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Relationships Between Socioecological Factors and Self-Efficacy to Participate in Physical Activity for Adults With Chronic Musculoskeletal Pain: An Integrative Review. 慢性肌肉骨骼疼痛成人的社会生态因素与参加体育活动的自我效能之间的关系:综合综述。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-02 DOI: 10.1093/ptj/pzae120
Mark Vorensky, Stephanie L Orstad, Allison Squires, Susan Parraga, Katherine Byrne, Ericka N Merriwether

Objective: Self-efficacy for leisure-time or health-promoting physical activity (SEPA) is a psychosocial determinant of physical activity. The socioecological model can provide a robust perspective of SEPA. The objective of this study was to synthesize the evidence on multilevel correlates of SEPA among individuals with chronic musculoskeletal pain. The second aim examined the extent to which socioecological disparities are associated with SEPA among individuals with chronic musculoskeletal pain.

Methods: An integrative review was conducted. Included studies needed to investigate the relationship between SEPA and socioecological factors at the interpersonal, institutional, community, and/or macrosystem level among adults with chronic musculoskeletal pain (≥3 months). Searches in PubMed, EMBASE, PsycINFO, and CINAHL were performed (December 30, 2020, and October 12, 2022), yielding 4047 records after duplicates were removed. Two independent reviewers completed screening, full-text reviews, and data extraction. After title and abstract screening and full-text reviews, 17 studies were included. The constant comparison method included: data reduction, data display, data comparison, and conclusion drawing/verification. Quality of evidence was assessed using the Joanna Briggs Institute appraisal tools.

Results: Five themes emerged with respect to relationships between SEPA and socioecological factors: social relations, social comparisons, patient-provider relationship, organizational resources, and accessibility to physical activity. Relationships between interpersonal factors and SEPA were most prominently studied. One study examined and addressed potential disparities in SEPA at the macrosystem level.

Conclusion: A spectrum of relationships from supporting to straining SEPA were found at the interpersonal level. Relationships between institutional, community, and macrosystem factors and SEPA were comparably sparse. Gaps in the literature were identified regarding how health disparities present across the socioecological model with respect to SEPA.

Impact: Clinicians can use this review to evaluate how SEPA can be supported or threatened by factors across the socioecological model. This may be a preliminary step towards examining and addressing health disparities in SEPA.

目的:闲暇时间或促进健康的体育活动(SEPA)的自我效能感是体育活动的一个社会心理决定因素。社会生态模型可以为 SEPA 提供一个可靠的视角。本研究的目的是综合慢性肌肉骨骼疼痛患者 SEPA 多层次相关性的证据。第二个目的是研究慢性肌肉骨骼疼痛患者的社会生态差异与 SEPA 的相关程度:方法:进行综合回顾。纳入的研究需要调查慢性肌肉骨骼疼痛(≥3 个月)成人中 SEPA 与人际、机构、社区和/或宏观系统层面的社会生态因素之间的关系。在 PubMed、EMBASE、PsycINFO 和 CINAHL 中进行了检索(2020 年 12 月 30 日和 2022 年 10 月 12 日),去除重复后共获得 4047 条记录。两名独立审稿人完成了筛选、全文审阅和数据提取工作。经过标题/摘要筛选和全文审阅,共纳入 17 项研究。恒定比较法包括:数据缩减、数据显示、数据比较和结论得出/验证。采用乔安娜-布里格斯研究所的评估工具对证据质量进行评估:关于 SEPA 与社会生态因素之间的关系,出现了五个主题:社会关系、社会比较、患者与提供者之间的关系、组织资源和体育活动的可及性。人际关系因素与 SEPA 之间关系的研究最为突出。一项研究从宏观系统层面研究并解决了SEPA的潜在差异:结论:研究发现,在人际层面上,存在着从支持到限制 SEPA 的一系列关系。机构、社区和宏观系统因素与 SEPA 之间的关系相对较少。研究发现,在社会生态模型中,健康差异与 SEPA 之间的关系存在文献空白:临床医生可利用本综述评估整个社会生态模式中的各种因素如何支持或威胁 SEPA。这可能是研究和解决 SEPA 健康差异的第一步。
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引用次数: 0
Women's Health Across the Lifespan: A Sex- and Gender-Focused Perspective. 妇女一生的健康:以性和性别为重点的视角。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-02 DOI: 10.1093/ptj/pzae121
Jessica L McKinney, Susan C Clinton, Laura E Keyser

