Physiotherapy Canada. Physiotherapie Canada最新文献

The emergence of coronavirus disease 2019 (COVID-19) has presented a global health threat, and it poses challenges to how physiotherapists deliver health care. Physiotherapists have an ethical obligation not only to reduce the spread of COVID-19 but also to provide client-centred care and to improve or maintain function among those living in the community. Telerehabilitation provides an opportunity to maintain function, prevent future hospitalizations, and assist with discharge from hospitals while maintaining physical distancing recommendations. This editorial outlines the evidence for telerehabilitation, key considerations for its use, challenges to its use, and we issue a call to action.

Purpose: Although the importance of increased physical activity for children with disabilities is widely acknowledged, formal links between rehabilitation practitioners and community physical activity programmes are often lacking. The role of physiotherapists in the promotion of community physical activity is also often unclear. This study set out to describe the beliefs, knowledge, and practices of Canadian physiotherapists related to promoting community-based physical activity for children with disabilities. Method: We used a mixed-methods design: a survey of Canadian physiotherapists and qualitative focus group interviews with physiotherapists. Results: A total of 116 therapists participated in the survey. Of these, 80 (69.0%) considered the promotion of community-based physical activity programmes to be a physiotherapy role, and 89 (76.7%) recommended programmes to families. Therapists with less than 6 years of paediatric experience were less likely to recommend programmes to families (χ² ₄ = 40.46, p < 0.001). Qualitative analysis resulted in three themes: (1) lack of clarity regarding the physiotherapy role, (2) "it's not easy" - challenges related to community-based physical activity promotion, and (3) one size does not fit all. Conclusions: Various factors shaped physiotherapists' ability to promote community physical activity, specifically their knowledge, practice setting expectations, and beliefs about their role. Concerted efforts to promote community-based physical activity may increase community capacity to support all children in physical activities.

Purpose: A systematic review was conducted to investigate the effect of respiratory physiotherapy on mortality, quality of life, functional recovery, intensive care length of stay, duration of ventilation, oxygenation, secretion clearance, and pulmonary mechanics for invasively ventilated adults with pneumonia. Method: Five databases were searched for randomized trials published between January 1995 and November 2018. Study quality was assessed using a standardized Joanna Briggs Institute critical appraisal tool, and Review Manager software was used to pool the studies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the level of certainty of the evidence. Results: A total of 14 studies of moderate quality included 251 subjects with pneumonia. Eight studies were pooled for meta-analysis. Interventions that increased inspiratory volume appeared to benefit secretion clearance by nearly 2 grams (mean difference [MD] 1.97; 95% CI: 0.80, 3.14; very low GRADE evidence) and increase static lung compliance immediately after treatment by more than 5 millilitres/centimetre H₂0 (MD 5.40 mL/cm H₂O; 95% CI: 2.37, 8.43; very low GRADE evidence) or by more than 6 millilitres/centimetre H₂O after a 20- to 30-minute delay (MD 6.86 mL/cm H₂O; 95% CI: 2.86, 10.86; very low GRADE evidence). No adverse events were found. Conclusions: Respiratory physiotherapy that increases tidal volume may benefit secretion clearance and lung compliance in invasively ventilated adults with pneumonia, but its impact on other outcomes, including mortality, length of stay, and other patient-centred outcomes, is unclear, and further research is required.

Purpose: The purpose of this study was to establish the clinical practice of physiotherapists who treat people with knee osteoarthritis (OA) in Canada and examine their knowledge, awareness, use of, and attitudes toward clinical practice guidelines (CPGs). Method: We conducted a cross-sectional survey of physiotherapists who are licensed to practise in Canada and who treat people with knee OA. Results: A total of 388 physiotherapists completed our survey. Approximately two-thirds of them (271) were aware of CPGs. Out of all CPG recommendations, most respondents provided leg strengthening exercises (380) and education (364). More than 80% believed that CPGs improved patient care and enhanced decision making and were confident in their ability to interpret CPGs. More physiotherapists (204) identified barriers to the use of CPGs than facilitators of their use (117). Physiotherapists who were employed in private practice were substantially more likely to use interventions such as acupuncture (odds ratio [OR] 5.98; 95% CI: 2.92, 12.23; p < 0.01) and joint mobilization and manipulation (OR 6.58; 95% CI: 3.45, 12.55; p < 0.01) than were physiotherapists employed in hospital settings. Conclusions: Two-thirds of respondents were aware of CPGs. Physiotherapists provided education and leg strengthening exercises more often than aerobic exercise and weight management advice. Physiotherapists employed in private practice were more likely to use adjunct interventions.

