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Silva HDJ, Miranda JPD, Melo CSD, Fonseca LS, Mascarenhas RDO, Veloso NS, Silva WT, Bastone ADC, Oliveira VC. The ESCAPE Trial for Older People With Chronic Low Back Pain: A Feasibility Study of a Clinical Trial of Group-Based Exercise in Primary Health Care. J Aging Phys Act 2024:1-10. [PMID: 39293792 DOI: 10.1123/japa.2024-0026] [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: 01/31/2024] [Revised: 05/30/2024] [Accepted: 06/26/2024] [Indexed: 09/20/2024]
Abstract
Low back pain is a highly disabling health condition that generates high costs for patients and healthcare systems. For this reason, it is considered a serious public health problem worldwide. This pilot study aimed to assess the feasibility of a future randomized controlled trial (RCT) by evaluating adherence to treatment, contamination between groups, satisfaction with treatment, and understanding of the exercise instructions provided by the physiotherapist. Additionally, we sought to identify and implement necessary modifications to the exercise protocol for better suitability in older people. We conducted a prospective, registered pilot RCT comparing an 8-week group-based exercise program with a waiting list in older people (≥60 years old) with chronic low back pain. Sixty participants were recruited through social media, pamphlets, and invitations at community referral centers. The study demonstrated the feasibility of a full RCT. Participants reported high satisfaction with the treatment (i.e., 100% indicated willingness to return for future services) and a high understanding of the exercise instructions (i.e., 81.8% reported "very easy" comprehension). Adherence to the exercise program exceeded the average reported for group exercise interventions in older adults (i.e., 82.58%). Dropout was associated solely with preexisting physical activity levels. The exercise protocol was successfully adapted to better suit the needs of the older adult population. This pilot RCT demonstrates the feasibility of a full-scale RCT to evaluate the effectiveness of group exercise in improving pain intensity and disability in older adults with chronic low back pain. The implemented adjustments to the exercise protocol and overall study approach strengthen the methodological foundation and expected accuracy of the future RCT.
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Affiliation(s)
- Hytalo de Jesus Silva
- Postgraduate Program in Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Júlio Pascoal de Miranda
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Camila Silva de Melo
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Leticia Soares Fonseca
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Rodrigo de Oliveira Mascarenhas
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Nathalia Soares Veloso
- Medical School, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Whesley Tanor Silva
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Alessandra de Carvalho Bastone
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
- Physical Therapy Department, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Vinícius Cunha Oliveira
- Postgraduate Program in Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
- Physical Therapy Department, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
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Hotz I, Mildner S, Stampfer-Kountchev M, Slamik B, Blättner C, Türtscher E, Kübler F, Höfer C, Panzl J, Rücker M, Brenneis C, Seebacher B. Robot-assisted gait training in patients with various neurological diseases: A mixed methods feasibility study. PLoS One 2024; 19:e0307434. [PMID: 39190743 DOI: 10.1371/journal.pone.0307434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 07/01/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Walking impairment represents a relevant symptom in patients with neurological diseases often compromising social participation. Currently, mixed methods studies on robot-assisted gait training (RAGT) in patients with rare neurological diseases are lacking. This study aimed to explore the feasibility, acceptability, goal attainment and preliminary effects of RAGT in patients with common and rare neurological diseases and understand the intervention context and process. METHODS A mixed-methods feasibility study was conducted at an Austrian rehabilitation centre. Twenty-eight inpatients after stroke in the subacute and chronic phases, with multiple sclerosis, Parkinson's disease, spinal cord injury, spinocerebellar ataxia, acute/chronic inflammatory demyelinating polyneuropathy and motor neuron disease were included. Patients received RAGT for 45 minutes, 4x/week, for 4 weeks. Baseline and post-intervention assessments included gait parameters, walking and balance, and questionnaires. Semi-structured observations were conducted twice during the intervention period and analysed using thematic analysis. Descriptive statistics within the respective disease groups and calculation of effect sizes for the total sample were performed. Triangulation was employed to develop a deeper understanding of the research topic. RESULTS Data from 26 patients (mean age 61.6 years [standard deviation 13.2]) were analysed. RAGT was highly accepted by patients and feasible, indicated by recruitment, retention, and adherence rates of 84.8% (95% confidence interval, CI 0.7-0.9), 92.2% (95% CI 0.7-1.0) and 94.0% (95% CI 91.4-96.2), respectively. Goal attainment was high, and only mild adverse events occurred. Improvements in walking speed (10-Metre Walk Test, effect size r = 0.876), walking distance (6-Minute Walk Test, r = 0.877), functional mobility (Timed Up and Go, r = 0.875), gait distance (r = 0.829) and number of steps (r = 0.834) were observed. Four themes were identified: familiarising with RAGT; enjoyment and acceptance through a trusting therapeutic relationship; actively interacting; and minimising dissatisfaction. DISCUSSION Sufficiently powered randomised controlled trials are needed to validate our results. TRIAL REGISTRATION German Clinical Trials Register, DRKS00027887.
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Affiliation(s)
- Isabella Hotz
- Department of Rehabilitation Science, Clinic for Rehabilitation Münster, Münster, Austria
| | - Sarah Mildner
- Department of Rehabilitation Science, Clinic for Rehabilitation Münster, Münster, Austria
| | | | - Bianca Slamik
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria
| | - Christoph Blättner
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria
| | - Elisabeth Türtscher
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria
| | - Franziska Kübler
- Department of Rehabilitation Science, Clinic for Rehabilitation Münster, Münster, Austria
| | - Clemens Höfer
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria
| | - Johanna Panzl
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria
| | - Michael Rücker
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria
| | - Christian Brenneis
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria
- Karl Landsteiner Institute of Interdisciplinary Rehabilitation Research, Münster, Austria
| | - Barbara Seebacher
- Department of Rehabilitation Science, Clinic for Rehabilitation Münster, Münster, Austria
- Karl Landsteiner Institute of Interdisciplinary Rehabilitation Research, Münster, Austria
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Christensen L, Hilde G, Eik H. Learning by leading: A qualitative inquiry into the perceived academic, personal, and professional development of PAL study group leaders in physiotherapy education. Physiother Theory Pract 2024:1-13. [PMID: 39186471 DOI: 10.1080/09593985.2024.2393206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 08/12/2024] [Accepted: 08/12/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Peer assisted learning (PAL), where student leaders facilitate their peers' learning, is prevalent in higher education. However, PAL leaders' development in physiotherapy education and their role perceptions relating to their future professional practice are understudied. PURPOSE We aimed to understand how PAL leaders in physiotherapy education perceive their own academic learning and personal development, and how they view their experiences as PAL leaders in relation to future physiotherapy practice. METHODS Focus group interviews were used to collect qualitative data from third-semester students who had been PAL leaders (n = 19). Data were analyzed using a reflexive, thematic analysis. RESULTS Three main themes were generated: "Being a PAL leader consolidates knowledge and facilitates new learning," "Personal growth through experiential learning outside the comfort zone within a community of practice," and "Learning by leading - transferability of being a PAL leader to future physiotherapy practice." CONCLUSION Overall, physiotherapy students leading PAL study groups demonstrated academic, personal, and professional growth via experiential learning in a community of practice. They developed skills likely transferable into their future physiotherapy roles. Our findings propose PAL study groups as an arena for PAL leaders to practice complex physiotherapy competences, positioning PAL study groups as valuable preclinical practice for physiotherapy students.
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Affiliation(s)
- Lene Christensen
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Gunvor Hilde
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Hedda Eik
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Doutre L, Beaumier M, Parent AA, Talbot S, Tremblay M. Kinesiophobia among health professionals' interventions: a scoping review. PeerJ 2024; 12:e17935. [PMID: 39184383 PMCID: PMC11344999 DOI: 10.7717/peerj.17935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 07/26/2024] [Indexed: 08/27/2024] Open
Abstract
Health professionals are regularly confronted with patients suffering from a fear of movement-related pain (unknown as kinesiophobia). The fear-avoidance attitudes and beliefs of healthcare professionals are likely to play a key role in their patients' therapeutic approach. However, kinesiophobia among health professionals is a relatively young topic. This scoping review aims to explore and catalogue the extent of scientific research that identifies the causes and consequences of kinesiophobia among health professionals while they perform their interventions. The review was based on the Joanna Briggs Institute manual and the PRISMA method for a scoping review. The research was conducted in May 2024 using CINHAL, Medline and Sportdiscus databases with the search terms "fear-avoidance", "kinesiophobia", "pain-related" and "physical therapist". Out of 2,162 potential studies, thirteen articles were included. No study directly mentioned kinesiophobia among health professionals, but it was studied through fear-avoidance beliefs. Two-thirds of the articles indicate that professionals with fear-avoidance beliefs tend to refer their patients to other specialists less frequently and limit their patients' activity, despite treatment guidelines. Most of the studies found were physiotherapists' interventions for chronic back pain patients. The current review emphasizes the need for additional studies involving more healthcare professionals and diverse health conditions.
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Affiliation(s)
- Lilian Doutre
- Programme d’activité physique adaptée et santé, Université Rennes 2, Rennes, France
- Department of Health Sciences, Université du Québec à Rimouski, Rimouski, Quebec, Canada
| | - Maryse Beaumier
- Department of Health Sciences, Université du Québec à Rimouski, Rimouski, Quebec, Canada
- Research Center of Centre intégré de santé and services sociaux de Chaudière-Appalaches (CISSS-CA), Québec, Québec, Canada
| | - Andrée-Anne Parent
- Department of Health Sciences, Université du Québec à Rimouski, Rimouski, Quebec, Canada
| | - Sébastien Talbot
- Department of Health Sciences, Université du Québec à Rimouski, Rimouski, Quebec, Canada
| | - Mathieu Tremblay
- Department of Health Sciences, Université du Québec à Rimouski, Rimouski, Quebec, Canada
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Šajnović U, Kokol P, Završnik J, Vošner HB. Trends in Physiotherapy of Chronic Low Back Pain Research: Knowledge Synthesis Based on Bibliometric Analysis. Healthcare (Basel) 2024; 12:1676. [PMID: 39201234 PMCID: PMC11354025 DOI: 10.3390/healthcare12161676] [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: 07/01/2024] [Revised: 08/19/2024] [Accepted: 08/20/2024] [Indexed: 09/02/2024] Open
Abstract
BACKGROUND Physiotherapy and chronic low back pain (CLBP) form a broad and quickly developing research area. The aim of this article was to holistically, thematically and chronologically analyze and synthesize the literature production in this research area and identify the most prolific research entities and research themes. METHODS This article quantitatively and qualitatively analyzed research literature production harvested from the Scopus bibliometric database, using a triangulation of bibliometric and thematic analysis. For this, Excel 2024, Bibliometrix Biblioshiny 4.1 and VOSviewer version 1.6.20 softwares were used. RESULTS In the Scopus database, 2843 data sources were found, which were published between 1974 and 26 February 2024. The growth trend has been linearly positive since the beginning of publication, and after 2018 exponential growth began. A review of the most prolific entities showed that the most literature was published in America, Europe and Australasia. The thematic analysis of the information sources identified six main themes (pathophysiology of CLBP and the quantification assessment tools, diagnostics and CLBP treatment, CLBP questionnaires and surveys, quality of life, complementary methods in physiotherapy and psychosocioeconomic aspects), while the chronological analysis revealed three main areas of development: assessment tools, CLBP processing and study methodology. CONCLUSIONS The results of this bibliometric study present a good starting point for further research, providing taxonomy and research landscapes as a holistic framework offering multidisciplinary knowledge about CLBP, while chronological analysis provides a basis for identifying prospective research trends. This article offers an interdisciplinary view of the current issue of public health. The results of this study provide a basis for the development of both the physiotherapy and epidemiological fields.
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Affiliation(s)
- Urška Šajnović
- Community Healthcare Center dr. Adolf Drolc Maribor, 2000 Maribor, Slovenia; (P.K.); (J.Z.); (H.B.V.)
- ECM Maribor, Alma Mater Europaea University, 2000 Maribor, Slovenia
| | - Peter Kokol
- Community Healthcare Center dr. Adolf Drolc Maribor, 2000 Maribor, Slovenia; (P.K.); (J.Z.); (H.B.V.)
- Faculty of Electrical Engineering and Computer Sciences, University of Maribor, 2000 Maribor, Slovenia
| | - Jernej Završnik
- Community Healthcare Center dr. Adolf Drolc Maribor, 2000 Maribor, Slovenia; (P.K.); (J.Z.); (H.B.V.)
- ECM Maribor, Alma Mater Europaea University, 2000 Maribor, Slovenia
| | - Helena Blažun Vošner
- Community Healthcare Center dr. Adolf Drolc Maribor, 2000 Maribor, Slovenia; (P.K.); (J.Z.); (H.B.V.)
- ECM Maribor, Alma Mater Europaea University, 2000 Maribor, Slovenia
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Amorim P, Paiva J, Silva de Lima J, Portugal da Fonseca L, Martins H, Silva PA. Lessons learned from investigating patients' and physiotherapists' perspectives on the design of a telerehabilitation platform. Disabil Rehabil Assist Technol 2024; 19:2377-2388. [PMID: 38070003 DOI: 10.1080/17483107.2023.2287160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/09/2023] [Accepted: 11/18/2023] [Indexed: 04/19/2024]
Abstract
PURPOSE Home self-rehabilitation exercises for musculoskeletal conditions are a valuable complement to rehabilitation plans. Telerehabilitation systems using artificial intelligence can provide reliable solutions and empower patients by providing them with guidance and motivating them to engage in rehabilitation plans and activities. This study aims to understand the patient's and physiotherapist's perspective on the requirements of effective face-to-face physiotherapy sessions to inspire the design of a telerehabilitation platform to be used in home settings. METHODS The authors used an ethnography-informed approach through observation and semi-structured interviews with patients (n = 13) and physiotherapists (n = 10) in two outpatient rehabilitation clinics. The AEIOU framework was used to structure and analyse the observation. Thematic analysis was used to code and analyse the data collected from the observations and the interviews. RESULTS Patients' and physiotherapists' perspectives emphasise the need for exercise instruction clarity, evolution monitoring, and feedback. In the absence of the physiotherapist, in home settings, patients feel insecure and fear execution difficulties and limited exercise instructions, while physiotherapists struggle with controlling patients' home exercise performance. Telerehabilitation is seen as an opportunity to move further into home self-rehabilitation programs. CONCLUSIONS Besides home exercise monitoring and guidance, telerehabilitation platforms must allow personalization and effective communication between patients and physiotherapists.
