of trust in community providers were the biggest barriers. Strategies to enhance PA promotion by physiotherapists should address time and information constraints, and build partnership connections between health professionals and community-based PA providers.
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Affiliation(s)
- Kerry West
- Institute for Musculoskeletal Health, Sydney Local Health District, Camperdown, NSW 2050, Australia; (K.P.); (A.H.); (J.T.); (L.H.); (C.S.)
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Physiotherapy Department, The Children’s Hospital at Westmead, Sydney Children’s Hospitals Network, Westmead, NSW 2145, Australia
- Correspondence:
| | - Kate Purcell
- Institute for Musculoskeletal Health, Sydney Local Health District, Camperdown, NSW 2050, Australia; (K.P.); (A.H.); (J.T.); (L.H.); (C.S.)
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Abby Haynes
- Institute for Musculoskeletal Health, Sydney Local Health District, Camperdown, NSW 2050, Australia; (K.P.); (A.H.); (J.T.); (L.H.); (C.S.)
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Jennifer Taylor
- Institute for Musculoskeletal Health, Sydney Local Health District, Camperdown, NSW 2050, Australia; (K.P.); (A.H.); (J.T.); (L.H.); (C.S.)
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Leanne Hassett
- Institute for Musculoskeletal Health, Sydney Local Health District, Camperdown, NSW 2050, Australia; (K.P.); (A.H.); (J.T.); (L.H.); (C.S.)
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, Sydney Local Health District, Camperdown, NSW 2050, Australia; (K.P.); (A.H.); (J.T.); (L.H.); (C.S.)
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
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Many physiotherapists lack preparedness to prescribe physical activity and exercise to people with musculoskeletal pain: A multi-national survey. Phys Ther Sport 2021; 49:98-105. [PMID: 33662892 DOI: 10.1016/j.ptsp.2021.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/03/2021] [Accepted: 02/06/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Determine physiotherapists' (i) awareness of physical activity, and exercise prescription guidelines; (ii) perceived role, knowledge, confidence, skills and training in prescribing and progressing aerobic exercise and resistance training to people with musculoskeletal pain; (iii) professional development preferences; and (iv) perceived influences of external factors on exercise prescription for people with musculoskeletal pain. DESIGN Multi-national cross-sectional survey. METHODS An open online survey was developed specifically for this study. RESULTS 1,352 physiotherapists from 56 countries participated. The majority of respondents correctly stated physical activity guidelines for adults (60%) and children (53%), but only 37% correctly stated guidelines for older adults. Eleven percent and 16% could name an accepted guideline for aerobic exercise and resistance training, respectively. Most agreed their role included prescribing aerobic exercise (75%) and resistance training (89%). Fewer reported they had the confidence, training or skills to prescribe aerobic exercise (38-50%) and resistance training (49-70%). Workshops were the most preferred (44%) professional development option. Most respondents believed appointment scheduling and access to equipment and professional development (62-79%) affected their ability to prescribe effective exercise. CONCLUSION Many physiotherapists lack knowledge and training to provide physical activity advice, and to prescribe aerobic exercise and resistance training to people with musculoskeletal pain.