Women's health in physical therapy has historically focused on sexual and reproductive health. The biological and social constructs of sex and gender, respectively, are determinants of health, including pathophysiology of disease and therapeutic outcomes, and an expansion of the concept of "women's health" is warranted. This Perspective explores the role of sex and gender as key determinants of women's and girls' health and highlights the factors pertinent to physical therapist practice. The Scale for the Assessment for Narrative Review Articles (SANRA), a 6-point assessment to evaluate the quality of narrative reviews, was used a priori and consulted throughout. Across the lifespan, sex- and gender-based health disparities exist. These include sex-based disparities in maternal-fetal outcomes linking female fetal sex to maternal hypertensive disorders of pregnancy, along with a sex-based female advantage in birth outcomes and the emergence of gender differences in motor development. A complex interplay of biological and socially influenced factors contributes to an increased care burden for women throughout adulthood and specific risks for the development of cardiovascular and pelvic floor conditions, decreased function, and increased disability. Sex- and gender-disaggregated data are lacking in outcomes literature. A sex- and gender-informed approach in physical therapy, including analyzing data by sex and gender, may better meet the needs of patients and better prepare physical therapist professionals to contribute to women's health across the lifespan. Success will take coordinated effort involving many stakeholders within and adjacent to the physical therapist community. The influence of sex and gender are lifelong determinants of health, making them critically important to consider in physical therapist practice, education, research, advocacy, and policy. In women's health, focusing on sexual and reproductive health is limiting and insufficient.

物理治疗中的女性健康历来侧重于性健康和生殖健康。性和性别的生物和社会结构分别是健康的决定因素,包括疾病的病理生理学和治疗结果,因此有必要扩展 "女性健康 "的概念。本视角探讨了性和性别作为妇女和女孩健康关键决定因素的作用,并强调了与理疗师实践相关的因素。叙事性综述文章评估量表(SANRA)是一种用于评估叙事性综述质量的 6 点评估方法,本研究事先使用了该量表,并在整个过程中进行了参考。在人的一生中,存在着基于性和性别的健康差异。这些差异包括母胎结局中的性别差异,将女性胎儿性别与孕产妇妊娠高血压疾病联系在一起,以及女性在出生结局中的性别优势和运动发育中出现的性别差异。生物因素和社会影响因素的复杂相互作用,导致妇女在整个成年期的护理负担加重,心血管和骨盆底疾病、功能下降和残疾增加的特定风险也随之增加。结果文献中缺乏按性别分列的数据。在物理治疗中采用以性和性别为基础的方法,包括按性和性别分析数据,可以更好地满足患者的需求,并使物理治疗师专业人员做好更充分的准备,为女性一生的健康做出贡献。要想取得成功,就需要理疗师群体内部和毗邻的许多利益相关者共同努力。性和性别的影响是健康的终生决定因素,因此在物理治疗师的实践、教育、研究、宣传和政策中都必须考虑到这一点。在妇女健康方面,只关注性健康和生殖健康是有局限性的,也是不够的。
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引用次数: 0
Vestibular Rehabilitation: Improving Symptomatic and Functional Outcomes of Persons With Vestibular Schwannoma: A Systematic Review. 前庭康复:改善前庭神经细胞瘤患者的症状和功能:系统性综述》。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-02 DOI: 10.1093/ptj/pzae085
Jayden Yap, Gretta Palmer, Kate Graving, Shona Stone, Elise M Gane

Objective: Persons with vestibular schwannoma suffer from dizziness, imbalance, and decreased function leading to reduced quality of life. Other forms of peripheral vestibular hypofunction show improvements in these signs and symptoms with vestibular rehabilitation; however, the efficacy of this intervention for those with vestibular schwannoma is unknown. Therefore, the aim of this systematic review was to determine the effect of vestibular physical therapy on subjective and objective measures of vestibular symptoms and function in people with vestibular schwannoma.

Methods: Four electronic databases were searched: PubMed, CINAHL, EMBASE, and Cochrane. Included studies were experimental or observational in design and featured patients with vestibular schwannoma who had undergone vestibular physical therapy. Screening and quality assessment was completed independently by 2 researchers. Risk of bias was assessed with a tool appropriate for study design (eg, Cochrane Risk of Bias 2.0 tool for randomized trials). The Grading of Recommendations Assessment, Development and Evaluation approach was used to synthesize findings.