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Affiliation(s)
- Paula Amorim
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
- Rehabilitation Medicine Centre of Central Region Rovisco Pais, Tocha, Portugal
| | - João Paiva
- School of Health, Polytechnic Institute of Porto, Porto, Portugal
| | - Jefferson Silva de Lima
- Centre for Informatics and Systems of the University of Coimbra, Department of Informatics Engineering, University of Coimbra, Portugal
| | - Leonor Portugal da Fonseca
- Centre for Informatics and Systems of the University of Coimbra, Department of Informatics Engineering, University of Coimbra, Portugal
| | - Henrique Martins
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Paula Alexandra Silva
- Centre for Informatics and Systems of the University of Coimbra, Department of Informatics Engineering, University of Coimbra, Portugal
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Miner D, Smith K, Wu PT, Price JH, Piscitelli D, Chui K. Pragmatic approach to mobilizing individuals with critical illness due to COVID-19: clinical perspective. Disabil Rehabil 2024; 46:4040-4048. [PMID: 37752855 DOI: 10.1080/09638288.2023.2263370] [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: 06/01/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE To provide pragmatic guidance for acute rehabilitation management and implementation of early mobility for individuals with critical illness due to COVID-19. METHODS Clinical perspective developed through reflective clinical practice and narrative review of best available evidence. RESULTS Current clinical practice guidelines do not provide guidance for implementation of early mobility interventions for individuals with critical illness due to COVID-19 who require enhanced ventilatory support or support of inhaled pulmonary artery vasodilators. Many individuals who may benefit from implementation of early mobility interventions are excluded by strict interpretation of current guidelines. CONCLUSIONS Risk vs benefit of implementing early mobility interventions in individuals with critical illness due to COVID-19 can be mitigated through coordinated efforts of interdisciplinary teams to promote shared decision-making through therapeutic alliances with patients and their families. Clinicians must clearly define the goals of care, understand the limitations of monitoring equipment in the intensive care unit, prepare to titrate levels of oxygen based on an individual's physiologic response to mobility interventions, and help individuals maintain external goal-directed focus of attention to optimize outcomes of early mobility interventions.
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Affiliation(s)
- Daniel Miner
- Department of Physical Therapy, Carilion Clinic, Radford University Carilion, Radford, VA, USA
| | - Kellen Smith
- Department of Physical Therapy, Carilion Clinic, Radford University, Roanoke, VA, USA
| | - Pei-Tzu Wu
- Department of Physical Therapy, Pacific University, Hillsboro, OR, USA
| | - Justin H Price
- Carilion Clinic, VA Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Daniele Piscitelli
- Department of Physical Therapy, University of Connecticut, Storrs, CT, USA
| | - Kevin Chui
- Department of Physical Therapy, Radford University, Radford, VA, USA
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Holmes MB, Jackson G, George SZ. Clinimetric Properties of the Working Alliance Inventory and Credibility Expectancy Questionnaire: Screening Options for Musculoskeletal Pain. Arch Phys Med Rehabil 2024; 105:1471-1479. [PMID: 38432329 DOI: 10.1016/j.apmr.2024.02.724] [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: 09/11/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To investigate clinimetric properties of 2 surveys used to evaluate common factors in the patient-provider relation and present screener options for the assessment of common factors and report their correlation with pain and functional outcomes. DESIGN Observational cohort. SETTING Outpatient physical therapy. PARTICIPANTS 100 individuals (58% women, mean age=34, SD=15; N=100) presenting to physical therapy with musculoskeletal pain in the following regions: 44% lower extremity, 36% spine, 19% upper extremity, 1% undetermined. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Participants completed the Working Alliance Inventory (WAI) and the Credibility and Expectancy Questionnaire (CEQ). Exploratory factor analysis (EFA) explored factor structure of the WAI and CEQ. Internal consistency was evaluated for scales derived from items retained based on factor loadings. Finally, options for screener tools were proposed and assessed based on their correlation to original surveys as well as pain and functional outcomes. RESULTS The data supported a 4-factor structure for the surveys. Some WAI items were excluded due to cross-loading. The derived four-factor scales demonstrated strong correlations with the original surveys (r=.89-.99) and exhibited good internal consistency (α=.824-.875). Two screening options were suggested: 1 retaining 11 of the original 18 items and the other comprising just 3 items. Both screening tools correlated with the original surveys and showed associations with improvements in pain and functional outcomes (r=-.21-.34). CONCLUSION The proposed screeners provide concise measurement options to facilitate use in clinical practice. These tools can aid in facilitating patient communication specifically addressing patient expectation and understanding the tasks required to enact behavior change.
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Affiliation(s)
| | | | - Steven Z George
- Duke Clinical Research Institute, Durham, NC; Department of Orthopaedic Surgery, Duke University, Durham, NC
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Jacobsen JS, O'Brien MJM, Christensen JR, Risberg MA, Milne L, Balakumar J, Jakobsen SS, Mechlenburg I, Kemp J. Rehabilitation following periacetabular osteotomy for acetabular dysplasia: A qualitative interview study exploring challenges, hopes and expectations among patients in Denmark and Australia. Int J Orthop Trauma Nurs 2024; 54:101116. [PMID: 38925029 DOI: 10.1016/j.ijotn.2024.101116] [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: 03/20/2024] [Revised: 05/13/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Guidelines have been proposed for post-operative rehabilitation following periacetabular osteotomy (PAO). However, the perspectives of individuals undergoing PAO have not been considered. AIM The present study aimed to explore the perceived challenges of everyday life and hopes for and expectations of post-PAO rehabilitation from the perspective of individuals with acetabular dysplasia living in Denmark and Australia. METHODS In this qualitative study, we used a hermeneutic phenomenological approach with semi-structured interviews to explore the perspectives of 25 participants (four males), aged 16-43 years, who underwent a PAO. Purposeful sampling was used to provide variations in age and sex. Inclusion criteria were age above 15 years, radiographic evidence of acetabular dysplasia, PAO within the last seven weeks and undergoing post-operative rehabilitation. Inductive content analysis was adopted to code and analyse interviews. RESULTS The analysis of the interview transcripts revealed four major themes: different expectations, self-confidence, tailored rehabilitation and aligning expectations. Several subthemes emerged within each theme, and similar patterns with minor variations were identified across countries. However, the financial burden of self-funded surgery and rehabilitation challenged some Australian participants, whereas none of the Danish participants mentioned this challenge. CONCLUSION Our findings elucidate the diverse range of hopes and expectations in individuals undergoing PAO, and how these relate to their perceived challenges. In particular, the findings highlight the importance of aligning expectations between individuals and clinicians when designing the rehabilitation.
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Affiliation(s)
- Julie S Jacobsen
- Research Centre for Rehabilitation, VIA University College, Aarhus, Denmark; Research Unit for General Practice, Aarhus, Denmark.
| | - Michael J M O'Brien
- La Trobe Sport Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia. m.o'
| | - Jeanette Reffstrup Christensen
- Research Unit for General Practice, Aarhus, Denmark; Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - May Arna Risberg
- Division of Orthopaedic Surgery, Oslo University Hospital and Department of Sport Medicine, Norwegian School Sport Sciences, Oslo, Norway.
| | | | | | | | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark.
| | - Joanne Kemp
- La Trobe Sport Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
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Maier L, Benzinger P, Abel B, Roigk P, Bongartz M, Wirth I, Cuvelier I, Schölch S, Büchele G, Deuster O, Bauer J, Rapp K, Ullrich C, Wensing M, Roth C. The role of patient-related factors in the implementation of a multimodal home-based rehabilitation intervention after discharge from inpatient geriatric rehabilitation (GeRas): a qualitative process evaluation. Eur Geriatr Med 2024:10.1007/s41999-024-01027-5. [PMID: 39085750 DOI: 10.1007/s41999-024-01027-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 07/12/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Structured aftercare programs are implemented to facilitate the transition from rehabilitation centers to patients' home environments. Taking the program GeRas as an example, this paper aims to evaluate the influence of patient-related factors on the implementation of the geriatric aftercare program GeRas from patients' and providers' perspectives. METHODS To capture patients' and providers' perspectives, qualitative interviews were conducted using a semi-structured interview guide. The analysis was inductive-deductive and based on the thematic analysis by Braun and Clarke and guided by Domain IV of the CFIR. RESULTS 16 participants (10 patients, 4 providers, 2 family members) were interviewed from May 2023 to November 2023. Patient-related factors were perceived as an important aspect during the implementation of the GeRas program. The results were allocated to the four Constructs of Domain IV of the CFIR (Motivation, Opportunity, Capability, Needs). Especially patients' intrinsic motivation, social environment, and physical capabilities seemed to be crucial for successful implementation. While extrinsic motivation can mitigate missing personal capabilities, it cannot replace the presence of intrinsic motivation and capabilities. The results showed that patient-related factors are interlinked. DISCUSSION/CONCLUSION The relevance of patient-related factors during the implementation of the GeRas program shows that such programs must consider these factors during intervention planning.
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Affiliation(s)
- Leonie Maier
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany.
| | - Petra Benzinger
- Center for Geriatric Medicine, Heidelberg University Hospital, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Bastian Abel
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Patrick Roigk
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Martin Bongartz
- Center for Geriatric Medicine, Heidelberg University Hospital, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Isabel Wirth
- Geriatric Center Karlsruhe, ViDia Christian Clinics Karlsruhe, Karlsruhe, Germany
| | - Ingeborg Cuvelier
- Geriatric Center Karlsruhe, ViDia Christian Clinics Karlsruhe, Karlsruhe, Germany
| | - Sabine Schölch
- Department of Telemedicine, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Oliver Deuster
- Interdisciplinary Centre for Clinical Trials (IZKS) at the University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jürgen Bauer
- Center for Geriatric Medicine, Heidelberg University Hospital, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Charlotte Ullrich
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
- Medical Faculty, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Catharina Roth
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
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Ginnerup-Nielsen E, Jørgensen TS, Dew-Hattens C, Christensen R, Berg JI, Vase L, Døssing A, Nielsen SM, Kristensen LE, Bliddal H, Ellegaard K, Henriksen M. The impact of an illness perception conversation on open-label placebo response in knee osteoarthritis: A randomised controlled trial. Osteoarthritis Cartilage 2024:S1063-4584(24)01311-6. [PMID: 39029733 DOI: 10.1016/j.joca.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 06/24/2024] [Accepted: 07/11/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVE To compare the effect of an illness perception conversation (IPC), relative to a research participation conversation (RPC), on 2-week changes in knee pain in patients with knee osteoarthritis. METHOD This was a randomised single-blind trial. Patients were randomised to two matched conversations. An IP conversation concerning the participant's knee pain-related illness perception (IP) or an RPC concerning the participant's motivation for participating in research. Both conversations were followed by an open-label intraarticular saline injection in the most symptomatic knee. The primary outcome was change in knee pain from baseline to 2 weeks follow-up on a 100 mm visual analogue scale (VAS). Key secondary outcomes included the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales: Activities of daily living (ADL) and Quality of life (QoL). Main analyses were based on the intention-to-treat population using repeated measures mixed effects linear models. RESULTS 103 patients were randomised to the IPC group (n = 52) and the RPC group (n = 51). VAS knee pain scores changed statistically significantly from baseline to end of treatment in both groups, -13.7 (standard error [SE]: 3.2) in the IPC group and -13.0 (SE: 3.1) in the RPC group with an adjusted between-group difference of -0.7 (95% CI: -8.3 to 6.9; P = 0.85). Likewise, no group differences were seen in KOOS ADL and KOOS QoL. CONCLUSION A conversation concerning knee pain-related IP did not augment the pain-relieving effect of an open-label placebo injection when compared to a similar control conversation concerning motivations for participating in research. TRIAL REGISTRATION NCT05225480.
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Affiliation(s)
| | | | - Camilla Dew-Hattens
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Robin Christensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Johannes Iuel Berg
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Lene Vase
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Anna Døssing
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Sabrina Mai Nielsen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Lars Erik Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Henning Bliddal
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Karen Ellegaard
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Marius Henriksen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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12
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Moecke DP, Camp PG. Social support from the physiotherapist and the therapeutic relationship in physiotherapy: bridging theory to practice. Physiother Theory Pract 2024:1-11. [PMID: 38949505 DOI: 10.1080/09593985.2024.2372687] [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: 11/02/2023] [Accepted: 06/21/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND/PURPOSE Therapeutic relationship and social support are critical components in physiotherapy that shape patient outcomes. However, defining these constructs, discerning their similarities and differences, and measuring them pose challenges. This article aims to facilitate scientific and clinical advancement on social support and the therapeutic relationship in physiotherapy by (a) providing conceptual clarity, (b) discussing measurement tools, and (c) offering practical recommendations for the deliberate incorporation of these constructs in clinical practice. METHODS This is a perspective paper drawing on examples from existing research. KEY RESULTS Assessing the nature and strength of social support and promoting naturally occurring social support networks are practical ways for physiotherapists to foster social support in physiotherapy clinical practice. Physiotherapists can offer direct support, facilitate the development of an individual's social skills, and promote participation in group activities. To strengthen the therapeutic relationship, it is important to maintain good communication, foster connectedness with the patient, demonstrate professional skills, and adopt a reflective practice. Physiotherapists are encouraged to establish clear roles and responsibilities, prioritize individualized patient-centered care, and involve patients in shared decision-making, ensuring congruence in goals and expectations. Willingness to dedicate time and energy within and beyond direct patient-therapist interactions can foster connections. Moreover, using the body - which is the main point of contact with patients - and physical touch can help physiotherapists to connect with patients. Finally, physiotherapists must be prepared to address and mend any conflicts which can impact the relationship's trajectory. CONCLUSION Social support and therapeutic relationships are complementary aspects of one's health care, and it is crucial to purposefully account for both in physiotherapy practice to optimize person-centered care and rehabilitation outcomes.