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Virgara R, Phillips A, Lewis L, Richardson M, Maher C. Development of Australian physical activity and screen time guidelines for outside school hours care: an international Delphi study. Int J Behav Nutr Phys Act 2021; 18:3. [PMID: 33407628 PMCID: PMC7789289 DOI: 10.1186/s12966-020-01061-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children's activity patterns in the periods before and after school make a key contribution to achieving 24-h movement guidelines. There are currently no national-level guidelines informing physical activity and screen time practices in Outside School Hours Care (OSHC) programs anywhere in the world. This study aimed to work with industry, government and academic stakeholders to develop draft physical activity and screen time guidelines for use in Australian OSHC. METHODS A 4-round online Delphi survey was conducted from May 2019 to January 2020. The Delphi participants included national and international experts and stakeholders from academia, education, government, health and the OSHC sectors. Round 1 consisted of open-ended questions exploring physical activity, screen time and sedentary behaviour in various periods of OSHC (before school, after school and vacation care). In rounds 2 and 3, participants rated the importance of items generated from the first round for inclusion in national guidelines using a Likert scale (1-9). Consensus was defined a priori as ≥80% of respondents rating an item as "critically important" (score 7-9). Between rounds 3 and 4, the guideline development panel used the consensus items, systematic review evidence, and followed the GRADE process, to draft the guidelines. In round 4, participants were invited to provide feedback on the draft guidelines and comment on barriers and enablers to implementation. RESULTS Sixty-seven stakeholders agreed to participate, with response rates 61, 81, 54 and 72% for the four rounds respectively. Of the 123 items generated across the three rounds, 48 statements achieved consensus agreement as critically important for inclusion in the guidelines. These included offering a variety of physical activities (free play, playground and equipment) and restriction of screen time. The final round provided feedback on the draft guidelines. The wording of the guidelines was found to be appropriate and preliminary enablers and barriers to implementation were identified. CONCLUSIONS This world-first expert and stakeholder consultation has underpinned the development of the draft Australian guidelines for physical activity and screen time in OSHC. Ongoing work is needed to further refine the guidelines, determine current rates of compliance with the guidelines and implement the guidelines into practice.
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Affiliation(s)
- Rosa Virgara
- Allied Health and Human Performance, University of South Australia, c/o GPO Box 2471, SA, 5001, Adelaide, Australia.
| | - Anna Phillips
- Allied Health and Human Performance, University of South Australia, c/o GPO Box 2471, SA, 5001, Adelaide, Australia
| | - Lucy Lewis
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | | | - Carol Maher
- Allied Health and Human Performance, University of South Australia, c/o GPO Box 2471, SA, 5001, Adelaide, Australia
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Knowledge, attitude and practice of physical activity promotion among physiotherapists in India during COVID 19. J Bodyw Mov Ther 2020; 26:463-470. [PMID: 33992283 DOI: 10.1016/j.jbmt.2020.12.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/28/2020] [Accepted: 12/28/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Coronavirus disease (COVID-19) pandemic and the nationwide lockdown has increased sedentary time and physical inactivity. Physiotherapists are one of the essential health professionals who are actively involved in promoting physical activities. The study objectives included assessing knowledge of physical activity guidelines, physiotherapist attitude towards involvement in physical activities and practice of routine physical activity assessment, and its promotion among physiotherapists in India during COVID-19. METHOD In this cross-sectional survey study, the study tool was prepared using Google Forms. It consisted of sixteen questions on knowledge, attitude, and practice of physical activities among physiotherapists. Study participants were physiotherapists with a minimum of a bachelor's degree qualification and practicing in India. RESULTS One hundred and eighty responses were received from sixteen states of India. The average age of respondents was 28 years, and the average work experience of five years. This study found that only 19% of physiotherapists could give the correct answer in all three domains of WHO PA guidelines. 70% of physiotherapists found with an appropriate attitude as they met the 150 min of moderate PA per week. 68% reported that they promote physical activities in routine practice. CONCLUSION This study suggested the majority of physiotherapists perform physical activity assessment and promotion in routine practice in India. Most of them have an appropriate attitude towards physical activity, but very few physiotherapists have adequate knowledge of WHO physical activity guidelines. Physiotherapists should actively promote physical activities in routine practice to reduce the impairment due to physical inactivity especially during the Corona virus disease pandemic in India. Efforts should be made to increase the physical activity awareness in terms of knowledge of WHO physical activity guidelines, different assessment, and promotion strategies.