Results: Twenty-three studies were included. Overall, the effect of vestibular physical therapy for patients with vestibular schwannoma was uncertain. Outcomes of dizziness, static and dynamic balance, and vestibular function all showed very low certainty on the Grading of Recommendations Assessment, Development and Evaluation assessment. Multimodal physical therapist interventions consistent with clinical practice guidelines (eg, gaze stability, habituation, balance training, gait training) demonstrated potential for improvement in dizziness, balance, and vestibular function, respectively. Results were mostly insignificant when a single modality was used.

Conclusion: There may be benefit in multimodal vestibular physical therapy for people with vestibular schwannoma to improve symptoms and function. More high-quality studies specific to vestibular schwannoma prehabilitation and rehabilitation are needed to increase the certainty in the evidence.

Impact: Physical therapists are encouraged to use multimodal vestibular rehabilitation for vestibular schwannoma in clinical practice in line with clinical guidelines for peripheral vestibular hypofunction.

目的:前庭分裂瘤患者会出现头晕、失衡和功能减退等症状,导致生活质量下降。其他形式的外周前庭功能减退通过前庭康复治疗可改善这些体征和症状;但这种干预对前庭分裂瘤患者的疗效尚不清楚。因此,本系统综述旨在确定前庭物理疗法对前庭分裂瘤患者前庭症状和功能的主观和客观测量的影响:方法:检索了四个电子数据库:方法:检索了四个电子数据库:PubMed、CINAHL、EMBASE 和 Cochrane。所纳入的研究均为实验性或观察性设计,并以接受过前庭物理治疗的前庭分裂瘤患者为研究对象。筛选和质量评估由两名研究人员独立完成。偏倚风险采用适合研究设计的工具进行评估(例如,用于随机试验的 Cochrane Risk of Bias 2.0 工具)。采用建议分级评估、发展和评价方法对研究结果进行综合:结果:共纳入 23 项研究。总体而言,前庭物理治疗对前庭分裂瘤患者的效果并不确定。眩晕、静态和动态平衡以及前庭功能的结果在建议分级评估、发展和评价中的确定性都很低。符合临床实践指南的多模式理疗师干预(如凝视稳定性、习惯化、平衡训练、步态训练)分别显示出改善头晕、平衡和前庭功能的潜力。结论:使用单一模式时,结果大多不显著:结论:对前庭分裂瘤患者进行多模式前庭物理治疗可能有助于改善症状和功能。需要针对前庭分裂瘤的预康复和康复进行更多高质量的研究,以增加证据的确定性:鼓励物理治疗师在临床实践中根据外周前庭功能减退的临床指南,采用多模式前庭康复治疗前庭分裂瘤。
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引用次数: 0
Transgender, Gender-Diverse, and Nonbinary Experiences in Physical Therapy: A Descriptive Qualitative Study. 物理治疗中的变性、性别多元化和非二元体验:描述性定性研究。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-02 DOI: 10.1093/ptj/pzae086
Madelaine Aird, Julie L Walters, Alex Ker, Megan H Ross

Objective: The objective was to explore experiences with and identify barriers and facilitators of utilizing physical therapy for people who identify as transgender, gender diverse, and nonbinary (TGNB).

Methods: A qualitative descriptive design was employed using semistructured interviews conducted in New Zealand. Eligible participants were individuals who were 12 years old or older, who self-identified as TGNB, and who had accessed physical therapy at a community-based clinic that also provides a gender-affirming service. Participants were recruited via email invitation to the clinic database. Interview data were analyzed using reflexive thematic analysis. Demographics are reported descriptively.

Results: Seventeen individuals (15-64 years old and identifying as 11 different genders) participated. All participants reported physical therapy experiences relating to 1 or more of the following 4 themes: challenging cisnormativity at policy, environmental, clinic, and therapist levels; safety and trust throughout the clinical experience, including clinic credibility for being a safe provider, clinic displays of TGNB inclusivity, implementation of safe clinic processes, and respectful therapist interactions; inclusive experiences in a clinic that provided affordable care and took active steps to understand and affirm TGNB identities and with physical therapists who had a high level of knowledge of TGNB-specific health issues and took a biopsychosocial approach to care; and sensitivity to body discomfort or dysphoria triggers. Barriers to and facilitators of care were identified at policy, environmental, clinic, and therapist levels.