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Affiliation(s)
- Débora Petry Moecke
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Sciences Graduate Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pat G Camp
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
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13
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Cruz S, Ko A, Chi D. A Qualitative Study on Dentists' Communication Approaches in Managing Fluoride-Hesitant Caregivers. JDR Clin Trans Res 2024; 9:212-220. [PMID: 37908047 PMCID: PMC11318380 DOI: 10.1177/23800844231203673] [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] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVES Guidelines on effective provider-led communication are available but may be underused in dentistry, even if such guidelines could help dentists manage complex clinical scenarios like topical fluoride hesitancy. The purpose of this study was to investigate current chairside communication approaches used by dentists with fluoride-hesitant caregivers. METHODS A 27-item semistructured interview script was developed and pretested with 3 dentists, revised, and finalized. One-on-one interviews were conducted with a purposive sample of pediatric dentists and general dentists from April to June 2020. Interviews were digitally recorded, transcribed, and analyzed to identify dentists' communication approaches used during clinical interactions with fluoride-hesitant caregivers. Thematic analyses identified themes and subthemes, and exemplary quotes were provided to illustrate each theme. RESULTS Twenty-seven dentists participated (21 pediatric dentists and 6 general dentists). The mean age of participants was 43.0 ± 8.2 y (range, 30-73). Most participants were women (88.9%), white (51.9%), and non-Hispanic (85.2%). Participants had been practicing dentistry for a mean of 13.2 ± 10.5 y (range, 2-40). There were 4 themes: leaving topical fluoride decisions completely up to the caregiver, educating the caregiver about fluoride, insisting that the caregiver accept fluoride, and engaging the caregiver and child. CONCLUSION Most communications approaches used by interviewed dentists to manage fluoride hesitancy in clinical settings are not evidence based. Future dental education efforts should ensure that trainees are exposed to and can demonstrate competency in appropriate, evidence-based patient-provider communication strategies. KNOWLEDGE TRANSFER STATEMENT The study highlights the need for dentists to apply evidence-based communication strategies when managing difficult clinical scenarios like fluoride hesitancy, which is important in optimizing dentist-patient trust.
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Affiliation(s)
- S. Cruz
- Department of Oral Health Sciences at the University of Washington, Seattle, WA, USA
| | - A. Ko
- Department of Oral Health Sciences at the University of Washington, Seattle, WA, USA
| | - D.L. Chi
- Department of Oral Health Sciences at the University of Washington, Seattle, WA, USA
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14
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Ley C, Putz P. Efficacy of interventions and techniques on adherence to physiotherapy in adults: an overview of systematic reviews and panoramic meta-analysis. Syst Rev 2024; 13:137. [PMID: 38773659 PMCID: PMC11106864 DOI: 10.1186/s13643-024-02538-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/17/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Adherence to physiotherapeutic treatment and recommendations is crucial to achieving planned goals and desired health outcomes. This overview of systematic reviews synthesises the wide range of additional interventions and behaviour change techniques used in physiotherapy, exercise therapy and physical therapy to promote adherence and summarises the evidence of their efficacy. METHODS Seven databases (PEDro, PubMed, Cochrane Library, Web of Science, Scopus, PsycINFO and CINAHL) were systematically searched with terms related to physiotherapy, motivation, behaviour change, adherence and efficacy (last searched on January 31, 2023). Only systematic reviews of randomised control trials with adults were included. The screening process and quality assessment with AMSTAR-2 were conducted independently by the two authors. The extracted data was synthesised narratively. In addition, four meta-analyses were pooled in a panoramic meta-analysis. RESULTS Of 187 reviews identified in the search, 19 were included, comprising 205 unique trials. Four meta-analyses on the effects of booster sessions, behaviour change techniques, goal setting and motivational interventions showed a significantly small overall effect (SMD 0.24, 95% CI 0.13, 0.34) and no statistical heterogeneity (I2 = 0%) in the panoramic meta-analysis. Narrative synthesis revealed substantial clinical and methodological diversity. In total, the certainty of evidence is low regarding the efficacy of the investigated interventions and techniques on adherence, due to various methodological flaws. Most of the RCTs that were included in the reviews analysed cognitive and behavioural interventions in patients with musculoskeletal diseases, indicating moderate evidence for the efficacy of some techniques, particularly, booster sessions, supervision and graded exercise. The reviews provided less evidence for the efficacy of educational and psychosocial interventions and partly inconsistent findings. Most of the available evidence refers to short to medium-term efficacy. The combination of a higher number of behaviour change techniques was more efficacious. CONCLUSIONS The overview of reviews synthesised various potentially efficacious techniques that may be combined for a holistic and patient-centred approach and may support tailoring complex interventions to the patient's needs and dispositions. It also identifies various research gaps and calls for a more holistic approach to define and measure adherence in physiotherapy. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021267355.
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Affiliation(s)
- Clemens Ley
- Department Health Sciences, Physiotherapy, FH Campus Wien University of Applied Sciences, Favoritenstrasse 226, 1100, Vienna, Austria.
| | - Peter Putz
- Department Health Sciences, Competence Center INDICATION, FH Campus Wien, University of Applied Sciences, Favoritenstrasse 226, 1100, Vienna, Austria
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Larivière C, Preuss R, Coutu MF, Sullivan MJ, Roy N, Henry SM. Disability reduction following a lumbar stabilization exercise program for low back pain: large vs. small improvement subgroup analyses of physical and psychological variables. BMC Musculoskelet Disord 2024; 25:358. [PMID: 38704535 PMCID: PMC11069239 DOI: 10.1186/s12891-024-07480-4] [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: 01/08/2024] [Accepted: 04/28/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Little is known about why patients with low back pain (LBP) respond differently to treatment, and more specifically, to a lumbar stabilization exercise program. As a first step toward answering this question, the present study evaluates how subgroups of patients who demonstrate large and small clinical improvements differ in terms of physical and psychological changes during treatment. METHODS Participants (n = 110) performed the exercise program (clinical sessions and home exercises) over eight weeks, with 100 retained at six-month follow-up. Physical measures (lumbar segmental instability, motor control impairments, range of motion, trunk muscle endurance and physical performance tests) were collected twice (baseline, end of treatment), while psychological measures (fear-avoidance beliefs, pain catastrophizing, psychological distress, illness perceptions, outcome expectations) were collected at four time points (baseline, mid-treatment, end of treatment, follow-up). The participants were divided into three subgroups (large, moderate and small clinical improvements) based on the change of perceived disability scores. ANOVA for repeated measure compared well-contrasted subgroups (large vs. small improvement) at different times to test for SUBGROUP × TIME interactions. RESULTS Statistically significant interactions were observed for several physical and psychological measures. In all these interactions, the large- and small-improvement subgroups were equivalent at baseline, but the large-improvement subgroup showed more improvements over time compared to the small-improvement subgroup. For psychological measures only (fear-avoidance beliefs, pain catastrophizing, illness perceptions), between-group differences reached moderate to strong effect sizes, at the end of treatment and follow-up. CONCLUSIONS The large-improvement subgroup showed more improvement than the small-improvement subgroup with regard to physical factors typically targeted by this specific exercise program as well as for psychological factors that are known to influence clinical outcomes.
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Affiliation(s)
- Christian Larivière
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), 505, boul. De Maisonneuve Ouest, Montreal, QC, H3A 3C2, Canada.
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 6363, Hudson Road, office 061, Montreal, QC, H3S 1M9, Canada.
| | - Richard Preuss
- School of Physical & Occupational Therapy, McGill University, 845 Sherbrooke Wst, Montreal, QC, H3G 1Y5, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 6363, Hudson Road, office 061, Montreal, QC, H3S 1M9, Canada
| | - Marie-France Coutu
- Charles-Le Moyne Hospital Research Centre, University of Sherbrooke, 150 Place Charles-Le Moyne, Office 200, Longueuil, QC, J4K 0A8, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 6363, Hudson Road, office 061, Montreal, QC, H3S 1M9, Canada
| | - Michael J Sullivan
- Department of Psychology, McGill University, 1205 Docteur Penfield, Montreal, QC, H3A 1B1, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 6363, Hudson Road, office 061, Montreal, QC, H3S 1M9, Canada
| | - Nicolas Roy
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 6363, Hudson Road, office 061, Montreal, QC, H3S 1M9, Canada
| | - Sharon M Henry
- Department of Neurological Sciences, University of Vermont, Burlington, VT, 05401, USA
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Feldberg G, Ricciardi JBS, Zorzi AR, Yamaguti-Hayakawa GG, Ozelo MC. Promoting pain coping skills in haemophilia: A remote intervention integrating exercise and pain education. Haemophilia 2024; 30:800-808. [PMID: 38523258 DOI: 10.1111/hae.14991] [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: 11/02/2023] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Chronic joint pain is a significant and widespread symptom in people with haemophilia (PWH). Despite medical advancements, effective pain management remains challenging. AIM This study presents an innovative approach that integrates remote physical exercises, pain neuroscience education, and coping strategies to address chronic pain in PWH. METHODS The remote intervention consisted of sixteen 5-min videos encompassing physical exercises for chronic pain management and pain education strategies. These videos formed an 8-week remote intervention program. Clinical and physical assessments were conducted before and after the intervention. RESULTS A total of thirty-one PWHs, with a median age of 34 years (ranging from 16 to 59 years), completed the remote intervention. The study revealed significant improvements in pain intensity, disability, and physical performance among PWH with chronic pain. Enhanced functional capacity was evident in the Timed Up and Go and Single Leg Stance tests, accompanied by improved scores on the Functional Independence Score in Haemophilia (FISH). Although lacking a control group, our findings are consistent with other successful exercise and pain education programs. CONCLUSIONS This innovative intervention holds promise for managing chronic pain in PWH, underscoring patient empowerment, education, and collaboration. Notably, our study stands out by uniquely combining pain education and coping strategies, bolstering evidence for effective pain management.
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Affiliation(s)
- Glenda Feldberg
- Hemophilia Treatment Center (HTC) "Cláudio Luiz Pizzigatti Corrêa", Hemocentro UNICAMP, University of Campinas, Campinas, SP, Brazil
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Janaína B S Ricciardi
- Hemophilia Treatment Center (HTC) "Cláudio Luiz Pizzigatti Corrêa", Hemocentro UNICAMP, University of Campinas, Campinas, SP, Brazil
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Alessandro R Zorzi
- Department of Orthopedic, Rheumatology and Traumatology, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, Brazil
| | - Gabriela G Yamaguti-Hayakawa
- Hemophilia Treatment Center (HTC) "Cláudio Luiz Pizzigatti Corrêa", Hemocentro UNICAMP, University of Campinas, Campinas, SP, Brazil
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Margareth C Ozelo
- Hemophilia Treatment Center (HTC) "Cláudio Luiz Pizzigatti Corrêa", Hemocentro UNICAMP, University of Campinas, Campinas, SP, Brazil
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, SP, Brazil
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17
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Pua YH, Yeo SJ, Clark RA, Tan BY, Haines T, Bettger JP, Woon EL, Tan HH, Tan JWM, Low J, Chew E, Thumboo J. Cost and outcomes of Hospital-based Usual cAre versus Tele-monitor self-directed Rehabilitation (HUATR) in patients with total knee arthroplasty: A randomized, controlled, non-inferiority trial. Osteoarthritis Cartilage 2024; 32:601-611. [PMID: 38049030 DOI: 10.1016/j.joca.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/16/2023] [Accepted: 11/02/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE To evaluate the clinical efficacy and cost-effectiveness of telemonitored self-directed rehabilitation (TR) compared with hospital-based rehabilitation (HBR) for patients with total knee arthroplasty (TKA). DESIGN In this randomized, non-inferiority clinical trial, 114 patients with primary TKA who were able to walk independently preoperatively were randomized to receive HBR (n = 58) or TR (n = 56). HBR comprised at least five physical therapy sessions over 10 weeks. TR comprised a therapist-led onboarding session, followed by a 10-week unsupervised home-based exercise program, with asynchronous monitoring of rehabilitation outcomes using a telemonitoring system. The primary outcome was fast-paced gait speed at 12 weeks, with a non-inferiority margin of 0.10 m/s. For economic analysis, quality-adjusted-life-years (QALY) was the primary economic outcome (non-inferiority margin, 0.027 points). RESULTS In Bayesian analyses, TR had >95% posterior probability of being non-inferior to HBR in gait speed (week-12 adjusted TR-HBR difference, 0.02 m/s; 95%CrI, -0.05 to 0.10 m/s; week-24 difference, 0.01 m/s; 95%CrI, -0.07 to 0.10 m/s) and QALY (0.006 points; 95%CrI, -0.006 to 0.018 points). When evaluated from a societal perspective, TR was associated with lower mean intervention cost (adjusted TR-HBR difference, -S$227; 95%CrI, -112 to -330) after 24 weeks, with 82% probability of being cost-effective compared with HBR at a willingness to pay of S$0/unit of effect for the QALYs. CONCLUSIONS In patients with uncomplicated TKAs and relatively good preoperative physical function, home-based, self-directed TR was non-inferior to and more cost-effective than HBR over a 24-week follow-up period. TR should be considered for this patient subgroup.
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Affiliation(s)
- Yong-Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore; Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore, Singapore.
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
| | - Ross Allan Clark
- Research Health Institute, University of the Sunshine Coast, Sunshine Coast, Australia.
| | - Bryan Yijia Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; Department of Orthopaedic Surgery, Woodlands Health, Singapore, Singapore.
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia.
| | - Janet Prvu Bettger
- Health and Rehabilitation Sciences, College of Public Health, Temple University, Philadelphia, PA, USA.
| | - Ee-Lin Woon
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore.
| | - Hong Han Tan
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore.
| | - John Wei-Ming Tan
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore.
| | - Juanita Low
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore.
| | - Eleanor Chew
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore.
| | - Julian Thumboo
- Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore, Singapore; Health Services Research & Evaluation, SingHealth Office of Regional Health, Singapore, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.