Purpose: This study investigated the effects of power mobility training provided to exploratory power mobility learners with cerebral palsy (CP; Gross Motor Function Classification System Level V) on (1) parenting stress, (2) parents' perceptions of their children, and (3) children's attainment of power mobility skills. Method: A non-concurrent, multiple-baseline A-B single-subject research design study was conducted with three participants. The target behaviour was changes in the magnitude of parenting stress as measured by the Parenting Stress Index-Short Form. Parents' perceptions of their children were assessed using the Caregiver Priorities and Child Health Index of Life with Disabilities Questionnaire and a parent interview. Children's attainment of power mobility skills was assessed using the Canadian Occupational Performance Measure (COPM), the Assessment of Learning Powered mobility use, and the Wheelchair Skills Checklist. Power mobility training was provided twice a week for 8 weeks using an alternative power mobility device. Results: Positive and negative changes in both magnitude of parenting stress and parents' perceptions were identified post-intervention. All participants gained power mobility skills, assessed with the COPM. Conclusions: Power mobility training provided to exploratory power mobility learners with CP may influence levels of parenting stress.

Purpose: Health care disparities exist for people from culturally and linguistically diverse (CALD) communities. Addressing the cultural competence of health care providers could limit these disparities. The aim of this study was to improve cultural knowledge of and humility regarding pain in a CALD community. Method: This interpretive description qualitative study used focus group discussions (FGDs) to generate ideas about how South Asian culture could influence how health care providers manage pain. A total of 14 people with pain and of South Asian background (6 women and 8 men, aged 28-70 y) participated. Two investigators independently analyzed the data. This process involved repeatedly reading the transcripts, then manually sorting the key messages into categories. The investigators compared their categorizations and resolved differences through discussion. Next, similar categories and concepts were grouped into ideas (potential themes). These ideas, along with supporting categories and verbatim quotes, were presented to the full research team for feedback. After compiling the feedback, the ideas formed the thematic representation of the data. Results: The data from the FGDs revealed how pain management could be culturally adapted. The FGDs generated four themes about South Asian cultural perspectives that could influence the pain management experience for people living with pain: (1) cultural and linguistic impediments to communication, (2) understanding of pain in terms of the extent to which it interferes with function and work, (3) nurturing or personal attention as a marker of good care, and (4) value attributed to traditional ideas of illness and treatment. Conclusion: This study demonstrates how engaging with CALD people living with pain can lead to improved cultural knowledge and humility that can form the basis for adapting pain management. Through this process, it is more likely that a meaningful and client-centred pain management plan can be developed.

Purpose: The Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) is a screening tool that incorporates many important psychosocial domains into one questionnaire to reduce the burden of completing multiple questionnaires. The objectives of this study were to examine the reliability and validity of the 10-item version of the OSPRO-YF with patients with shoulder conditions. Method: The study group consisted of injured workers with an active compensation claim for a shoulder injury. The control group consisted of patients with a complaint of shoulder pain but without a work-related shoulder injury. We examined reliability (internal consistency, test-retest) and validity (factorial, convergent, known groups). The Hospital Anxiety and Depression Scale; the Quick Disabilities of Arm, Shoulder and Hand; and the short Örebro Musculoskeletal Pain Screening Questionnaire were used for comparison. Results: Eighty patients had an active compensation claim, and 160 were in the control group. The intra-class correlation coefficient values for two observations of the domain scores varied from 0.91 to 0.94. The test-retest reliability of the dichotomous constructs was moderate to perfect for 8 of 11 constructs. The 10-item OSPRO-YF questionnaire had three distinct domains, as conceptualized by the developers: mood, fear avoidance, and positive affect-coping. The Cronbach's a coefficients for these domains were 0.88, 0.94, and 0.94, respectively. The associations between the psychological constructs and domains and the similar theoretically derived scales were moderate to high and in the expected direction. Of the 11 constructs of the OSPRO-YF, 10 differentiated between patients with and without a work-related injury (p-values ranging from 0.028 to < 0.001). Conclusions: The 10-item OSPRO-YF reduces the burden of using multiple questionnaires and has acceptable test-retest and internal consistency reliability and factorial, convergent, and known-groups validity.

Purpose: This study identified the individuals responsible for making decisions about physiotherapy (PT) wait time, frequency of treatment, and treatment duration for persons with low back pain and determined which factors guided these decisions. Method: A cross-sectional survey was sent to Canadian PT professionals treating adult patients with musculoskeletal problems. It included a clinical vignette describing a patient with low back pain. Respondents were asked who made decisions about wait time, treatment frequency, and treatment duration as well as on which factors they based these decisions. Results: Clinicians were most often responsible for making decisions about treatment frequency and duration. Although clinicians and managers or coordinators were mainly responsible for making decisions about wait time, there was more variability depending on sector of care: in the private sector, administrative assistants played a much larger role. Clinical judgment, clinical guidelines, and patients' demands were the predominant factors influencing wait time and frequency decisions. Treatment duration was related to patients' goals, clinical progression, patients' motivation, and patients' return to work. Conclusions: Decisions about service provision for wait times are made by a range of stakeholders, and a wide variety of factors guide Canadian PT professionals' decision making. Identifying these factors is essential for informing a discussion of decisions about evidence-based and equitable service delivery so that the actors involved can reach a consensus.