Conclusion: People who identify as TGNB face challenges to accessing safe and culturally sensitive physical therapy. However, there are achievable areas for improvement at policy, environmental, clinic, and physical therapist levels to gain trust and engagement in care for the TGNB community.

Impact: This study provides a detailed exploration of TGNB physical therapy experiences and identifies specific areas of improvement for TGNB physical therapy care to provide clinicians and physical therapy clinics insights into the provision of safe and culturally sensitive physical therapy.

目的目的是探索变性者、性别多元化者和非二元性者(TGNB)使用物理疗法的经验,并确定使用物理疗法的障碍和促进因素:方法:采用定性描述设计,在新西兰进行半结构式访谈。符合条件的参与者年龄在 12 岁或以上,自我认同为 TGNB,并在社区诊所接受过物理治疗,该诊所还提供性别确认服务。参与者通过诊所数据库的电子邮件邀请进行招募。访谈数据采用反思性主题分析法进行分析。结果:17 人(15-64 岁,自称 11 种不同性别)参加了访谈。所有参与者都报告了与以下 4 个主题中的一个或多个相关的理疗师经历:在政策、环境、诊所和治疗师层面挑战顺性别规范;整个临床经历中的安全和信任,包括诊所作为安全提供者的信誉、诊所对 TGNB 的包容性展示、安全诊所流程的实施以及尊重治疗师的互动;在提供负担得起的医疗服务、采取积极措施理解和肯定 TGNB 身份的诊所,以及在对 TGNB 特定健康问题有高度了解并采取生物心理社会方法进行护理的理疗师那里获得的包容性体验;以及对身体不适或焦虑症诱因的敏感性。从政策、环境、诊所和治疗师等层面确定了护理的障碍和促进因素:结论:被认定为 TGNB 的人在获得安全且具有文化敏感性的物理治疗方面面临挑战。然而,在政策、环境、诊所和理疗师层面都有可以改进的地方,以赢得对 TGNB 群体的信任并使其参与到护理中来:本研究详细探讨了 TGNB 物理治疗师的经验,并确定了 TGNB 物理治疗护理需要改进的具体领域,为临床医生和物理治疗诊所提供了提供安全且具有文化敏感性的物理治疗的见解。
{"title":"Transgender, Gender-Diverse, and Nonbinary Experiences in Physical Therapy: A Descriptive Qualitative Study.","authors":"Madelaine Aird, Julie L Walters, Alex Ker, Megan H Ross","doi":"10.1093/ptj/pzae086","DOIUrl":"10.1093/ptj/pzae086","url":null,"abstract":"<p><strong>Objective: </strong>The objective was to explore experiences with and identify barriers and facilitators of utilizing physical therapy for people who identify as transgender, gender diverse, and nonbinary (TGNB).</p><p><strong>Methods: </strong>A qualitative descriptive design was employed using semistructured interviews conducted in New Zealand. Eligible participants were individuals who were 12 years old or older, who self-identified as TGNB, and who had accessed physical therapy at a community-based clinic that also provides a gender-affirming service. Participants were recruited via email invitation to the clinic database. Interview data were analyzed using reflexive thematic analysis. Demographics are reported descriptively.</p><p><strong>Results: </strong>Seventeen individuals (15-64 years old and identifying as 11 different genders) participated. All participants reported physical therapy experiences relating to 1 or more of the following 4 themes: challenging cisnormativity at policy, environmental, clinic, and therapist levels; safety and trust throughout the clinical experience, including clinic credibility for being a safe provider, clinic displays of TGNB inclusivity, implementation of safe clinic processes, and respectful therapist interactions; inclusive experiences in a clinic that provided affordable care and took active steps to understand and affirm TGNB identities and with physical therapists who had a high level of knowledge of TGNB-specific health issues and took a biopsychosocial approach to care; and sensitivity to body discomfort or dysphoria triggers. Barriers to and facilitators of care were identified at policy, environmental, clinic, and therapist levels.</p><p><strong>Conclusion: </strong>People who identify as TGNB face challenges to accessing safe and culturally sensitive physical therapy. However, there are achievable areas for improvement at policy, environmental, clinic, and physical therapist levels to gain trust and engagement in care for the TGNB community.</p><p><strong>Impact: </strong>This study provides a detailed exploration of TGNB physical therapy experiences and identifies specific areas of improvement for TGNB physical therapy care to provide clinicians and physical therapy clinics insights into the provision of safe and culturally sensitive physical therapy.</p>","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141564101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Upper Limb Function in People With Upper and Lower Limb Loss 8 Years Postinjury: The Armed Services Trauma Outcome Study (ADVANCE) Cohort Study. 伤后 8 年上下肢缺失者的上肢功能:武装部队创伤结果研究(ADVANCE)队列研究》。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-10-02 DOI: 10.1093/ptj/pzae082
Fraje C E Watson, Angela E Kedgley, Susie Schofield, Fearghal P Behan, Christopher J Boos, Nicola T Fear, Alexander N Bennett, Anthony M J Bull