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Mattila M, Honkanen S, Sjögren T, Piirainen A, Aartolahti E. Interaction during equine-facilitated rehabilitation from the rehabilitees' perspective - A phenomenological study. Physiother Theory Pract 2024; 40:999-1010. [PMID: 36437737 DOI: 10.1080/09593985.2022.2151332] [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: 12/19/2021] [Revised: 11/09/2022] [Accepted: 11/19/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Interaction has a multidimensional role in equine-facilitated rehabilitation. PURPOSE The aim of this study was to understand rehabilitees' experiences of interaction during equine-facilitated rehabilitation. METHODS Six children and four adults with individual diagnoses or reasons to participate in equine-facilitated rehabilitation were included in this qualitative study. Data were collected by interviewing individually the rehabilitees. A phenomenological Spiegelberg's seven-phase meaning analysis was performed to reveal the meanings. RESULTS Seven meanings were identified: 1) Trust; 2) Friendly horse; 3) Mirror of feelings; 4) Inspiring riding; 5) Feeling competent; 6) Rehabilitee-oriented approach; and 7) Uniting experience. In addition, the essential meanings of the phenomenon form three different circles: circle of recognition, circle of supporting active agency and circle of empowerment. CONCLUSION Interaction during equine-facilitated rehabilitation is essential to rehabilitees in many ways that have important roles in the entire rehabilitation process that aims for empowerment in the rehabilitees' daily lives.
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Affiliation(s)
- Minna Mattila
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Sari Honkanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Tuulikki Sjögren
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Arja Piirainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Eeva Aartolahti
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Institute of Rehabilitation, JAMK University of Applied Science, Jyväskylä, Finland
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Zimney KJ, Puentedura E, Kolber MJ, Louw A. The correlation of trust as part of the therapeutic alliance in physical therapy and their relation to outcomes for patients with chronic low back pain. Physiother Theory Pract 2024:1-8. [PMID: 38578206 DOI: 10.1080/09593985.2024.2338428] [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: 01/24/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Previous qualitative research has listed trust as a component of the therapeutic alliance in physical therapy. OBJECTIVE Quantitatively correlate trust and therapeutic alliance in physical therapy care for patients with chronic low back pain. The secondary aim was to investigate the relation of trust and therapeutic alliance with outcomes over the course of treatment. METHODS The Primary Care Assessment Survey was used to measure trust and the Working Alliance Inventory-Short Revised tool measured therapeutic alliance. The patient recorded these measures after the initial visit and at discharge. Self-report patient outcome measures for pain, function, and global rating of change were also measured at the same time points. RESULTS A strong correlation (rs = 0.747 and rs = 0.801) was found between trust scores and therapeutic alliance measures post-initial visit and at discharge, respectively. In addition, there were moderate to strong correlations between trust and therapeutic alliance scores with the various improved outcome measures of pain, function, and global rating of change. CONCLUSION There appears to be a connection between trust and therapeutic alliance along with improved patient outcomes related to higher trust and therapeutic alliance scores in a cohort with chronic low back pain.
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Affiliation(s)
- Kory J Zimney
- Department of Physical Therapy, University of South Dakota, Vermillion, SD, USA
| | | | - Morey J Kolber
- Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, FL, USA
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Carpi M, Bruschini M, Di Vito A, Burla F. Burnout and perceived stress among Italian physical therapists during the COVID-19 pandemic: a cross-sectional study. PSYCHOL HEALTH MED 2024; 29:843-855. [PMID: 37647243 DOI: 10.1080/13548506.2023.2253508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 08/25/2023] [Indexed: 09/01/2023]
Abstract
High levels of burnout and psychological distress have been reported for healthcare workers, with seemingly worse outcomes after the outbreak of the COVID-19 pandemic. However, to date, scarce evidence has been gathered about the condition of physical therapists. This cross-sectional study investigated the three burnout dimensions of emotional exhaustion, depersonalization, and personal accomplishment as measured by the Maslach Burnout Inventory (MBI) and assessed perceived stress with the 10-item Perceived Stress Scale (PSS) in a sample of Italian physical therapists with the aim of examining the relationships between these variables and demographic and work-related factors. An anonymous questionnaire was administered to a convenience sample of 671 professionals from the whole nation and associations between burnout, perceived stress, and work-related variables were investigated with descriptive and inferential statistical methods. Overall, 25% of the participants showed high burnout risk (40% scored high on emotional exhaustion, 36% scored high on depersonalization, and 19% scored low on personal accomplishment), whereas 50% reported high levels of perceived stress. Having been exposed to verbal or physical aggressive behaviors at work (OR = 4.06) was associated with high burnout risk, and participants at risk were significantly younger than those showing no burnout risk (d = 0.27). Having a partner (OR = 0.54) and having children (OR = 0.56) were associated on the other hand with reduced burnout risk. Regression models identified weekly working hours (β = 0.16), exposure to aggressive behaviors at work (β = 0.12), and perceived stress (β = 0.66) as significant predictors of emotional exhaustion, gender (β = 0.18), exposure to aggressive behaviors (β = 0.09), and perceived stress (β = 0.37) as predictors of depersonalization, and gender (β=-0.1) and perceived stress (β=-0.35) as predictors of personal accomplishment.In summary, this study found high rates of burnout and psychological distress among Italian physical therapists a year after the outbreak of COVID-19. Significant relations were found between burnout, psychological distress, and both socio-demographic and work-related variables.
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Affiliation(s)
- Matteo Carpi
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Marco Bruschini
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessandro Di Vito
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Education and Competence Development Unit, San Giovanni Addolorata Hospital, Rome, Italy
| | - Franco Burla
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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Ivanova D, Newell D, Field J, Bishop FL. The development of working alliance in early stages of care from the perspective of patients attending a chiropractic teaching clinic. Chiropr Man Therap 2024; 32:10. [PMID: 38515190 PMCID: PMC10958961 DOI: 10.1186/s12998-023-00527-8] [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: 09/11/2023] [Accepted: 12/21/2023] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The clinician-patient relationship has consistently been found to predict treatment success in both physical and mental health settings. This relationship has been operationalised in the literature as "Working Alliance," which consists of three key components: patient-clinician agreement on the goals of care, agreement on the tasks required to achieve those goals, and the establishment of a strong bond. While research has demonstrated the impact of working alliance in physical health settings, it often measures working alliance early in patients' care journeys. However, no primary research has investigated how early working alliance develops between patients and chiropractors. Evidence suggests that musculoskeletal practitioners may require further training to feel confident in establishing working alliance. Therefore, this study aims to explore the development of working alliance in the early stages of chiropractic care from the patients' perspective to inform evidence-based practice. METHODS Participants for this qualitative study were recruited from a teaching clinic at a specialised healthcare professions training university in the United Kingdom between September 2022 and April 2023. A total of 25 adult patients completed semi-structured interviews during the early stages of their care. The interview transcripts were analysed using Reflexive Thematic Analysis, from a critical realist stance. RESULTS The findings highlight that an early working alliance entails the gradual development of patients' confidence in their decision to seek help from trainee chiropractors to alleviate their symptoms. The four themes describe the impact of the clinical context on patients' expectations, the trainee chiropractors' qualities that participants considered important for early working alliance, the role of explanations, and the interplay between pain and early working alliance. CONCLUSIONS Establishing an early trainee chiropractor-patient working alliance involves a process of building patients' confidence in the trainee chiropractors' expertise, identifying the correct goals of care, and recognising the value of the proposed treatment plan. Factors shaping this process include the context of the care journey, patients' perceptions of trainee chiropractors' qualities, their bodily sensations, their expectations, their past experiences, and their satisfaction with trainee chiropractors' explanations.
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Affiliation(s)
- Dima Ivanova
- School of Psychology, University of Southampton, University Road, Southampton, Hampshire, SO17 1BJ, UK.
| | - Dave Newell
- AECC University College, Parkwood Campus, Parkwood Road, Bournemouth, Dorset, BH5 2DF, UK
| | | | - Felicity L Bishop
- School of Psychology, University of Southampton, University Road, Southampton, Hampshire, SO17 1BJ, UK
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22
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Seebacher B, Geimer C, Neu J, Schwarz M, Diermayr G. Identifying central elements of the therapeutic alliance in the setting of telerehabilitation: A qualitative study. PLoS One 2024; 19:e0299909. [PMID: 38457374 PMCID: PMC10923432 DOI: 10.1371/journal.pone.0299909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 02/17/2024] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION Therapeutic alliance is a relevant aspect of healthcare and may influence patient outcomes. So far, little is known about the therapeutic alliance in telerehabilitation. PURPOSE To identify and describe central elements of therapeutic alliance in the setting of telerehabilitation and compare it to those in conventional rehabilitation. METHODS In this qualitative study, a literature search and in-depth semi-structured interviews with rehabilitation and telerehabilitation experts were conducted from 15.5.-10.8.2020 on elements influencing the therapeutic alliance in rehabilitation and telerehabilitation. Using a combined deductive and inductive approach, qualitative content analysis was used to identify categories and derive central themes. RESULTS The elements bond, communication, agreement on goals and tasks and external factors were identified in the literature search and informed the development of the interview guide. Twelve purposively sampled experts from the fields of physiotherapy, occupational therapy, speech and language therapy, psychology, general medicine, sports science and telerehabilitation software development participated in the interviews. We identified three central themes: building effective communication; nurturing a mutual relationship of trust and respect; and agreement on goals and tasks and drivers of motivation. CONCLUSIONS In this qualitative study, key elements of therapeutic alliance in rehabilitation confirmed those reported in the literature, with additional elements in telerehabilitation comprising support from others for ensuring physical safety and technical connectedness, caregivers acting as co-therapists and applying professional touch, and promoting patient autonomy and motivation using specific strategies.
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Affiliation(s)
- Barbara Seebacher
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Rehabilitation Science, Clinic for Rehabilitation Münster, Münster, Austria
| | - Carole Geimer
- School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
| | - Julia Neu
- School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
| | - Maria Schwarz
- Department of Psychosocial Rehabilitation, Clinic for Rehabilitation Münster, Münster, Österreich
| | - Gudrun Diermayr
- School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
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23
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Benzo MV, Kelpin SS, Werneburg B, Hoult J, Clark MM, Novotny P, Benzo R. Patient Engagement in Health Coaching and Self-Management Abilities in Chronic Obstructive Pulmonary Disease. Am J Lifestyle Med 2024; 18:243-251. [PMID: 38559791 PMCID: PMC10979730 DOI: 10.1177/15598276221120523] [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: 04/04/2024] Open
Abstract
Objective: Health coaching has the potential to improve self-management abilities (SM) in patients with Chronic Obstructive Pulmonary Disease (COPD). Patient engagement with health care providers has a beneficial effect on patient outcomes. We examined the association of patient engagement with the health coach on SM abilities in patients with COPD. Methods: We analyzed the association between the degree of engagement measured by the Working Alliance Inventory (WAI-SR) and the SM measured by the Self-Management-Ability-Scale-30 (SMAS-30) at the end of a COPD health coaching intervention. Results: The cohort included 146 moderate to severe COPD patients. The WAI-SR total score was 85% of the maximum possible scores indicating a high degree of engagement between the health coach and the patients. The WAI-SR Task and Bond domains were positively associated with SM abilities after adjusting for lung function (FEV1 %) and depression symptoms (PHQ-2). Conclusion: The degree of engagement between a health coach and patients is associated with the perception of SM abilities in patients with COPD. Our results may inform self-management intervention and clinical practice.
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Affiliation(s)
- Maria V. Benzo
- Mindful Breathing Lab, Mayo Clinic, Rochester, MN, USA (MVB, JH, RB); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA (SSK, MMC); Patient Experience-Training, Education & Coaching, Mayo Clinic, Rochester, MN, USA (BW); and Research Services, Mayo Clinic, Rochester, MN, USA (PN)
| | - Sydney S. Kelpin
- Mindful Breathing Lab, Mayo Clinic, Rochester, MN, USA (MVB, JH, RB); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA (SSK, MMC); Patient Experience-Training, Education & Coaching, Mayo Clinic, Rochester, MN, USA (BW); and Research Services, Mayo Clinic, Rochester, MN, USA (PN)
| | - Brooke Werneburg
- Mindful Breathing Lab, Mayo Clinic, Rochester, MN, USA (MVB, JH, RB); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA (SSK, MMC); Patient Experience-Training, Education & Coaching, Mayo Clinic, Rochester, MN, USA (BW); and Research Services, Mayo Clinic, Rochester, MN, USA (PN)
| | - Johanna Hoult
- Mindful Breathing Lab, Mayo Clinic, Rochester, MN, USA (MVB, JH, RB); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA (SSK, MMC); Patient Experience-Training, Education & Coaching, Mayo Clinic, Rochester, MN, USA (BW); and Research Services, Mayo Clinic, Rochester, MN, USA (PN)
| | - Matthew M. Clark
- Mindful Breathing Lab, Mayo Clinic, Rochester, MN, USA (MVB, JH, RB); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA (SSK, MMC); Patient Experience-Training, Education & Coaching, Mayo Clinic, Rochester, MN, USA (BW); and Research Services, Mayo Clinic, Rochester, MN, USA (PN)
| | - Paul Novotny
- Mindful Breathing Lab, Mayo Clinic, Rochester, MN, USA (MVB, JH, RB); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA (SSK, MMC); Patient Experience-Training, Education & Coaching, Mayo Clinic, Rochester, MN, USA (BW); and Research Services, Mayo Clinic, Rochester, MN, USA (PN)
| | - Roberto Benzo
- Mindful Breathing Lab, Mayo Clinic, Rochester, MN, USA (MVB, JH, RB); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA (SSK, MMC); Patient Experience-Training, Education & Coaching, Mayo Clinic, Rochester, MN, USA (BW); and Research Services, Mayo Clinic, Rochester, MN, USA (PN)
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24
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Barrett DR, Nielsen LM, Rhon DI, Young JL. What are patients' perspectives on the value of physical therapy? A prospective cohort study. Musculoskeletal Care 2024; 22:e1871. [PMID: 38393306 DOI: 10.1002/msc.1871] [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: 01/30/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE To assess and identify patients' perceptions about the overall value of physical therapy services for musculoskeletal conditions and how these values were associated with their outcomes. METHODS The association between the perceived value of physical therapy (as a score) and Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference and physical function at 6-weeks was assessed in a prospective cohort. Generalised linear models were used to identify relationships between the value of physical therapy score and PROMIS outcomes. Kendall's tau was used to identify correlations between responses and outcomes. RESULTS A total of 133 participants met the final inclusion criteria. The majority of participants were female (63.9%) with a mean age of 55.53 (SD 15.36) years. A majority of participants (63.9%) reported a previous positive personal experience with physical therapy. There was no significant relationship between perceived value of physical therapy and pain interference (β -0.32, p = 0.07, 95% CI-0.67, 0.03) or physical function (β 0.19, p = 0.29, 95% CI-0.16, 0.54). Stronger beliefs in agreement with the value of non-invasive treatment were significant, but weakly correlated with lower pain interference (r = -0.18, p = 0.048) and higher physical function scores (r = 0.22, p = 0.03). CONCLUSIONS Participants had an overall positive perception of the value of physical therapy prior to initiating physical therapy, but this perception was not associated with 6-week pain and function outcomes. A better understanding of the driving factors encouraging patients to seek physical therapy services is needed to provide value-based care.