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Matthews J, Hall AM, Keogh A. Evaluating the effects of behavior change training on the knowledge, confidence and skills of sport and exercise science students. BMC Sports Sci Med Rehabil 2020; 12:62. [PMID: 33042551 PMCID: PMC7539374 DOI: 10.1186/s13102-020-00209-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/24/2020] [Indexed: 12/02/2022]
Abstract
Background Behavior change interventions have the potential to have a transformative effect on the health of populations. Allied health professionals have a key role to play in delivering these interventions. However, traditionally undergraduate allied health professional programs have not had a behavior change focus. The aim of this study was to assess the effectiveness of a training program on sport and exercise science students’ knowledge, confidence and skills in the provision of behavior change support. Method A mixed method convergent design was used to address the research question. Fifteen sport and exercise science students took part in a training program consisting of seven 90-min weekly face to face group sessions. Student satisfaction with training methods was assessed. Pre-to-post training changes in students’ confidence and knowledge in the provision of behavior change support was evaluated. Delivery of behavior change support was assessed by an audio recorded role-play rated by an expert using the Health Care Climate Questionnaire, and an adapted version of the Communication Evaluation in Rehabilitation Tool. Students also completed a reflective assignment. Results Students were satisfied with the training. There were increases in students’ confidence and knowledge of certain behavior change components post-training but not behavior change techniques. Students delivered behavior change support in a broadly needs supportive manner. The reflective assignment showed that students found particular behavior change strategies difficult to implement. Conclusion It is feasible to train undergraduate students in particular components of behavior change support. Academic institutions should embed behavior change training into the allied health professional curriculum to ensure graduates are job ready with the knowledge, confidence and skills to support health related behavior change within the wider health system.
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Affiliation(s)
- James Matthews
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland.,Institute of Sport and Health, University College Dublin, Dublin, Ireland
| | - Amanda M Hall
- Faculty of Medicine, Memorial University, Newfoundland, Canada
| | - Alison Keogh
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
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Paim T, Low-Choy N, Dorsch S, Kuys S. An audit of physiotherapists' documentation on physical activity assessment, promotion and prescription to older adults attending out-patient rehabilitation. Disabil Rehabil 2020; 44:1537-1543. [PMID: 32809850 DOI: 10.1080/09638288.2020.1805644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Identify if physiotherapists document the assessment, promotion and prescription of physical activity to older adults attending out-patient rehabilitation and assist them in the transition to an active lifestyle. METHODS An audit of physiotherapists' documentation in medical records of older adults who attended an out-patient rehabilitation program at a tertiary hospital. RESULTS Fifty-six medical records were reviewed. Mean age (SD) of participants was 79 (7) years. No documentation was found on the use of validated tools to assess physical activity levels of older adults. Prescription of physical activity was documented in 55/56 (98%) medical records. Seven (12.5%) medical records included documentation on goal setting regarding physical activity participation. Advice on regular physical activity post-discharge from the rehabilitation program was documented in 28/56 (50%) medical records. Formal referral to community-based physical activity programs was documented in 4/56 (7%) medical records. CONCLUSIONS Evidence-practice gaps were found in physiotherapists' documentation of the promotion of physical activity to older adults attending out-patient rehabilitation, indicating a lack of assistance in the transition to an active lifestyle. These gaps were evident in the lack of; physical activity assessment, implementation of behaviour change strategies and formal referral to physical activity in the community post-discharge from out-patient rehabilitation.Implications for rehabilitationOur findings suggest that physiotherapists are not widely applying evidence-based practice to promote physical activity to older adults attending out-patient rehabilitation nor supporting them in the transition to engage in physical activity in the community post-discharge from rehabilitation program.Incorporating physical activity assessment and behaviour change strategies into usual care may enable physiotherapists to successfully promote physical activity to older adults attending out-patient rehabilitation.Collaboration between the health care system and community-based physical activity programs is imperative to facilitate the sustainability of an active lifestyle after discharge from rehabilitation program.