Objective: Upper limb (UL) disability in people with UL loss is well reported in the literature, less so for people with lower limb loss. This study aimed to compare UL disability in injured (major trauma) and uninjured UK military personnel, with particular focus on people with upper and lower limb loss.

Methods: A volunteer sample of injured (n = 579) and uninjured (n = 566) UK military personnel who served in a combat role in the Afghanistan war were frequency matched on age, sex, service, rank, regiment, role, and deployment period and recruited to the Armed Services Trauma Rehabilitation Outcome (ADVANCE) longitudinal cohort study. Participants completed the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, scored from 0 (no disability) to 100 (maximum disability) 8 years postinjury. Mann-Whitney U and Kruskal-Wallis tests were used to compared DASH scores between groups. An ordinal model was used to assess the effect of injury and amputation on DASH scores.

Results: DASH scores were higher in the Injured group compared to the Uninjured group (3.33 vs 0.00) and higher in people with lower limb loss compared to the Uninjured group (0.83 vs 0.00), although this was not statistically significant. In the adjusted ordinal model, the odds of having a higher DASH score was 1.70 (95% CI = 1.18-2.47) times higher for people with lower limb loss compared to the Uninjured group. DASH score was not significantly different between people with major and partial UL loss (15.42 vs 12.92). The odds of having a higher DASH score was 8.30 (95% CI = 5.07-13.60) times higher for people with UL loss compared to the Uninjured group.

Conclusion: People with lower limb loss have increased odds of having more UL disability than the Uninjured population 8 years postinjury. People with major and partial UL loss have similar UL disability. The ADVANCE study will continue to follow this population for the next 20 years.

Impact: For the first time, potential for greater long-term UL disability has been shown in people with lower limb loss, likely resulting from daily biomechanical compensations such as weight-bearing, balance, and power generation. This population may benefit from prophylactic upper limb rehabilitation, strength, and technique.