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Affiliation(s)
- Dustin R Barrett
- Bellin College, Physical Therapy, Green Bay, Wisconsin, USA
- Department of Physical Therapy, Emory and Henry College, Marion, Virginia, USA
| | | | - Daniel I Rhon
- Bellin College, Physical Therapy, Green Bay, Wisconsin, USA
- Department of Physical Medicine & Rehabilitation, F. Edward Hébert School of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Jodi L Young
- Bellin College, Physical Therapy, Green Bay, Wisconsin, USA
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25
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Kunavar T, Jamšek M, Avila-Mireles EJ, Rueckert E, Peternel L, Babič J. The Effects of Different Motor Teaching Strategies on Learning a Complex Motor Task. SENSORS (BASEL, SWITZERLAND) 2024; 24:1231. [PMID: 38400387 PMCID: PMC10892071 DOI: 10.3390/s24041231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024]
Abstract
During the learning of a new sensorimotor task, individuals are usually provided with instructional stimuli and relevant information about the target task. The inclusion of haptic devices in the study of this kind of learning has greatly helped in the understanding of how an individual can improve or acquire new skills. However, the way in which the information and stimuli are delivered has not been extensively explored. We have designed a challenging task with nonintuitive visuomotor perturbation that allows us to apply and compare different motor strategies to study the teaching process and to avoid the interference of previous knowledge present in the naïve subjects. Three subject groups participated in our experiment, where the learning by repetition without assistance, learning by repetition with assistance, and task Segmentation Learning techniques were performed with a haptic robot. Our results show that all the groups were able to successfully complete the task and that the subjects' performance during training and evaluation was not affected by modifying the teaching strategy. Nevertheless, our results indicate that the presented task design is useful for the study of sensorimotor teaching and that the presented metrics are suitable for exploring the evolution of the accuracy and precision during learning.
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Affiliation(s)
- Tjasa Kunavar
- Laboratory for Neromechanics and Biorobotics, Department of Automatics and Biocybernetics, Jožef Stefan Institute, 1000 Ljubljana, Slovenia
- Jožef Stefan International Postgraduate School, Jamova cesta 39, 1000 Ljubljana, Slovenia
| | - Marko Jamšek
- Laboratory for Neromechanics and Biorobotics, Department of Automatics and Biocybernetics, Jožef Stefan Institute, 1000 Ljubljana, Slovenia
| | - Edwin Johnatan Avila-Mireles
- Laboratory for Neromechanics and Biorobotics, Department of Automatics and Biocybernetics, Jožef Stefan Institute, 1000 Ljubljana, Slovenia
| | - Elmar Rueckert
- Chair of Cyber-Physical-Systems, Montauniversität Leoben, 8700 Leoben, Austria
| | - Luka Peternel
- Department of Cognitive Robotics, Delft University of Technology, 2628 CD Delft, The Netherlands
| | - Jan Babič
- Laboratory for Neromechanics and Biorobotics, Department of Automatics and Biocybernetics, Jožef Stefan Institute, 1000 Ljubljana, Slovenia
- Faculty of Electrical Engineering, University of Ljubljana, 1000 Ljubljana, Slovenia
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26
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Wood L, Foster NE, Dean SG, Booth V, Hayden JA, Booth A. Contexts, behavioural mechanisms and outcomes to optimise therapeutic exercise prescription for persistent low back pain: a realist review. Br J Sports Med 2024; 58:222-230. [PMID: 38176852 DOI: 10.1136/bjsports-2023-107598] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE Therapeutic exercises are a core treatment for low back pain (LBP), but it is uncertain how rehabilitative exercise facilitates change in outcomes. Realist reviews explore how the context (C) of certain settings or populations and underlying mechanisms (M) create intended or unintended outcomes (O). Our objective was to explore and understand the behavioural mechanisms by which therapeutic exercise creates change in outcomes of adherence, engagement and clinical outcomes for patients with LBP. METHODS This was a realist review reported following the Realist and Meta-narrative Evidence Syntheses: Evolving Standards guidance. We developed initial programme theories, modified with input from a steering group (experts, n=5), stakeholder group (patients and clinicians, n=10) and a scoping search of the published literature (n=37). Subsequently, an information specialist designed and undertook an iterative search strategy, and we refined and tested CMO configurations. RESULTS Of 522 initial papers identified, 75 papers were included to modify and test CMO configurations. We found that the patient-clinician therapeutic consultation builds a foundation of trust and was associated with improved adherence, engagement and clinical outcomes, and that individualised exercise prescription increases motivation to adhere to exercise and thus also impacts clinical outcomes. Provision of support such as timely follow-up and supervision can further facilitate motivation and confidence to improve adherence to therapeutic exercises for LBP. CONCLUSIONS Engagement in and adherence to therapeutic exercises for LBP, as well as clinical outcomes, may be optimised using mechanisms of trust, motivation and confidence. These CMO configurations provide a deeper understanding of ways to optimise exercise prescription for patients with LBP.
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Affiliation(s)
- Lianne Wood
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nadine E Foster
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Brisbane, Queensland, Australia
| | | | - Vicky Booth
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Nottingham, UK
| | - Jill A Hayden
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew Booth
- Information Resources Group, University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
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27
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Wood L, Booth V, Dean S, Foster NE, Hayden JA, Booth A. Understanding how therapeutic exercise prescription changes outcomes important to patients with persistent non-specific low back pain: a realist review protocol. Syst Rev 2024; 13:63. [PMID: 38331838 PMCID: PMC10854159 DOI: 10.1186/s13643-024-02466-8] [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: 06/07/2023] [Accepted: 01/20/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Persistent low back pain (LBP) is the leading cause of disability worldwide, and therapeutic exercise is recommended as a first-line treatment in international guidelines. The effects of exercise on clinical outcomes of pain and physical function are small to moderate, despite broader impacts on cardiovascular systems, biological health, mood, and emotional well-being. Therapeutic exercise prescription is defined as exercise that is prescribed by a clinician for a health-related treatment. It is unknown how therapeutic exercise prescription creates effects on outcomes of importance. Realist reviews explore how underlying mechanisms (M) may be active in the context (C) of certain situations, settings, or populations to create an intended or unintended outcome (O). Our objective is to explore and understand the mechanisms by which therapeutic exercise prescription changes outcomes for people with persistent LBP. METHODS We will develop initial programme theories based on preliminary data from a previous systematic review and consensus workshop. These theories will be modified with input from a steering group (experts), a stakeholder group (people with lived experience of exercise for persistent LBP and clinicians), and a scoping search of the published literature. An information specialist will design and undertake an iterative search strategy. These will be used to create CMO configurations, which will be refined and tested using the literature. The realist review will be reported following RAMESES guidance. DISCUSSION Realist reviews are uncommon in LBP research to date, yet those offer an opportunity to contrast with traditional methods of randomised controlled trials and systematic reviews and provide additional information regarding the contexts and mechanisms that may trigger certain outcomes. This can aid our understanding of the contextual features that may influence exercise prescription, such as for whom they are most effective, in what setting, how they are implemented and why. This realist synthesis will enhance our understanding of therapeutic exercise prescription to improve adherence and engagement and ultimately will provide clinically relevant recommendations regarding exercise prescription for those with persistent LBP. SYSTEMATIC REVIEW REGISTRATION The review has been registered with PROSPERO (CRD42017072023).
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Affiliation(s)
- Lianne Wood
- Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences University of Exeter, Exeter, UK.
- Faculty of Medicine, University of Keele, Newcastle Under Lyme, UK.
- Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Vicky Booth
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Nottingham, UK
| | - Sarah Dean
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Nadine E Foster
- Faculty of Medicine, University of Keele, Newcastle Under Lyme, UK
- Surgical, Treatment And Rehabilitation Service (STARS) Education and Research Alliance, Metro North Health and The University of Queensland, Brisbane, QLD, Australia
| | - Jill A Hayden
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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28
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van der Meer HA, Doomen A, Visscher CM, Engelbert RHH, Nijhuis-van der Sanden MWG, Speksnijder CM. The additional value of e-Health for patients with a temporomandibular disorder: a mixed methods study on the perspectives of orofacial physical therapists and patients. Disabil Rehabil Assist Technol 2024; 19:433-445. [PMID: 35960692 DOI: 10.1080/17483107.2022.2094000] [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: 09/14/2021] [Accepted: 06/17/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE To assess the experience and perceived added value of an e-Health application during the physical therapy treatment of patients with temporomandibular disorders (TMD). MATERIALS AND METHODS A mixed-methods study including semi-structured interviews was performed with orofacial physical therapists (OPTs) and with TMD patients regarding their experience using an e-Health application, Physitrack. The modified telemedicine satisfaction and usefulness questionnaire and pain intensity score before and after treatment were collected from the patients. RESULTS Ten OPTs, of which nine actively used Physitrack, described that the e-Health application can help to provide personalised care to patients with TMD, due to the satisfying content, user-friendliness, accessibility, efficiency, and ability to motivate patients. Ten patients, of which nine ended up using Physitrack, felt that shared decision-making was very important. These patients were positive towards the application as it was clear, convenient, and efficient, it helped with reassurance and adherence to the exercises and overall increased self-efficacy. This was mostly built on their experience with exercise videos, as this feature was most used. None of the OPTs or patients used all features of Physitrack. The overall satisfaction of Physitrack based on the telemedicine satisfaction and usefulness questionnaire (TSUQ) was 20.5 ± 4.0 and all patients (100%) showed a clinically relevant reduction of TMD pain (more than 2 points and minimally 30% difference). CONCLUSION OPTs and patients with TMD shared the idea that exercise videos are of added value on top of usual physical therapy care for TMD complaints, which could be delivered through e-Health.Implications for RehabilitationPhysical therapists and patients with temporomandibular disorders do not use all features of the e-Health application Physitrack in a clinical setting.Exercise videos were the most often used feature and seen as most valuable by physical therapists and patients.Based on a small number of participants, e-Health applications such as Physitrack may be perceived as a valuable addition to the usual care, though this would need verification by a study designed to evaluate the therapeutic effect (e.g., a randomised clinical trial).
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Affiliation(s)
- Hedwig A van der Meer
- University Medical Center Utrecht, Department of Oral-Maxillofacial Surgery and Special Dental Care, Utrecht University, Utrecht, The Netherlands
- Department of Orofacial Pain and Disfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit (VU) University Amsterdam, Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation, Amsterdam, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Location Meibergdreef 9, The Netherlands
- Radboud University Medical Center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Annet Doomen
- Physiotherapy Private Practice 'De Molen', Houten, The Netherlands
- Institute of Movement Studies, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Corine M Visscher
- Department of Orofacial Pain and Disfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit (VU) University Amsterdam, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation, Amsterdam, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Location Meibergdreef 9, The Netherlands
| | | | - Caroline M Speksnijder
- University Medical Center Utrecht, Department of Oral-Maxillofacial Surgery and Special Dental Care, Utrecht University, Utrecht, The Netherlands
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29
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Rodríguez-Nogueira Ó, Leirós-Rodríguez R, Pinto-Carral A, Álvarez-Álvarez MJ, Morera-Balaguer J, Moreno-Poyato AR. Relationship between competency for evidence-based practice and level of burnout of physical therapists with the establishment of the therapeutic relationship. Physiother Theory Pract 2024; 40:357-365. [PMID: 35972934 DOI: 10.1080/09593985.2022.2112638] [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: 05/17/2022] [Accepted: 08/06/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Evidence-based practice (EBP) interventions and effective therapeutic alliance (TA) are associated with greater treatment success. Furthermore, burnout syndrome could be detrimental to the development of such TA. OBJECTIVE To examine the association between EBP competencies and burnout level with the quality of TA among Spanish physiotherapists. METHODS Cross-sectional research with an electronic survey including the EBP Questionnaire-19, Maslach Burnout Inventory and Working Alliance Inventory-Short (WAI-S) and administered to 471 physiotherapists. RESULTS Regarding the EBP Questionnaire-19, physiotherapists scored highest on attitude and lowest on knowledge. For WAIS which achieved appropriate results of internal consistency and validity in the sample analyzed, bond scored the highest and goals the lowest. Years of experience was significantly associated with the task (r = 0.5; p = .003) and bond (r = 0.7; p = .002) and the WAIS total score (r = 0.8; p < .001), and all burnout subscales (-0.7 < r > 0.7; p < .001 for all). CONCLUSION Lower levels of burnout and improved EBP competencies are associated with a TA of greater quality. The association between attitudes toward EBP, a higher level of self-confidence and a lower perception of depersonalization appear to be determinant factors for improving TA.
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Affiliation(s)
- Óscar Rodríguez-Nogueira
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Universidad de León, Leon, Spain
| | - Raquel Leirós-Rodríguez
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Universidad de León, Leon, Spain
| | - Arrate Pinto-Carral
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Universidad de León, Leon, Spain
| | - María José Álvarez-Álvarez
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Universidad de León, Leon, Spain
| | - Jaume Morera-Balaguer
- Physical Therapy Department, CEU Universities, Universidad Cardenal Herrera-CEU, Elche, Spain
| | - Antonio R Moreno-Poyato
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Feixa Llarga, Hospitalet del Llobregat, Spain
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30
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Kleiner MJ, Kinsella EA, Miciak M, Teachman G, Walton DM. "Passion to do the right thing": searching for the 'good' in physiotherapist practice. Physiother Theory Pract 2024; 40:288-303. [PMID: 36097762 DOI: 10.1080/09593985.2022.2116740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 08/17/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Practitioners' perspectives of what constitutes a 'good' physiotherapist have not been explicitly examined despite their potential implications for the future practice of physiotherapy. Physiotherapists' perceptions may inform professional priorities including education curricula, professional practices, competency profiles, and patient interactions. PURPOSE The purpose of this research was to examine physiotherapists' perceptions of what constitutes a 'good' physiotherapist. The context of the study was musculoskeletal practice (MSK). METHODS A hermeneutic phenomenological investigation was undertaken. Semi-structured interviews were conducted with twelve experienced MSK physiotherapists to examine their perceptions of what constitutes a 'good' physiotherapist. FINDINGS Seven themes were identified. Good physiotherapists were depicted as: 1) oriented to care; 2) integrating knowledge sources; 3) competent; 4) responsive; 5) reflective; 6) communicative; and 7) reasoning. To deepen the understanding of these themes, we discuss the findings in relation to Joan Tronto's ethic of care theory. CONCLUSIONS Physiotherapists' perceptions of what constitutes a 'good' physiotherapist highlight practices that may underpin an ethic of care including the pivotal role of person-centered and relational dimensions of practice. The findings call into question the profession's emphasis on a technical rationalist approach to education and clinical practice and invites conversation about future directions that balance technical competence with relational dimensions of practice.
