Physiotherapy's Place in a Rapidly Changing World: A Pan-Canadian Perspective of Threats Facing Practice from the Physio Moves Canada Project, Part 2

Critical physiotherapy: a ten-year retrospective

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

Leadership and physiotherapy: A scoping review

Questions

The challenges faced by healthcare organizations require effective leaders. Leadership has been extensively studied in medicine and nursing, but it is limited in physiotherapy. The objective of this study is to know and analyze the published research on the characteristics of leadership in physiotherapy.

Design

A scoping review was conducted following the PRISMA extension guidelines. MEDLINE, The Cochrane Library, PEDro, Embase, CINAHL, Web Of Science and Scopus databases were reviewed between 01/01/2000 and 30/06/2022.All quantitative studies addressing the characteristics of leadership in physiotherapy were selected. Data extraction was performed using a table including author, year of publication, country of origin, title, objective, measurement instrument, sample and main findings.

Data synthesis

The results obtained were framed within the framework for the study of leadership designed by Bolman and Deal.

Results

Eight studies were selected. The characteristics most valued or used by physiotherapists are communication, desire for continuous learning and improvement, credibility and professionalism.

Conclusion

Leadership is very important for physiotherapists, and for physiotherapy, as profession they consider it very important to have vision and to lead change. Communication skills are the most highly regarded characteristic.

A Pan-Canadian Perspective on Education and Training Priorities for Physiotherapists. Part 2: Professional Interactions and Context of Practice

Purpose: Canadian physiotherapists who participated in the Physio Moves Canada (PMC) project of 2017 identified the state of training programmes as a threat facing professional growth of the discipline. One purpose of the project was to identify priority areas for physiotherapist training programmes as identified by academics and clinicians across Canada. Method: The PMC project included a series of interviews and focus groups conducted across clinical sites in every Canadian province and in Yukon Territory. Data were interpreted using descriptive thematic analysis; identified sub-themes were returned to participants for reflection. Results: Overall, 116 physiotherapists and 1 physiotherapy assistant participated in 10 focus groups and 26 semi-structured interviews. Results are presented using the curriculum guidelines of the time for organization. Here we describe two themes: Physiotherapy Professional Interactions, further defined by interpersonal and interprofessional competencies, and Context of Practice further defined by advocacy, leadership, community awareness, and business competencies. Conclusions: Participants appear to express a desire for programmes to train reflexive and adaptable primary health care practitioners with strong foundational knowledge and clinical expertise, complemented by interpersonal and interprofessional skills to empower physiotherapists to effectively care and advocate for patients, to lead health care teams, and to share ideas to inspire change towards a future of physiotherapy practice.

A Pan-Canadian Perspective on Education and Training Priorities for Physiotherapists. Part 1: Foundations for Clinical Practice

Purpose: Canadian physiotherapists who participated in the Physio Moves Canada (PMC) project of 2017 identified the current state of training programmes as a threat facing professional growth of the discipline in Canada. One purpose of this project was to identify key priority areas for physiotherapist training programmes as identified by academics and clinicians across Canada. Method: The PMC project included a series of interviews and focus groups conducted across clinical sites in every Canadian province and in the Yukon Territory. Data were interpreted using descriptive thematic analysis; identified sub-themes were returned to participants for reflection. Results: Overall, 116 physiotherapists and 1 physiotherapy assistant participated in 10 focus groups and 26 semi-structured interviews. Participants identified critical appraisal of continuing professional development options, knowledge translation, cultural fluency, professionalism, pharmaceutical knowledge, and clinical reasoning as priorities. For clinical practice specifically, participants identified practical knowledge, scope of practice, exercise prescription, health promotion, care of complex patients, and digital technologies as the priorities. Conclusion: Training priorities identified by participants may be useful to physiotherapy educators in preparing graduates to be adaptable and flexible primary health care providers for the future needs of a diverse population.

Immersion Therapy with Head-Mounted Display for Rehabilitation of the Upper Limb after Stroke-Review

Immersive virtual therapy technology is a new method that uses head-mounted displays for rehabilitation purposes. It offers a realistic experience that puts the user in a virtual reality. This new type of therapy is used in the rehabilitation of stroke patients. Many patients after this disease have complications related to the upper extremities that limit independence in their everyday life, which affects the functioning of society. Conventional neurological rehabilitation can be supplemented by the use of immersive virtual therapy. The system allows patients with upper limb dysfunction to perform a motor and task-oriented training in virtual reality that is individually tailored to their performance. The complete immersion therapy itself is researched and evaluated by medical teams to determine the suitability for rehabilitation of the upper limb after a stroke. The purpose of this article is to provide an overview of the latest research (2019-2022) on immersive virtual reality with head-mounted displays using in rehabilitation of the upper extremities of stroke patients.

Physiotherapists' Perspectives on the Threats Facing Their Profession in the Areas of Leadership, Burnout, and Branding: A Pan-Canadian Perspective from the Physio Moves Canada Project, Part 3

Purpose: Physiotherapist is the professional designation of those who provide physiotherapy (PT). Physiotherapists have earned a reputation as important providers of medical and non-medical rehabilitation for Canadians after injury, illness, or surgery. Despite the fact that physiotherapy has a nearly 100-year presence in Canada, some would suggest that practitioners arguably remain under-recognized for the value they offer to the spectrum of health care. Method: In the latter half of 2017, a cross-Canada qualitative study was conducted through which a subgroup of physiotherapists in every Canadian province and in Yukon Territory volunteered to share their perspectives on the threats facing the current practice of physiotherapy in the next 5-15 years. The data were collected from a series of nominal-group-technique-based focus groups and one-on-one interviews and then analyzed to condense the ideas generated into themes. A total of 117 physiotherapy professionals participated in focus sessions or one-on-one interviews as part of the Physio Moves Canada project, which was set up to explore, capture, and synthesize the perspectives of academics, front-line clinicians, and administrators on the future of the profession. Results: This article, the third in a series, describes the results of the descriptive thematic analysis of three identified threats: issues pertaining to professional leadership and direction, clinician burnout, and clarity of the physiotherapy brand. Informed by 11 sub-themes, the results suggest that participants were concerned about the ability of the professional body to mobilize toward shared and common goals while simultaneously defending against external pressures and internal disagreements on what exactly physiotherapy as a discipline is meant to be. Many respondents also identified reasons for optimism if the professional community is able to work together as a large and motivated single entity. Conclusions: The findings are described in terms of possible directions for priority investment of resources or critical reflection by professional leadership, educators, and regulators.