目的:文献中对UL截肢者的上肢(UL)残疾情况有大量报道,但对下肢截肢者的报道较少。本研究旨在比较受伤(重大创伤)和未受伤的英国军人的上肢残疾情况,尤其关注上肢和下肢截肢者:在阿富汗战争中服役的英国受伤(579 人)和未受伤(566 人)军人的志愿者样本在年龄、性别、服役时间、军衔、兵团、角色和部署时间上进行了频率匹配,并被招募到武装部队创伤康复结果(ADVANCE)纵向队列研究中。参与者在受伤后 8 年完成了手臂、肩部和手部残疾(DASH)问卷调查,得分从 0(无残疾)到 100(最大残疾)不等。Mann-Whitney U 和 Kruskal Wallis 检验用于比较不同组间的 DASH 分数。采用序数模型评估受伤和截肢对 DASH 评分的影响:结果:受伤组的 DASH 得分高于未受伤组(3.33 vs 0.00),下肢缺失者的 DASH 得分高于未受伤组(0.83 vs 0.00),但差异无统计学意义。在调整后的序数模型中,与未受伤组相比,下肢缺失者 DASH 得分较高的几率为 1.70(95% CI = 1.18-2.47)倍。主要UL缺失者和部分UL缺失者的DASH评分差异不大(15.42 vs 12.92)。与未受伤组相比,UL缺失者DASH评分较高的几率是未受伤组的8.30倍(95% CI = 5.07-13.60):结论:与未受伤的人群相比,下肢缺失者在伤后8年出现更多UL残疾的几率更高。主要和部分UL缺失者的UL残疾程度相似。ADVANCE研究将在未来20年内继续跟踪这一人群:影响:首次发现下肢长期缺失者的上肢残疾可能性更大,这可能是日常生物力学代偿(如负重、平衡和发电)造成的。这一人群可能会从预防性上肢康复、力量和技术中受益。
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引用次数: 0
A Framework for Integrating Artificial Intelligence and Machine Learning into Physical Therapy. 将人工智能和机器学习融入物理治疗的框架。
4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-17 DOI: 10.1093/ptj/pzae137
Nathan Morelli
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引用次数: 0
Addressing Health Care Access Disparities Through A Public Health Approach to Physical Therapist Practice 通过物理治疗师实践中的公共卫生方法解决获得医疗服务的差距问题
4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-17 DOI: 10.1093/ptj/pzae136
Jessica McKinney, Nicole Kelm, Brett Windsor, Laura E Keyser
As the field evolves as a doctoring profession, the role and scope of physical therapist practice must also grow to meet important and urgent public health needs. Scalable, population-level interventions must be prioritized to the same degree as tailored, individual level care. Drawing from public health frameworks, this Perspective proposes an approach to population-level physical therapist care delivery that aims to mitigate disease and disability and improve health outcomes by expanding access, decreasing cost, and improving quality of care for those facing the greatest health disparities. Application of these frameworks prompts the development of novel approaches to rehabilitation service delivery to advance twin goals of promoting access to care and reducing health disparities. This paper describes how a population health framework and public health approach can be used to support necessary evolution and innovation within the field of physical therapy and to improve rehabilitation service delivery. Rapid developments in the digital and virtual health space have created a unique opportunity for physical therapists to lean into a new vision of their role as clinicians within the broader health ecosystem. This paper will provide clinicians with a broader perspective of physical therapist expertise and describe opportunities for the development and application of a physical therapist skill set towards driving population health outcomes. Real-world examples will guide clinicians to consider opportunities in their own practice for implementing this public health approach and potentially addressing various contributors to persistent health disparities.
随着这一领域作为医生职业的发展,理疗师的作用和执业范围也必须扩大,以满足重要而紧迫的公共卫生需求。可扩展的、人群层面的干预措施必须与量身定制的、个人层面的护理同等重要。本视角借鉴公共卫生框架,提出了一种提供人群级理疗师护理的方法,旨在通过为面临最大健康差异的人群扩大获取途径、降低成本和提高护理质量来减轻疾病和残疾,并改善健康状况。这些框架的应用促使我们开发出新的康复服务提供方法,以推进促进获得医疗服务和减少健康差距的双重目标。本文介绍了如何利用人口健康框架和公共卫生方法来支持物理治疗领域的必要发展和创新,并改善康复服务的提供。数字和虚拟健康领域的快速发展为物理治疗师创造了一个独特的机会,使他们能够在更广泛的健康生态系统中以新的视角看待自己作为临床医生的角色。本文将从更广阔的视角向临床医生介绍理疗师的专业知识,并描述发展和应用理疗师技能集以推动人口健康成果的机遇。真实世界的例子将引导临床医生考虑在自己的实践中实施这种公共卫生方法的机会,并有可能解决造成持续健康差异的各种因素。
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引用次数: 0
Validation of a Clinical Teaching Competency Framework for Physical Therapists: A Mixed-Methods Approach. 物理治疗师临床教学能力框架的验证:混合方法。
IF 3.5 4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-16 DOI: 10.1093/ptj/pzae138
Amanda Sharp, Catherine Bilyeu, Carissa Wengrovius, Katherine Myers

Objective: A competency framework for clinical teaching in physical therapy was established in a recent study. Validation of competency frameworks requires multiple steps, including consideration of end-user perceptions of value and utility. The purpose of this study was to further validate the clinical teaching competency framework by gathering input specifically from clinical education faculty.

Methods: This study used an explanatory sequential mixed methods approach to seek input from clinical instructors (CI) and site coordinators of clinical education (SCCE) from diverse practice areas and geographic regions. A survey invited participation from active clinical education faculty, and survey respondents were invited to participate in a focus group. Two focus groups were held via Zoom.

Results: Survey responses from those holding roles of CI (59.3%), SCCE (11.3%), and CI/SCCE (29.4%) indicated support for the competency framework, including perceived value to their role (93.1%) and enhancement of quality of clinical education (94.1%). Concern regarding ease of utilization of the framework was indicated by 24% of respondents. There were no statistically significant differences in responses based on role or credentials. The focus groups resulted in an overarching theme of Collective Impact, with 4 subthemes: Assessment, CI development, Implementation, and Guidelines.