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Affiliation(s)
- Michelle J Kleiner
- QuinnRehab, Barrie, ON, Canada
- Health and Rehabilitation Sciences Graduate Program, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Elizabeth Anne Kinsella
- Health and Rehabilitation Sciences Graduate Program, Faculty of Health Sciences, Western University, London, ON, Canada
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Maxi Miciak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Gail Teachman
- Health and Rehabilitation Sciences Graduate Program, Faculty of Health Sciences, Western University, London, ON, Canada
- School of Occupational Therapy, Faculty of Health Sciences, Western University, Elborn College, London, ON, Canada
| | - David M Walton
- Health and Rehabilitation Sciences Graduate Program, Faculty of Health Sciences, Western University, London, ON, Canada
- School of Physical Therapy, Faculty of Health Sciences, Western University, Elborn College, London, ON, Canada
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Tiong K, Palmer GM, Jaaniste T. Attrition from Face-to-Face Pediatric Outpatient Chronic Pain Interventions: A Narrative Review and Theoretical Model. CHILDREN (BASEL, SWITZERLAND) 2024; 11:126. [PMID: 38275436 PMCID: PMC10814025 DOI: 10.3390/children11010126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
There is limited understanding of attrition (premature treatment withdrawal and non-completion) from pediatric chronic pain services. This narrative review aimed to summarize attrition prevalence from face-to-face pediatric outpatient chronic pain interventions, identify associated factors and develop a theoretical model to account for attrition in this setting. A comprehensive search of the published literature revealed massive variability (0-100%) in the reported attrition rates from pediatric chronic pain interventions that varied in type and format (individual vs. group, single discipline vs. interdisciplinary, psychological only vs. multiple combined interventions, of different durations). The factors associated with attrition from pediatric chronic pain programs varied between the studies: some have assessed patient sex, psychological and other comorbidities, avoidance strategies, missed schooling, family composition/tensions, caregiver catastrophizing, scheduling, caregiver leave and clinic access. A theoretical model is presented depicting youth, caregiver and service factors that may impact attrition from pediatric chronic pain interventions. Where available, literature is drawn from the pediatric chronic pain context, but also from adult chronic pain and pediatric weight management fields. The implications for research and clinical practice are discussed, including improved reporting, patient screening and targeted supports to promote intervention completion. This review contributes to a better understanding of attrition, which is crucial for optimizing pediatric chronic pain service outcomes.
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Affiliation(s)
- Kristen Tiong
- School of Clinical Medicine, University of New South Wales, Kensington, NSW 2052, Australia;
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Greta M. Palmer
- Children’s Pain Management Service, Department of Anaesthesia and Pain Management, Royal Children’s Hospital, Melbourne, VIC 3052, Australia;
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
| | - Tiina Jaaniste
- School of Clinical Medicine, University of New South Wales, Kensington, NSW 2052, Australia;
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
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Godfrey N, Donovan-Hall M, Roberts L. A qualitative study exploring the ritual-like activity and therapeutic relationship between Pilates teachers and clients with persistent low back pain. J Bodyw Mov Ther 2024; 37:25-37. [PMID: 38432814 DOI: 10.1016/j.jbmt.2023.11.004] [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: 03/19/2022] [Revised: 10/02/2023] [Accepted: 11/06/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND AND PURPOSE Pilates is a commonly recommended exercise modality for the management of persistent low back pain. Whilst guidelines recommend the use of exercise for low back pain, research suggests that no one exercise is superior, creating a question over the mechanism of effect. The patient-practitioner relationship may be important in managing low back pain; however, the relationship between Pilates teachers and clients is not well understood. The purpose of this study was to identify the components of the relationship between Pilates teachers and clients with persistent low back pain, explore key influences on the relationship, and ascertain the nature of the relationship. METHOD We conducted a qualitative, ethnographically-informed study at eight sites in the South of England, observing 24 Pilates sessions and interviewing 9 Pilates teachers and 10 clients with persistent low back pain. Fieldnotes and interview transcripts were analysed thematically. RESULTS The findings demonstrate a complex, multi-faceted interaction that occurs during Pilates sessions, grounded within certain health perceptions, and predicated on expectations of individuality, choice and expertise. A key finding reveals the perceived importance of mastery of prescribed movements with control and precision, in which clients particularly value the authority of the teacher in a directive learning environment. CONCLUSION We contend that the role of the Pilates teacher in this study facilitated the alleviation of clients' distress through the application of ritual-like Pilates activity. We conclude that the relationship between Pilates teachers and clients with persistent low back pain may be considered a therapeutic relationship.
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Affiliation(s)
- Nicola Godfrey
- University of Southampton, Health Sciences, Highfield, Southampton, Hants, SO17 1BJ, UK.
| | - Maggie Donovan-Hall
- University of Southampton, Health Sciences, Highfield, Southampton, Hants, SO17 1BJ, UK.
| | - Lisa Roberts
- University of Southampton, Health Sciences, Highfield, Southampton, Hants, SO17 1BJ, UK.
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Cook CE, O’Halloran B, Karas S, Klopper M, Young JL. Treatment fidelity in clinical trials. Arch Physiother 2024; 14:65-69. [PMID: 39308755 PMCID: PMC11413885 DOI: 10.33393/aop.2024.3128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 08/18/2024] [Indexed: 09/25/2024] Open
Abstract
In the context of clinical trials, treatment fidelity (TF) has traditionally referred to the extent to which an intervention or treatment is implemented by the clinicians as intended by the researchers who designed the trial. Updated definitions of TF have included an appropriate design of the intervention that was performed in a way that is known to be therapeutically beneficial. This requires careful attention to three key components: (1) protocol and dosage adherence, (2) quality of delivery, and (3) participant adherence. In this viewpoint, we describe several cases in which TF was lacking in clinical trials and give opportunities to improve the deficits encountered in those trials. We feel that along with quality, risk of bias, and certainty of evidence, TF should be considered an essential element of the veracity of clinical trial.
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Affiliation(s)
- Chad E. Cook
- Department of Orthopaedics, Duke University School of Medicine, Duke University, Durham, North Carolina - USA
- Department of Population Health Sciences, Duke University, Durham, North Carolina - USA
- Duke Clinical Research Institute, Duke University, Durham, North Carolina - USA
| | - Bryan O’Halloran
- Division of Physical Therapy, Medical University of South Carolina, Charleston, South Carolina - USA
| | - Steve Karas
- Department of Physical Therapy, Chatham University, Pittsburgh, Pennsylvania - USA
| | - Mareli Klopper
- Department of Physical Therapy, Graceland University, Independence, MO - USA
| | - Jodi L. Young
- Department of Physical Therapy, Bellin College, Green Bay, Wisconsin - USA
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Karachi F, van Nes MB, Gosselink R, Hanekom S. Patient perceptions of ICU physiotherapy: 'Your body needs to go somewhere to be recharged … '. SOUTHERN AFRICAN JOURNAL OF CRITICAL CARE 2023; 39:e1092. [PMID: 38357692 PMCID: PMC10866209 DOI: 10.7196/sajcc.2023.v39i3.1092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 02/16/2024] Open
Abstract
Background Patient satisfaction is an essential concept to consider for the improvement of quality care in healthcare centres and hospitals and has been linked to increased patient compliance with treatment plans, better patient safety and improved clinical outcomes. Objectives As part of a before-and-after clinical trial aimed to investigate the implementation of an evidence-based and -validated physiotherapy protocol within a surgical intensive care unit (ICU), we decided to include the patient perception of physiotherapy received in the intervention unit. Methods A nested, exploratory, descriptive, qualitative study design was adopted. Purposively selected adult patients discharged from ICU during the implementation phase of the trial were interviewed. Results Eighteen patients (10 male) with a median age of 44 years and median ICU length of stay (LOS) of six days were included. Three themes and nine categories emerged: (i) linking therapy to clinical outcome (patient expectations and understanding; physiotherapy activities and the implication of mobilisation; physiotherapy benefits and progression); (ii) the importance of developing a trusting relationship (physiotherapy value; safety; continuity of care); and (iii) communication (satisfaction; interactions and patient perception and experience of physiotherapy). Conclusion While confirming barriers to early mobility, patients perceived participation in mobility activities as a marked jolt in their journey to recovery following a critical incident. Effective communication and preservation of trust between physiotherapist and patient are essential for understanding expectations and can facilitate improved outcomes. Clinicians can use the information when managing critically ill patients. Including patient-reported outcomes to measure physiotherapy interventions used in the ICU is feasible and can inform the development of such outcomes. Contribution of the study The study highlights the feasibility and importance of the use of patient-reported outcomes to measure physiotherapy interventions and informs the development of patient reported outcomes and the importance of patient centred physiotherapy care in the ICU setting.
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Affiliation(s)
- F Karachi
- Physiotherapy Department, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | - M B van Nes
- Physiotherapy Department, Department of Health and Rehabilitation Sciences, Stellenbosch University, Tygerberg, South Africa
| | - R Gosselink
- Respiratory Rehabilitation, Department of Rehabilitation Sciences, KU Leuven, Belgium; and Department of Physiotherapy, Stellenbosch University,
Tygerberg, South Africa
| | - S Hanekom
- Physiotherapy Department, Department of Health and Rehabilitation Sciences, Stellenbosch University, Tygerberg, South Africa
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DeBord K, Ding P, Harrington M, Duggal R, Genther DJ, Ciolek PJ, Byrne PJ. Clinical application of physical therapy in facial paralysis treatment: A review. J Plast Reconstr Aesthet Surg 2023; 87:217-223. [PMID: 37918298 DOI: 10.1016/j.bjps.2023.10.076] [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: 06/27/2023] [Revised: 09/14/2023] [Accepted: 10/07/2023] [Indexed: 11/04/2023]
Abstract
This review aims to summarize recent studies regarding the specific modalities of physical therapy as a form of treatment for patients with facial paralysis, analyze the different components of physical therapy, and provide healthcare providers with guidance for their best practice in treating patients with facial paralysis. This paper will discuss the mechanism, indications, and impact factors for facial retraining, evaluate the standards for facial retraining, the creation of a treatment plan, and analyze the combined use of facial retraining with botulinum toxin injections and the application of facial retraining in post facial reanimation patients. Other modes of physical therapy, including electrical stimulation, dry needling, and acupuncture, will be addressed. Lastly, the application of new digital technology will be discussed.
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Affiliation(s)
- Katelyn DeBord
- Department of Exercise Science, John Carroll University, University Heights, OH 44118, United States
| | - Peng Ding
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH 44195, United States.
| | | | - Radhika Duggal
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States
| | - Dane J Genther
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Peter J Ciolek
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Patrick J Byrne
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH 44195, United States
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Celenay ST, Korkut Z, Bulbul SB, Altay H, Oskay K. Effects of spinal stabilization exercises focusing on the pelvic floor in women with overactive bladder. Int Urogynecol J 2023; 34:2959-2967. [PMID: 37638983 DOI: 10.1007/s00192-023-05638-7] [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: 06/05/2023] [Accepted: 07/23/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to investigate the effects of spinal stabilization exercises (SSEs) focusing on the pelvic floor with regard to urinary symptoms, pelvic floor muscle strength (PFMS), core stability, quality of life (QoL), and perception of subjective improvement (PSI) in women with overactive bladder (OAB). METHODS Patients were randomly divided into SSE (n=23) and control (n=24) groups. The SSE group received SSEs focusing on the pelvic floor for 3 days a week for 8 weeks and recommendation. The control group received only recommendation. Before (BT) and after treatment (AT), urinary symptoms were evaluated with Overactive Bladder Questionnaire-Version 8 (OAB-V8) and bladder diary. PFMS, core stability, and QoL were assessed using the Modified Oxford Scale (MOS), Sharman test, and King's Health Questionnaire (KHQ) respectively. AT, PSI with a Likert-type scale, and compliance with recommendations using a visual analog scale were assessed. RESULTS The OAB-V8 and the KHQ scores, the number of voids per day and voids per night decreased and the MOS and the Sharman scores increased in the SSE group (p<0.05). In the control group, the OAB-V8 and incontinence effect, social limitations, emotional state, and sleep sub-dimension scores related to KHQ decreased (p<0.05). The OAB-V8, role and physical limitations, emotional state, and sleep sub-dimension scores decreased more, and the MOS, the Sharman, the PSI, and the compliance with recommendations scores increased more in the SSE group than in the control group (p<0.05). CONCLUSIONS The SSEs focusing on the pelvic floor improved urinary symptoms, PFMS, core stability, QoL, and PSI. This exercise approach may be beneficial in the management of OAB.