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Affiliation(s)
- Tatiana Paim
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia.,School of Allied Health, Australian Catholic University, Brisbane, Australia
| | - Nancy Low-Choy
- School of Allied Health, Australian Catholic University, Brisbane, Australia
| | - Simone Dorsch
- School of Allied Health, Australian Catholic University, Sydney, Australia.,StrokeEd Collaboration, Sydney, Australia
| | - Suzanne Kuys
- School of Allied Health, Australian Catholic University, Brisbane, Australia
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Albert FA, Crowe MJ, Malau-Aduli AEO, Malau-Aduli BS. Physical Activity Promotion: A Systematic Review of The Perceptions of Healthcare Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4358. [PMID: 32570715 PMCID: PMC7345303 DOI: 10.3390/ijerph17124358] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/13/2020] [Accepted: 06/14/2020] [Indexed: 12/18/2022]
Abstract
Physical activity (PA) is a cost-effective and non-pharmacological foundation for the prevention and management of chronic and complex diseases. Healthcare professionals could be viable conduits for PA promotion. However, the evidence regarding the effectiveness and benefits of the current forms of PA promotion are inconclusive. Healthcare professionals' perceptions on key determinants impact on the optimum promotion of PA were explored in this review. Thirty-four (34) studies were identified after systematically searching seven databases for peer-reviewed articles published within the last decade. PA advice or counselling was the most recorded form of PA promotion, limited counselling time was the most reported obstacle while providing incentives was viewed as a key facilitator. There is widespread consensus among healthcare professionals (HCPs) on some aspects of PA promotion. Utilisation of all PA promotional pathways to their full potential could be an essential turning point towards the optimal success of PA promotional goals. Hence, strategies are required to broaden chronic disease treatment methods to include preventive and integrative PA promotion approaches particularly, between frontline HCPs (e.g., GPs) and PA specialists (e.g., EPs). Future studies could explore the functionality of GP to EP referral pathways to determining what currently works and areas requiring further development.
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Affiliation(s)
- Francis A. Albert
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia;
| | - Melissa J. Crowe
- Division of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia;
| | - Aduli E. O. Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia;
| | - Bunmi S. Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia;
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Geidl W, Wais J, Fangmann C, Demisse E, Pfeifer K, Sudeck G. Physical activity promotion in daily exercise therapy: the perspectives of exercise therapists in German rehabilitation settings. BMC Sports Sci Med Rehabil 2019; 11:28. [PMID: 31827805 PMCID: PMC6886191 DOI: 10.1186/s13102-019-0143-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/17/2019] [Indexed: 12/21/2022]
Abstract
Background This study aims to explore exercise therapists' perspectives on the topic of physical activity promotion (PAP) with a focus on identifying (i) the intervention content and methodological approaches used for promoting physical activity (PA) in daily practice and (ii) the barriers and facilitators that affect PAP. Methods This qualitative study comprised the heads of exercise therapy departments (n = 58; 41% women; mean age = 45 years) from different rehabilitation clinics in Germany. Each participant took part in a semi-structured focus-group discussion on PAP in exercise therapy. The findings of the focus groups were processed and interpreted using a conventional qualitative content analysis. Results The exercise therapists demonstrated detailed didactic-methodological strategies and action orientations for PAP. The identified core topics of the content and methods of PAP were (1) conceptualization, (2) exercise and PA for enjoyment and pleasure, (3) education with practice-theory combinations, (4) media and materials for self-directed training, and (5) strategies to enhance personal responsibility and independence. The core topics for the associated barriers and facilitators were (1) structural conditions, (2) the role of exercise therapists, (3) the interdisciplinary rehabilitation team, (4) rehabilitant experiences and expectations, and (5) aftercare services. Conclusion The topic of PAP is addressed with a high level of variability; exercise therapists involved in this study identify various methods and content for the promotion of PA within their individual practices. However, they display a limited awareness of existing evidence- and theory-based concepts for the promotion of PA as well as underlying theories of behavioural change. This variability may be due to the lack of a defined common framework for promoting PA, insufficient emphasis being placed on PA promotion in the current curricula and training, or extensive conceptual differences within German exercise therapy departments (e.g. different weighting of PAP).