Conclusion: Clinical education faculty perceive value and utility in the Clinical Teaching Competency Framework. Implementation of the framework into practice should be collaborative and consistent across academic and clinical education programs.

Impact statement: This study moves the profession one step closer to use of a competency framework specifically targeted at clinical teaching in physical therapy. Clinical education faculty will be primary users of a competency framework and buy-in from this user group is key to implementation. Continued efforts to validate this framework contribute to addressing the need for CI development and support in delivering excellence in clinical education.

目的:最近的一项研究建立了物理治疗临床教学的能力框架。验证能力框架需要多个步骤,包括考虑最终用户对价值和效用的看法。本研究旨在通过收集临床教育工作者的意见,进一步验证临床教学能力框架:本研究采用了一种解释性顺序混合方法,以征求来自不同实践领域和地理区域的临床导师(CI)和临床教育站点协调员(SCCE)的意见。调查邀请在职临床教育教师参与,并邀请调查对象参加焦点小组。两个焦点小组通过 Zoom 进行了讨论:担任 CI(59.3%)、SCCE(11.3%)和 CI/SCCE (29.4%)职务的人员对调查的答复表明,他们支持能力框架,包括认为该框架对他们的职务有价值(93.1%)和提高临床教育质量(94.1%)。有 24% 的受访者对能力框架的易用性表示担忧。不同角色或资历的受访者在回答问题时没有明显的统计学差异。焦点小组得出了 "集体影响 "这一总主题,以及 4 个分主题:结论:临床教育教师认为临床教学能力框架具有价值和实用性。该框架在实践中的实施应在学术和临床教育项目中进行合作并保持一致:这项研究使物理治疗专业离使用专门针对临床教学的能力框架更近了一步。临床教育教师将是能力框架的主要用户,这一用户群体的认同是实施的关键。继续努力验证该框架有助于满足临床教育中对 CI 发展和支持的需求。
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引用次数: 0
Feasibility of a Multidomain Resiliency Assessment in Patients with Advanced Heart Failure Requiring Surgery: A Pilot Study 对需要手术的晚期心力衰竭患者进行多域复原力评估的可行性:试点研究
4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-10 DOI: 10.1093/ptj/pzae135
Karlyn J Green, Rebecca North, Adam D DeVore, Samantha Green, Ashley K Poole
Objective The resiliency of patients who have advanced heart failure (HF) and undergo a physical stressor such as heart transplantation or left ventricular assist device implantation has yet to be studied in the physical, cognitive, and psychosocial domains. The primary aim of this pilot study was to assess the feasibility of a multidomain resiliency assessment in patients who have advanced HF and require surgery. Methods A battery of assessments in each of the domains was completed at baseline before surgical intervention, after intensive care discharge, and 3 and 6 months after surgery. Feasibility was assessed through completion rates, time required to complete the assessments, and qualitative feedback from assessors. Results Although various completion rates were noted at different time points, high completion rates were seen for grip strength, the modified Fried frailty phenotype, and the Montreal Cognitive Assessment. Additionally, when controlled for patients who were medically restricted from physical function, the Short Physical Performance Battery, gait speed, and the 30-second chair stand test also had high completion rates. A trend toward return to baseline status or an improvement in baseline status was observed in all physical and cognitive assessments and most psychosocial assessments at 3 and 6 months. Minimal change was noted in the Brief Resilience Scale questionnaire. Conclusion This pilot study demonstrates that a multidomain assessment of resiliency is feasible in patients with advanced HF. Future studies are needed to help determine specific assessments or patient factors that would help predict positive postsurgical outcomes in this population. Impact This study has implications for clinical practice on the most feasible assessments in multiple domains for patients who have advanced HF and are being evaluated for heart transplantation or left ventricular assist device.