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Affiliation(s)
- Seyda Toprak Celenay
- Health Sciences Faculty, Department of Physiotherapy and Rehabilitation, Ankara Yildirim Beyazit University, Ankara, Turkey.
| | | | - Saliha Beste Bulbul
- Health Sciences Institute, Physiotherapy and Rehabilitation Graduate Program, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Hafize Altay
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Mardin Artuklu University, Mardin, Turkey
| | - Kemal Oskay
- Ankara Gazi Mustafa Kemal Occupational and Environmental Diseases Hospital, Department of Urology, Ankara, Turkey
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Comstock BCD. Patient-practitioner interaction within the field of prosthetics and orthotics: A scoping review. Prosthet Orthot Int 2023; 47:640-646. [PMID: 37708341 DOI: 10.1097/pxr.0000000000000281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 07/20/2023] [Indexed: 09/16/2023]
Abstract
Patient-practitioner interaction has been shown to positively affect patient outcomes and experiences in various medical fields. However, the career of prosthetics and orthotics (P&O) includes components and processes unique to its field. Therefore, the concepts, practices, and information of patient-practitioner interaction need to be identified to understand how P&O practitioners can positively influence patient outcomes. A scoping review of PubMed, PsycINFO, and CINAHL was conducted for empirical research involving patient-practitioner interaction in P&O between the years of 1990 and 2021. Initial searches discovered 646 unique articles. Only 2 quantitative studies and 3 qualitative studies were included in the final analysis. Three interconnected themes were prevalent across the 5 articles: the knowledge available to the patient and the practitioner, the difference in expectations of both patient and practitioner, and communication processes. These 3 concepts create a feedback loop of consequences that can be addressed by ensuring that adequate and useful patient-practitioner communication is applied during the care process. Despite multiple calls for research in this area over the past 50 years, very few articles have addressed patient-practitioner interactions. Future research is needed to understand how interactions in P&O can be optimized to positively affect patient experience and outcomes.
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Washmuth NB, Stephens R, McAfee B, McAfee AD, Bise CG, Durham J. Using expletives to enhance therapeutic outcomes: A case report. Health Psychol Res 2023; 11:89726. [PMID: 37953825 PMCID: PMC10638054 DOI: 10.52965/001c.89726] [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: 11/14/2023] Open
Abstract
Background Swearing deserves attention in the physical therapy setting due to its potential positive effects on pain, physical performance, and therapeutic alliance. The purpose of this case report is to describe the strategic use of swearing in the clinical setting. Case Presentation A 44-year-old female completed an episode of physical therapy after undergoing patellofemoral arthroplasty. Swearing was formally included into the plan of care, and the patient swore out loud during the most challenging and painful interventions. Results The patient reported that repeating a swear word was funny, distracted the patient, and made the patient feel more confident. The patient and physical therapist self-reported a strong therapeutic alliance. Conclusion There is evidence repeating a swear word out loud can strengthen the therapeutic alliance, improve physical performance, and decrease pain. This is, to our knowledge, the first report of a patient swearing during an episode of physical therapy care.
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Demers M, Cain A, Bishop L, Gunby T, Rowe JB, Zondervan DK, Winstein CJ. Understanding stroke survivors' preferences regarding wearable sensor feedback on functional movement: a mixed-methods study. J Neuroeng Rehabil 2023; 20:146. [PMID: 37915055 PMCID: PMC10621082 DOI: 10.1186/s12984-023-01271-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND In stroke rehabilitation, wearable technology can be used as an intervention modality by providing timely, meaningful feedback on motor performance. Stroke survivors' preferences may offer a unique perspective on what metrics are intuitive, actionable, and meaningful to change behavior. However, few studies have identified feedback preferences from stroke survivors. This project aims to determine the ease of understanding and movement encouragement of feedback based on wearable sensor data (both arm/hand use and mobility) for stroke survivors and to identify preferences for feedback metrics (mode, content, frequency, and timing). METHODS A sample of 30 chronic stroke survivors wore a multi-sensor system in the natural environment over a 1-week monitoring period. The sensor system captured time in active movement of each arm, arm use ratio, step counts and stance time symmetry. Using the data from the monitoring period, participants were presented with a movement report with visual displays of feedback about arm/hand use, step counts and gait symmetry. A survey and qualitative interview were used to assess ease of understanding, actionability and components of feedback that users found most meaningful to drive lasting behavior change. RESULTS Arm/hand use and mobility sensor-derived feedback metrics were easy to understand and actionable. The preferred metric to encourage arm/hand use was the hourly arm use bar plot, and similarly the preferred metric to encourage mobility was the hourly steps bar plot, which were each ranked as top choice by 40% of participants. Participants perceived that quantitative (i.e., step counts) and qualitative (i.e., stance time symmetry) mobility metrics provided complementary information. Three main themes emerged from the qualitative analysis: (1) Motivation for behavior change, (2) Real-time feedback based on individual goals, and (3) Value of experienced clinicians for prescription and accountability. Participants stressed the importance of having feedback tailored to their own personalized goals and receiving guidance from clinicians on strategies to progress and increase functional movement behavior in the unsupervised home and community setting. CONCLUSION The resulting technology has the potential to integrate engineering and personalized rehabilitation to maximize participation in meaningful life activities outside clinical settings in a less structured environment.
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Affiliation(s)
- Marika Demers
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA.
- School of Rehabilitation, University of Montreal, 7077 Ave. du Parc, Montreal, QC, H3N 1X7, Canada.
| | - Amelia Cain
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Lauri Bishop
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Tanisha Gunby
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | | | | | - Carolee J Winstein
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Toonders SAJ, van der Meer HA, van Bruxvoort T, Veenhof C, Speksnijder CM. Effectiveness of remote physiotherapeutic e-Health interventions on pain in patients with musculoskeletal disorders: a systematic review. Disabil Rehabil 2023; 45:3620-3638. [PMID: 36369923 DOI: 10.1080/09638288.2022.2135775] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/04/2022] [Accepted: 10/09/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE To systematically review the literature on effectiveness of remote physiotherapeutic e-Health interventions on pain in patients with musculoskeletal disorders. MATERIALS AND METHODS Using online data sources PubMed, Embase, and Cochrane in adults with musculoskeletal disorders with a pain-related complaint. Remote physiotherapeutic e-Health interventions were analysed. Control interventions were not specified. Outcomes on effect of remote e-Health interventions in terms of pain intensity. RESULTS From 11,811 studies identified, 27 studies were included. There is limited evidence for the effectiveness for remote e-Health for patients with back pain based on five articles. Twelve articles studied chronic pain and the effectiveness was dependent on the control group and involvement of healthcare providers. In patients with osteoarthritis (five articles), total knee surgery (two articles), and knee pain (three articles) no significant effects were found for remote e-Health compared to control groups. CONCLUSIONS There is limited evidence for the effectiveness of remote physiotherapeutic e-Health interventions to decrease pain intensity in patients with back pain. There is some evidence for effectiveness of remote e-Health in patients with chronic pain. For patients with osteoarthritis, after total knee surgery and knee pain, there appears to be no effect of e-Health when solely looking at reduction of pain. Implications for rehabilitationThis review shows that e-Health can be an effective way of reducing pain in some populations.Remote physiotherapeutic e-Health interventions may decrease pain intensity in patients with back pain.Autonomous e-Health is more effective than no treatment in patients with chronic pain.There is no effect of e-Health in reduction of pain for patients with osteoarthritis, after total knee surgery and knee pain.
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Affiliation(s)
- Suze A J Toonders
- Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, Netherlands
- Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sport, Physical Therapy Research Group, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hedwig A van der Meer
- Department of Oral-Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Orofacial Pain and Disfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit (VU) University Amsterdam, Amsterdam, The Netherlands
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Thijs van Bruxvoort
- Product Management, Thijs van Bruxvoort, Founda B.V, Amsterdam, The Netherlands
| | - Cindy Veenhof
- Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sport, Physical Therapy Research Group, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Research Group Innovation of Human Movement Care, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Caroline M Speksnijder
- Department of Oral-Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Pereira F, Cameirão MS, Bermúdez I Badia S. The impact of exergames on the functional balance of a teenager with cerebral palsy - a case report. Disabil Rehabil Assist Technol 2023; 18:1074-1083. [PMID: 34591721 DOI: 10.1080/17483107.2021.1980623] [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: 01/19/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To understand the impact of an intensive rehabilitation program based on exergames in balance and lower limb function in a teenager with cerebral palsy. METHODS The rehabilitation program comprised different customised exergames and was delivered in 5 weekly sessions of 30 min for 4 weeks. Pre-, post-, and 1-month Follow-up assessments included the following metrics: Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Gross Motor Function Measure (GMFM), Posturography, and Gait analysis. RESULTS We observed increased scores after the intervention of 9/72 points in GMF - Module E (Walk, Run and Jump) and of 9/56 points in BBS, sustained at Follow-up. Changes in function, specifically in the quality and independence of the performance of specific movements such as turning 360°, increased distance reaching forward, walk behind, step over obstacles, and step stairs up and down were also observed. Gait kinematics and Spatio-temporal parameters tended to get closer to the 50th percentile. CONCLUSIONS We observed positive changes in motor function of a teenager with cerebral palsy, with sustained increased scores at a 1-month Follow-up. Findings are suggestive that intensive rehabilitation programs using exergames with high customisation features are a potentially valuable rehabilitation tool for training balance in teenagers with Cerebral Palsy.Implications for rehabilitationExergames may be a useful for providing balance training for teenagers who have a mixed form of cerebral palsy.Exergames that require body displacement may be suitable for modulating gait kinematics and spatio-temporal parameters.The customisation of virtual rehabilitation tools seems to impact the motivation and effort of the user positively.
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Affiliation(s)
- Fábio Pereira
- Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, Funchal, Portugal
- Madeira Interactive Technologies Institute, Universidade da Madeira, Funchal, Portugal
- NOVA Laboratory for Computer Science and Informatics, Caparica, Portugal
| | - Mónica S Cameirão
- Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, Funchal, Portugal
- Madeira Interactive Technologies Institute, Universidade da Madeira, Funchal, Portugal
- NOVA Laboratory for Computer Science and Informatics, Caparica, Portugal
| | - Sergi Bermúdez I Badia
- Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, Funchal, Portugal
- Madeira Interactive Technologies Institute, Universidade da Madeira, Funchal, Portugal
- NOVA Laboratory for Computer Science and Informatics, Caparica, Portugal
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Johnson L, Mardo J, Demain S. Understanding implementation of a complex intervention in a stroke rehabilitation research trial: A qualitative evaluation using Normalisation Process Theory. PLoS One 2023; 18:e0282612. [PMID: 37682841 PMCID: PMC10490858 DOI: 10.1371/journal.pone.0282612] [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: 09/07/2022] [Accepted: 02/18/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND The Implicit Learning in Stroke study was a pilot cluster randomised controlled trial, investigating the use of different motor learning strategies in acute stroke rehabilitation. Participating Stroke Units (n = 8) were from the South East/West regions of the UK, with the experimental intervention (implicit learning) being delivered by clinical teams. It required therapists to change how they gave instructions and feedback to patients during rehabilitation. This paper reports the processes underpinning implementation of the implicit learning intervention. The evaluation aimed to i) understand how therapists made sense of, engaged with and interpreted the effects of the intervention; ii) compare this to the experience reported by patients; iii) extrapolate learning of broader relevance to the design and conduct of research involving complex interventions in stroke rehabilitation. METHODS Qualitative evaluation, with data collected through focus groups with clinical staff (n = 20) and semi structured interviews with people with stroke (n = 19). Mixed inductive and theory driven analysis, underpinned by Normalisation Process Theory. RESULTS How therapists made sense of and experienced the intervention impacted how it was implemented. The intervention was delivered by individual therapists, and was influenced by their individual values, beliefs and concerns. However, how teams worked together to build a shared (team) understanding, also played a key role. Teams with a more "flexible" interpretation, reported the view that the intervention could have benefits in a wide range of scenarios. Those with a more fixed, "rule based" interpretation, found it harder to implement, and perceived the benefits to be more limited. Therapists' concerns that the intervention may impair therapeutic relationships and patient learning were not reflected in how patients experienced it. CONCLUSIONS Changing practice, whether in a research study or in the "real world", is complex. Understanding the process of implementation is crucial to effective research delivery. Implementation frameworks facilitate understanding, and subsequently the systematic and iterative development of strategies for this to be addressed. How teams (rather than individuals) work together is central to how complex interventions are understood and implemented. It is possible that new complex interventions work best in contexts where there are 'flexible' cultures. Researchers should consider, and potentially measure this, before they can effectively implement and evaluate an intervention. TRIAL REGISTRATION Clinical Trials - NCT03792126.
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Affiliation(s)
- Louise Johnson
- University Hospitals Dorset NHS Foundation Trust, Castle Lane East, Bournemouth, Dorset, United Kingdom
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Julia Mardo
- Dorset Healthcare NHS Foundation Trust, Yeatman Hospital, Hospital Lane, Sherborne, Dorset, United Kingdom
| | - Sara Demain
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
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Purton J, Sim J, Hunter SM. Stroke survivors' views on their priorities for upper-limb recovery and the availability of therapy services after stroke: a longitudinal, phenomenological study. Disabil Rehabil 2023; 45:3059-3069. [PMID: 36111388 DOI: 10.1080/09638288.2022.2120097] [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: 07/13/2021] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Forty percent of stroke survivors have a persistent lack of function in the upper limb, causing significant disability. Most personal-care tasks and meaningful activities require bi-manual function of both upper limbs. However, lower-limb mobility is often viewed as the priority in stroke services. Perspectives of stroke survivors on priorities for upper-limb recovery and therapy have not been investigated in detail. Therefore, this study aimed to explore their views. MATERIALS AND METHODS Thirteen stroke survivors each engaged in up to four semi-structured interviews over 18 months. A phenomenological approach guided the research. RESULTS Three themes were identified. Priorities change on coming home: recovery of walking is a priority early after stroke but upper-limb recovery becomes equally important over time, particularly once living at home. Limited therapy services: therapy has a short duration, prioritizes lower-limb mobility, and is short-lived in the community; people feel abandoned by services. Active partners in recovery: stroke survivors want intermittent access to review and advice so they can be active partners with therapists to manage their upper-limb recovery. CONCLUSION Therapy services should recognize stroke survivors' changing priorities and work with them as active partners in upper-limb recovery. Intermittent access to review and advice should be included in service design.Implications for rehabilitationStroke survivors' priorities may change over time from recovery of walking toward upper-limb recovery.Post-stroke services can be perceived as insufficient to meet the needs of stroke survivors who want to participate actively in rehabilitation of their upper limb.Stroke survivors may prefer services that are more flexible to provide regular review of their progress, access to guidance and support to self-manage their recovery.
