[Quo vadis Therapeutic Health Care Professionals--What do Occupational and Physical Therapists Think about their Future? Results of a Survey throughout Germany]

BACKGROUND

The introduction of occupational and physical therapy as academic disciplines is evidence of radical changes in the therapeutic health care professions. Therapists' professional associations are planning and negotiating both with health insurance companies and with other branches of the health care professions concerning future spheres of activity. In order to find out what the therapists in these professions think about their future, we conducted a survey of physical and occupational therapists through-out Germany. Our findings regarding professional life, job satisfaction, competition and cooperation have already been published. This article presents therapists' assessments of the future of their professions.

METHOD

From May until December 2008 we performed a cross-sectional survey, interviewing physical and occupational therapists throughout Germany. Statements were answered on a 6-step Likert scale; open questions were answered in free-text fields. The evaluation was performed quantitatively; the free texts were also evaluated qualitatively.

RESULTS

A total of 3,506 questionnaires were evaluated; 1,273 were completed by occupational therapists and 2,233 by physical therapists. Nearly half of the therapists (n=1,687; 48.4%) used the opportunity to emphasise the need for change. We identified 4,026 statements about 8 general topics: remuneration, employee co-determination, professional recognition, continuing education, cooperation, initial access to the professions, and their academic status. Therapists illustrated certain items in the questionnaire with examples from their professional experience, suggested additional topics, and proposed concrete changes. We document a broad range of opinions and concerns, especially in regard to such subjects concerning the future of the professions as their new academic status and initial access.

CONCLUSION

Physical and occupational therapists are concerned about the future development of their professions. They see a need for change in the following areas: remuneration, employee co-determination, initial access and cooperation as well as in the development of their profession as an academic discipline. Policy makers need to heed therapists' assessments of the state of their professions and their calls for its increased professionalisation.

Effects of exercise on fitness and cognition in progressive MS: a randomized, controlled pilot trial

Background:

Exercise may have beneficial effects on both well-being and walking ability in multiple sclerosis (MS). Exercise is shown to be neuroprotective in rodents and may also enhance cognitive function in humans. It may, therefore, be particularly useful for MS patients with pronounced neurodegeneration.

Objective:

To investigate the potential of standardized exercise as a therapeutic intervention for progressive MS, in a randomized-controlled pilot trial.

Methods:

Patients with progressive MS and moderate disability (Expanded Disability Status Scale (EDSS) of 4–6) were randomized to one of three exercise interventions (arm ergometry, rowing, bicycle ergometry) for 8–10 weeks or a waitlist control group. We analyzed the drop-out rate as a measure of feasibility. The primary endpoint of the study was aerobic fitness. Secondary endpoints were walking ability, cognitive function as measured by a neuropsychological test battery, depression and fatigue.

Results:

A total of 42 patients completed the trial (10.6% drop-out rate). Significant improvements were seen in aerobic fitness. In addition, exercise improved walking ability, depressive symptoms, fatigue and several domains of cognitive function.

Conclusion:

This study indicated that aerobic training is feasible and could be beneficial for patients with progressive MS. Larger exercise studies are needed to confirm the effect on cognition.

Trial Registration:

ISRCTN (trial number 76467492) http://isrctn.org