目的 对晚期心力衰竭(HF)患者在接受心脏移植或左心室辅助装置植入等身体应激后的恢复能力,尚未从身体、认知和社会心理等方面进行研究。本试验研究的主要目的是评估对需要手术的晚期心房颤动患者进行多领域复原力评估的可行性。方法 在手术干预前、重症监护出院后、术后 3 个月和 6 个月的基线期完成每个领域的评估。通过完成率、完成评估所需的时间以及评估者的定性反馈来评估可行性。结果 尽管在不同的时间点有不同的完成率,但握力、改良弗里德虚弱表型和蒙特利尔认知评估的完成率都很高。此外,如果对那些在医学上限制身体功能的患者进行控制,短期体能测试、步态速度和 30 秒椅子站立测试的完成率也很高。在 3 个月和 6 个月时,所有身体和认知评估以及大多数社会心理评估都出现了恢复基线状态或改善基线状态的趋势。简易复原力量表问卷的变化很小。结论 这项试点研究表明,对晚期高血压患者进行多领域复原力评估是可行的。未来的研究需要确定有助于预测该人群术后积极疗效的特定评估或患者因素。影响 这项研究对临床实践具有重要意义,可帮助晚期 HF 患者在接受心脏移植或左心室辅助装置评估时在多个领域进行最可行的评估。
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引用次数: 0
Written Mobility Communication in Acute Care Medical Wards: An Observational Study of Physical Therapists’ and Nurses’ Documentation Practice 急诊病房中的书面移动交流:物理治疗师和护士文件记录实践的观察研究
4区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-10 DOI: 10.1093/ptj/pzae122
Emily Harvey, Julie Adsett, Alison Mudge, Michael Steele, Prue McRae
Objective Low inpatient mobility is associated with poor hospital outcomes. Poor communication between clinicians has been identified as a barrier to improving mobility. Understanding how mobility is communicated within the multi-disciplinary team may help inform strategies to improve inpatient mobility. The aim of this study was to describe written mobility communication by physical therapists and nurses in acute care medical wards. Methods This cross-sectional observational study was conducted across 4 hospitals in an Australian health service. A survey of physical therapists and nurses identified preferred sources and content of written mobility communication. An audit described and compared written mobility communication in the most strongly preferred documentation sources. Findings were described and compared graphically between discipline and site. Results Questionnaires were completed by 85 physical therapists and 150 nurses. Twenty-two sources of documentation about mobility were identified. Preferences for sources and content varied between disciplines. Physical therapists nominated several preferred information sources and sought and documented broader mobility content. Nurses often sought nursing documents which focused on current mobility assistance and aids, with limited communication of mobility level or mobility goals. Audits of 104 patient records found that content varied between sources and sites, and content was variably missing or inconsistent between sources. Conclusion Written mobility communication focused on mobility assistance and aids, rather than mobility levels or mobility goals, with poor completion and inconsistency within documentation. More complete and consistent documentation might improve progressive mobilization of hospital inpatients. Impact statement Physical therapists and nurses seek and document different content in a wide range of locations, leading to incomplete and inconsistent written documentation. Understanding and resolving these practice differences offers potential to improve mobility communication and practice.
目标 住院病人行动不便与住院效果不佳有关。临床医生之间沟通不畅已被认为是改善移动能力的一个障碍。了解多学科团队之间如何交流移动能力,有助于制定改善住院患者移动能力的策略。本研究旨在描述急诊内科病房中物理治疗师和护士的书面移动沟通情况。方法 这项横断面观察性研究在澳大利亚一家医疗服务机构的 4 家医院中进行。通过对理疗师和护士进行调查,确定了书面移位沟通的首选来源和内容。一项审计描述并比较了最受青睐的文件来源中的书面移位沟通内容。调查结果在不同学科和地点之间进行了描述和图形比较。结果 85 名理疗师和 150 名护士填写了调查问卷。确定了 22 种有关移动能力的文件来源。不同学科对资料来源和内容的偏好各不相同。物理治疗师提名了几个首选信息来源,并寻求和记录了更广泛的移动性内容。护士通常寻求的护理文件主要集中在当前的移位协助和辅助工具上,而对移位水平或移位目标的交流则很有限。对 104 份病历的审核发现,不同来源和地点的内容各不相同,不同来源的内容也存在缺失或不一致的情况。结论 书面的移位沟通主要集中在移位辅助工具上,而不是移位水平或移位目标上,文件的完整性和一致性较差。更完整、更一致的文件记录可能会改善住院患者的渐进式移动。影响陈述 物理治疗师和护士在不同的地方寻求和记录不同的内容,导致书面记录不完整和不一致。了解并解决这些实践中的差异,为改善移动交流和实践提供了可能。
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引用次数: 0
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Physical Therapy
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