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Affiliation(s)
- Judy Purton
- School of Allied Health Professions, Keele University, Keele, UK
- School of Science, Technology and Health, York St John University, York, UK
| | - Julius Sim
- School of Allied Health Professions, Keele University, Keele, UK
- School of Medicine, Keele University, Keele, UK
| | - Susan M Hunter
- School of Allied Health Professions, Keele University, Keele, UK
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Bastemeijer CM, van Ewijk JP, Hazelzet JA, Voogt LP. Physical therapists' perspectives of patient values and their place in clinical practice: a qualitative study. Braz J Phys Ther 2023; 27:100552. [PMID: 37862915 PMCID: PMC10590717 DOI: 10.1016/j.bjpt.2023.100552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/12/2023] [Accepted: 09/24/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND In physical therapy practice patients and therapists exchange their perspectives on musculoskeletal health problems and their meaning for both of them. However, literature indicates that physical therapists find it difficult to enquire about the patients' values during clinical encounters. OBJECTIVES The aim of this study was to gain deeper insight into the perspectives of physical therapists about patient values. DESIGN Explorative qualitative focus group study. METHOD Twenty-three physical therapists were interviewed in the Netherlands from March to May 2021. Two researchers analyzed the interviews and derived relevant codes. After an iterative process of comparing, analyzing, conceptualizing and discussing the codes, themes were identified through a thematic framework, illustrated with meaningful quotes. RESULTS Three major themes were identified: Humane, Tacit, and Responsive. It appeared that patient values play unconsciously a major role in daily practice and are associated with humanity, not technical or procedural aspects of the encounter. Responsive denotes that all values require interaction in which aligning with the individual patient forms the basis of treatment. Barriers for being responsive are identified as subthemes: Choices, Trust, Diverseness, and Boundaries. CONCLUSION The concept of patient values appeared to be implicit. The professional intuitively attunes as a fellow human being to values and expectations of the individual patient. This study contributes to finding a balance and mutual reinforcement of implicit and explicit knowledge. With all found experiences and insights the concept of patient values became more explicit in physical therapy to create a framework for education and research in the future.
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Affiliation(s)
- Carla M Bastemeijer
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | | | - Jan A Hazelzet
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Lennard P Voogt
- Department of Physical Therapy Studies, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
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Young DL, Johnson JK, Guo N, Tereshchenko LG, Martinez M, Rothberg MB. Association between physical therapy frequency and postacute care for a national cohort of patients hospitalized with pneumonia. J Hosp Med 2023; 18:803-811. [PMID: 37545436 DOI: 10.1002/jhm.13186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Annually more than 300,000 patients hospitalized for pneumonia need postacute care. Patients and systems prefer home discharge, but physical limitations often necessitate postacute care. It is unknown whether frequency of physical therapy in the hospital affects postacute care discharges. OBJECTIVE Examine the relationship between physical therapy visit frequency and disposition among a national sample of patients hospitalized with pneumonia. DESIGNS Observational cohort study. SETTING Acute care hospital. PARTICIPANTS Adult patients with primary diagnosis of pneumonia in the Premier Data Set who received physical therapy in the hospital during a 5-day window, with therapy on at least days 1 and 5. INTERVENTION Physical therapy visit frequency. MAIN OUTCOME AND MEASURES Discharge disposition (home or postacute care). RESULTS We included 18,886 patients from 595 hospitals. Just over half were discharged home (n = 9638; 51.0%) and 558 (2.95%) died. Patients getting more frequent therapy were older, non-Hispanic white, treated in small non-teaching rural hospitals in the West, Midwest, or South, and had fewer severe illness indicators. In adjusted models, patients who received physical therapy on 100% of days were 7% [(95% confidence interval, 4.3-9.7), p < .0001] more likely to go home than patients who received physical therapy on 40% of days. As a falsification test, we found that there was no relationship between physical therapy frequency and all-cause mortality. Physical therapy visit frequency was positively associated with discharge to home. Increasing visit frequency of physical therapy in hospitals might reduce the need for postacute care, but randomized controlled trials are needed to confirm the effect.
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Affiliation(s)
- Daniel L Young
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Joshua K Johnson
- Department of Physical Medicine & Rehabilitation, Cleveland Clinic, Cleveland, Ohio, USA
- Rehabilitation and Sports Therapy, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ning Guo
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Maylyn Martinez
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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Cogan AM, Bailie JM. Therapeutic Relationship in mTBI Rehabilitation: The Disparity Between the Illness Experience and Clinical Definitions. Mil Med 2023; 188:e3010-e3016. [PMID: 37192051 DOI: 10.1093/milmed/usad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/15/2023] [Accepted: 04/25/2023] [Indexed: 05/18/2023] Open
Abstract
INTRODUCTION A positive therapeutic relationship is characterized by trust and mutually perceived genuineness. It is positively associated with patients' adherence to treatment, satisfaction, and health outcomes. When service members with a history of mild traumatic brain injury (mTBI) present to rehabilitation clinics with nonspecific symptoms, a disparity between their experience of disability and clinical expectations of mTBI may disrupt the establishment of a positive therapeutic relationship between patients and providers. The objectives of this study are to (1) explore disparities between military service members and rehabilitation clinicians about the clinical diagnosis and illness experience of mTBI and (2) identify barriers to the establishment of a positive therapeutic relationship. MATERIALS AND METHODS This is a qualitative descriptive study of military service members with prior mTBI (n = 18) and clinicians (n = 16) who participated in interviews and focus groups. Data were analyzed thematically using Kleinman's framing of illness experience and clinical diagnosis. RESULTS Three themes reflected the potential breakdowns in the therapeutic relationship. The first theme, clinical expectations for post-injury recovery versus patients' experience of ongoing disability, reflects the inconsistency between clinicians' expectations of symptom resolution within 90 days following mTBI and service members' experiences of symptoms that worsened over several months or years. The second theme, symptom attribution to mental health conditions versus tissue injury, describes the difficulty in attributing symptoms to the physical impact of the mTBI or mental health diagnoses that may also stem from the injury event. The third theme, suspected malingering versus valid disability, describes clinicians' reports of frustration with cases in which they suspected malingering for secondary gains in contrast with service members' feelings that their problems were not taken seriously by clinicians. CONCLUSIONS This study extended previous research on therapeutic relationships by examining the situation of mTBI rehabilitation services for military service members. The findings reinforce the best practice recommendations of acknowledging patients' experiences, addressing the presenting symptoms and problems, and encouraging progressive return to activity following mTBI. Acknowledgment of and attention to patients' illness experience by rehabilitation clinicians is necessary and important for supporting a positive therapeutic relationship and ultimately to optimize patients' health outcomes and reduce disability.
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Affiliation(s)
- Alison M Cogan
- Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - Jason M Bailie
- Traumatic Brain Injury Center of Excellence (TBICoE), Defense Health Agency (DHA), Intrepid Spirit, Naval Hospital Camp Pendleton, Oceanside, CA 92058, USA
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Nelson C, Mandrusiak A, Forbes R. Embarking on a cultural journey: a qualitative study of new graduate physiotherapists' experiences of working in First Nations Australian health settings. Physiother Theory Pract 2023:1-11. [PMID: 37585714 DOI: 10.1080/09593985.2023.2246547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/10/2023] [Accepted: 08/06/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Internationally, there is growing momentum in the physiotherapy profession to improve the cultural safety and capabilities of physiotherapists. In Australia, this is essential given the important role physiotherapists play in the delivery of healthcare to First Nations Australians. Understanding the experiences of the newest members of the profession who work with First Nations Australians is an important step in exploring the broader professions' cultural safety journey. OBJECTIVE To explore new graduate physiotherapists' experiences working in First Nations Australian health settings. METHODS The study used an interpretative phenomenological approach through semi-structured interviews to explore the experiences of seven new graduate physiotherapists, in their first 2 years of practice. All participants worked within a First Nations Australian health setting for some or all of their experience as a new graduate physiotherapist. RESULTS Three themes were generated: 1) enrichment through connection; 2) navigating challenges; and 3) a catalyst for self-reflection. CONCLUSION New graduate physiotherapists reported positive experiences when working within a First Nations Australian health setting, underpinned by building a strong therapeutic relationship through rapport building; navigating challenges alongside their clients; and delving into critical self-reflection.
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Affiliation(s)
- Curtley Nelson
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Australia
| | - Allison Mandrusiak
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Australia
| | - Roma Forbes
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Australia
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Al-Wardat M, Etoom M, Lena F, Pellicciari L, D’Amone F, Kossi O, Brindisino F, Abdullahi A. Exploring Communication Practices in Italian Physiotherapy: Knowledge and Use of Effective Communication Strategies-A National Descriptive Study. Healthcare (Basel) 2023; 11:2247. [PMID: 37628446 PMCID: PMC10454614 DOI: 10.3390/healthcare11162247] [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: 06/17/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
This study aimed to investigate the knowledge and use of effective communication strategies among Italian physiotherapists. We utilized a questionnaire consisting of 19 questions to collect data on the knowledge and use of effective communication strategies among Italian physiotherapists. The results revealed that only 35.8% of the respondents reported being aware of communication strategies related to physiotherapy, with their first exposure occurring during their three-year degree. Despite the majority of respondents agreeing that communication is an effective strategy for improving patient adherence, only about half reported making moderate use of open-ended questions and metaphors during treatment sessions. Furthermore, more than half of the respondents reported being unaware of Motivational Interviewing. The results of this study found that there is a consensus among Italian physiotherapists about the importance of effective communication in clinical practice, though the knowledge and application of some communication strategies remain limited. These findings suggest that there is room for improvement in the training and education of physiotherapists in Italy, with a need for greater emphasis on communication strategies in the university educational curriculum, starting from the bachelor's degree.
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Affiliation(s)
- Mohammad Al-Wardat
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Mohammad Etoom
- Department of Physical Therapy, Aqaba University of Technology, Aqaba 77110, Jordan;
| | - Francesco Lena
- IRCCS INM Neuromed, Department of Neurology, 86077 Pozzilli, Italy
| | | | - Francesco D’Amone
- Department of Medicine and Health Science, “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy; (F.D.); (F.B.)
| | - Oyéné Kossi
- ENATSE, National School of Public Health and Epidemiology, University of Parakou, Parakou 03 BP 10, Benin;
- Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou 01 BP 02, Benin
| | - Fabrizio Brindisino
- Department of Medicine and Health Science, “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy; (F.D.); (F.B.)
| | - Auwal Abdullahi
- Department of Physiotherapy, Bayero University, Kano 700271, Nigeria
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Pilch M, van Rietschoten T, Ortiz-Catalan M, Lendaro E, van der Sluis CK, Hermansson L. Interplay Between Innovation and Intersubjectivity: Therapists Perceptions of Phantom Motor Execution Therapy and Its Effect on Phantom Limb Pain. J Pain Res 2023; 16:2747-2761. [PMID: 37577161 PMCID: PMC10422994 DOI: 10.2147/jpr.s412895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose Interpersonal processes, including therapeutic alliance, may modulate the impact of interventions on pain experience. However, the role of interpersonal context on the effects of technology-enhanced interventions remains underexplored. This study elicited therapists' perspectives on how a novel rehabilitative process, involving Phantom Motor Execution (PME), may impact phantom limb pain. The mediating role of therapeutic alliance, and the way PME influenced its formation, was investigated. Methods A qualitative descriptive design, using a framework method, was used to explore therapists' (n=11) experiences of delivering PME treatment. Semi-structured online-based interviews were conducted. Results A 3-way interaction between therapist, patient, and the PME device was an overarching construct tying four themes together. It formed the context for change in phantom limb experience. The perceived therapeutic effects (theme 1) extended beyond those initially hypothesised and highlighted the mediating role of the key actors and context (theme 2). The therapeutic relationship was perceived as a transformative journey (theme 3), creating an opportunity for communication, collaboration, and bonding. It was seen as a cause and a consequence of therapeutic effects. Future directions, including the role of expertise-informed adaptations and enabling aspects of customised solutions, were indicated (theme 4). Conclusion This study pointed to intrapersonal, interpersonal, and contextual factors that should be considered in clinical implementation of novel rehabilitative tools. The results demonstrated that therapists have unique insights and a crucial role in facilitating PME treatment. The study highlighted the need to consider the biopsychosocial model of pain in designing, evaluating, and implementing technology-supported interventions.
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Affiliation(s)
- Monika Pilch
- Centre for Health Policy & Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Tijn van Rietschoten
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
- University of Groningen, Faculty of Medical Sciences, Groningen, the Netherlands
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden
- Bionics Institute, Melbourne, VC, Australia
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Eva Lendaro
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Corry K van der Sluis
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Liselotte Hermansson
- Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Alt A, Luomajoki H, Luedtke K. Which aspects facilitate the adherence of patients with low back pain to physiotherapy? A Delphi study. BMC Musculoskelet Disord 2023; 24:615. [PMID: 37501088 PMCID: PMC10375614 DOI: 10.1186/s12891-023-06724-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The effectiveness of physiotherapy to reduce low back pain depends on patient adherence to treatment. Facilitators and barriers to patient adherence are multifactorial and include patient and therapist-related factors. This Delphi study aimed to identify an expert consensus on aspects facilitating the adherence of patients with back pain to physiotherapy. METHOD International experts were invited to participate in a three-round standard Delphi survey. The survey contained 49 items (32 original and 17 suggested by experts) which were rated on 5-point Likert scales. The items were assigned to six domains. The consensus level was defined as 60%. RESULTS Of 38 invited experts, 15 followed the invitation and completed all three rounds. A positive consensus was reached on 62% of the 49 proposed items to facilitate adherence. The highest consensus was achieved in the domains "Influence of biopsychosocial factors" (89%) and "Influence of cooperation between physiotherapists and patients" (79%). Additional important domains were the "Influence of competencies of physiotherapists" (71%) and "Interdisciplinary congruence" (78%). "Administration aspects" and the "Use of digital tools" did not reach expert consensus. CONCLUSIONS Biopsychosocial factors, therapeutic skills, and patient-physiotherapist collaboration should be considered in physiotherapy practice to facilitate adherence in patients with LBP. Future studies should prospectively evaluate the effectiveness of individual or combined identified aspects for their influence on patient adherence in longitudinal study designs.
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Affiliation(s)
- Andreas Alt
- Institute of Health Sciences, Department of Physiotherapy, Universität zu Lübeck, Lübeck, Germany
| | - Hannu Luomajoki
- Institute of physiotherapy, Zürich University of applied Sciences (ZHAW), Katharina-Sulzer-Platz 9, Winterthur, CH-8401, Switzerland.
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Universität zu Lübeck, Lübeck, Germany
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