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Affiliation(s)
- Wolfgang Geidl
- 1Department of Sport Science and Sport, Division of Exercise and Health, Friedrich-Alexander University Erlangen-Nürnberg, Gebbertstraße 123b, 91058 Erlangen, Germany
| | - Judith Wais
- 2Institute of Sport Science, Department of Education and Health Research, Eberhard Karls University Tübingen, Wächterstraße 76, 72074 Tübingen, Germany
| | - Cheyenne Fangmann
- 2Institute of Sport Science, Department of Education and Health Research, Eberhard Karls University Tübingen, Wächterstraße 76, 72074 Tübingen, Germany
| | - Ewnet Demisse
- 1Department of Sport Science and Sport, Division of Exercise and Health, Friedrich-Alexander University Erlangen-Nürnberg, Gebbertstraße 123b, 91058 Erlangen, Germany
| | - Klaus Pfeifer
- 1Department of Sport Science and Sport, Division of Exercise and Health, Friedrich-Alexander University Erlangen-Nürnberg, Gebbertstraße 123b, 91058 Erlangen, Germany
| | - Gorden Sudeck
- 2Institute of Sport Science, Department of Education and Health Research, Eberhard Karls University Tübingen, Wächterstraße 76, 72074 Tübingen, Germany
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Yona T, Ben Ami N, Azmon M, Weisman A, Keshet N. Physiotherapists lack knowledge of the WHO physical activity guidelines. A local or a global problem? Musculoskelet Sci Pract 2019; 43:70-75. [PMID: 31352177 DOI: 10.1016/j.msksp.2019.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/17/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Physical inactivity is a significant cause of premature deaths globally, yet many physiotherapists)PT's) have little knowledge of the World Health Organization's physical activity guidelines (PA). OBJECTIVES To assess the knowledge of Israeli PT's regarding the World Health Organization's (WHO) recommendations for PA for adults and adolescents. Secondary aims were to determine how many Israeli PT's, are recommending PA for their patients and to evaluate the knowledge level of Israeli PT's in relation to PT's in other countries. DESIGN Cross-sectional online survey. PARTICIPANTS Of the 1413 Israeli PT's offered the survey, 1062 (75%) completed it, which represents 16.4% of the 6450 licensed PT's in Israel. RESULTS A mere 6.8% physiotherapists were aware of the WHO-recommended level of adult PA, and only 4% were knowledgeable of the recommendations for adolescents. Novice PT's (5 > years of experience) knew significantly more about adult PA recommendations (P < 0.05) than did the more senior physiotherapists. Nine out of every ten (90%) PT's routinely initiate conversations about PA, 83.5% signpost to PA support elsewhere, and 70.5% deliver brief intervention themselves for PA. The main barriers to promoting PA were (1) the belief that promotion would not change patient behavior, (2) lack of time, and (3) perceived lack of skills at counseling for behavior change. CONCLUSIONS Israeli PT's have poor knowledge of the WHO's adults and adolescent guidelines for PA. Lack of knowledge among PT's regarding the WHO's PA guidelines is a recurrent global problem that requires immediate attention.
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Affiliation(s)
- Tomer Yona
- The Israeli Physiotherapy Society, Tel-Aviv, Israel.
| | - Noa Ben Ami
- Faculty of Health Sciences, Department of Physiotherapy, Ariel University, Ariel, Israel
| | - Michal Azmon
- The Israeli Physiotherapy Society, Tel-Aviv, Israel; Faculty of Health Sciences, Department of Physiotherapy, Ariel University, Ariel, Israel
| | - Asaf Weisman
- Spinal Research Laboratory, Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Naama Keshet
- The Israeli Physiotherapy Society, Tel-Aviv, Israel; Shmuel Harofeh Geriatric Medical Center, Beer-Yaacov, Israel
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Freene N, Davey R, McPhail SM. Frequency of a very brief intervention by physiotherapists to increase physical activity levels in adults: a pilot randomised controlled trial. BMC Sports Sci Med Rehabil 2019; 11:6. [PMID: 31139419 PMCID: PMC6530136 DOI: 10.1186/s13102-019-0118-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 05/01/2019] [Indexed: 01/09/2023]
Abstract
Background There is evidence that brief physical activity interventions by health professionals can increase physical activity levels. In addition, there is some evidence that simply measuring physical activity alone can increase physical activity behaviour. However, preliminary work is required to determine the effects of potential measurement frequency. The aim of this pilot study was to examine whether frequency of physical activity measurement, with very brief advice from a physiotherapist, influenced objectively measured physical activity in insufficiently active adults. Methods Using concealed allocation and blinded assessments, eligible participants (n = 40) were randomised to a lower-measurement-frequency (baseline and 18-weeks) or higher-measurement-frequency group (baseline, 6, 12 and 18-weeks). The primary outcome was daily minutes of moderate-to-vigorous physical activity (accelerometry). Secondary outcomes included functional aerobic capacity (STEP tool), quality-of-life (AQoL-6D), body mass index, waist circumference, waist-to-hip ratio and blood pressure. Results Between-group comparisons were not significant in intention-to-treat analyses. However, there was a trend for the higher-measurement-frequency group to complete more daily minutes of moderate-to-vigorous physical activity at 18-weeks (mean difference 19.6 vs − 11.9 mins/week, p = 0.084), with a medium effect size (Cohen’s d = 0.58). This was significant in per-protocol analysis (p = 0.049, Cohen’s d = 0.77). Within-group comparisons indicated both groups increased their aerobic fitness (p ≤ 0.01), but only the higher-measurement-frequency group decreased their waist circumference (mean decrease 2.3 cm, 95%CI 0.3–4.3, p = 0.024), diastolic blood pressure (mean decrease 3.4 mmHg, 95%CI 0.03–6.8, p = 0.048) and improved their quality-of-life for independent living (mean increase 3.3, 95%CI 0.2–6.4, p = 0.031). Conclusion Very brief physical activity interventions by physiotherapists may be an efficient approach to increase physical activity in community-dwelling adults. A larger trial is warranted. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12616000566437, http://www.ANZCTR.org.au/ACTRN12616000566437.aspx, registered 2 May 2016.
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Affiliation(s)
- Nicole Freene
- 1Physiotherapy, Faculty of Health, University of Canberra, Bruce, 2617 Australia
| | - Rachel Davey
- 2Centre for Research & Action in Public Health, University of Canberra, Bruce, 2617 Australia
| | - Steven M McPhail
- 3School of Public Health & Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Victoria Park Road, Kelvin Grove, 4059 Australia.,4Centre for Functioning and Health Research, Metro South Health, Corner of Ipswich Road and Cornwall Street, Buranda, 4103 Australia
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Brannan M, Bernardotto M, Clarke N, Varney J. Moving healthcare professionals - a whole system approach to embed physical activity in clinical practice. BMC MEDICAL EDUCATION 2019; 19:84. [PMID: 30876426 PMCID: PMC6419815 DOI: 10.1186/s12909-019-1517-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 03/11/2019] [Indexed: 05/27/2023]
Abstract
BACKGROUND Healthcare professionals are key informants to support individual behaviour change, and although there has been some progress in empowering clinicians to promote physical activity and health at work, an effective strategy overarching the whole medical educational journey is still lacking. This report provides an overview from the Moving Healthcare Professionals programme (MHPP), a whole-system educational approach to embed prevention and physical activity promotion into clinical practice. METHODS The MHPP model integrates educational resources into three core domains of medical education: undergraduate education, postgraduate education and continuing professional development. The interventions are designed to spiral through existing educational approaches rather than as additional special study modules or bolt-on courses, thus reducing self-selection bias in exposure. Interventions include spiral undergraduate education materials, e-learning, embedded post-graduate resources and face-to-face peer-to-peer education. RESULTS To date the MHPP model has been applied in two key areas, physical activity and health and work. The physical activity programme in a partnership between Public Health England and Sport England has delivered face-to-face training to 17,105 healthcare professionals, embedded materials in almost three quarters of English medical schools and overseen > 95,000 e-learning modules completed over two and half years. Evaluation of the individual elements of the model is ongoing and aims to show improvements in knowledge, skills and practice. Further evaluation is planned to assess patient impact. CONCLUSIONS The MHPP model offers a coherent whole-system approach to embed public health action into existing healthcare education models, and as such provides a framework for rapid change as well as upstream implementation to support the clinicians of today and tomorrow.
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Affiliation(s)
| | | | | | - Justin Varney
- Public Health, Birmingham City Council, Birmingham, UK
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