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Understanding Physiotherapists' Intention to Counsel Clients with Chronic Pain on Exercise: A Focus on Psychosocial Factors. 了解物理治疗师对慢性疼痛患者进行运动咨询的意图:关注社会心理因素。
Pub Date : 2019-11-01 DOI: 10.3138/PTC-2018-38
Jocelyn E. Blouin, Miranda A Cary, Mackenzie G Marchant, N. Gyurcsik, D. Brittain, Jenelle Zapski
Purpose: Twenty percent of Canadians experience chronic pain. Exercise is an effective management strategy, yet participation levels are low. Physiotherapists can be key to counselling clients to engage in long-term unsupervised exercise. Yet, investigations that identify psychosocial factors related to physiotherapists' intention to counsel are lacking. The purpose of this study was to examine whether physiotherapists' knowledge of chronic pain, beliefs about pain, and self-efficacy to counsel on exercise predicted their intention to counsel clients with chronic pain on exercise. Method: Practicing physiotherapists (N = 64) completed an online survey that assessed their knowledge of chronic pain, beliefs about pain, self-efficacy, and intention to counsel. A two-step hierarchical multiple regression predicted intention. Step 1 controlled for years of practice, and Step 2 included study variables significantly correlated with intention. Results: Beliefs about pain (r = -0.35, p < 0.01) and self-efficacy (r = 0.69, p < 0.01) were significantly correlated with intention. The overall regression model was significant, F 3,60 = 18.73; p < 0.001. Self-efficacy was the sole significant predictor, t 60 = 5.71, p < 0.0001, sr 2 = 28%. Conclusions: Self-efficacy may facilitate physiotherapists' intention to counsel on exercise for chronic pain. If shown to be a causal factor, interventions that target a change in physiotherapists' self-efficacy should be pursued.
目的:20%的加拿大人患有慢性疼痛。锻炼是一种有效的管理策略,但参与率很低。物理治疗师是建议客户进行长期无监督运动的关键。然而,确定与物理治疗师的咨询意向相关的心理社会因素的调查是缺乏的。本研究的目的是探讨物理治疗师对慢性疼痛的认知、对疼痛的信念和运动咨询的自我效能是否能预测他们对慢性疼痛患者的运动咨询意愿。方法:执业物理治疗师(N = 64)完成了一项在线调查,评估了他们对慢性疼痛的认识、对疼痛的信念、自我效能感和咨询意愿。两步层次多元回归预测意图。步骤1以实践年数为对照,步骤2纳入与意向显著相关的研究变量。结果:疼痛信念(r = -0.35, p < 0.01)和自我效能感(r = 0.69, p < 0.01)与意向显著相关。整体回归模型显著,f3,60 = 18.73;P < 0.001。自我效能是唯一显著的预测因子,t 60 = 5.71, p < 0.0001, sr 2 = 28%。结论:自我效能感可能有助于物理治疗师对慢性疼痛的运动建议。如果被证明是一个因果因素,针对物理治疗师自我效能感变化的干预措施应该被追求。
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引用次数: 2
Students' Perspectives on Their Experience in Clinical Placements: Using a Modified Delphi Methodology to Engage Physiotherapy Stakeholders in Revising the National Form. 学生对其临床实习经验的看法:使用改进的德尔菲方法使物理治疗利益相关者参与修改国家形式。
Pub Date : 2019-11-01 DOI: 10.3138/PTC-2018-43.E
Brenda Mori, M. Quesnel, S. Wojkowski
Purpose: We developed an evidence-informed Student Evaluation of the Clinical Placement form. This form gives students the opportunity to share their feedback and perceptions of their clinical placement experiences and provides meaningful data to all stakeholders. Method: We used a modified Delphi process to engage a sample of national stakeholders: physiotherapy clinical education leads of academic departments, centre coordinators of clinical education, clinical instructors, and students. An expert consultant panel, in addition to the investigators, reviewed the responses from each round and helped develop the questionnaire for the subsequent round and finalize the evaluation form. Results: The response rate was 65.3% (47 of 72) for Round 1, 76.6% (36 of 47) for Round 2, and 100% (36 of 36) for Round 3. After three rounds of questionnaires, 89% of participants thought that the evaluation form met their needs. Conclusions: We developed a revised Student Evaluation of the Clinical Placement form that is informed by the literature and meaningful to all stakeholders. This form is being implemented in physiotherapy university programmes across Canada to enable students to share their experiences at clinical sites.
目的:我们开发了一种循证学生临床实习评估表。此表格让学生有机会分享他们对临床实习经验的反馈和看法,并为所有利益相关者提供有意义的数据。方法:我们使用改进的德尔菲过程来参与国家利益相关者的样本:学术部门的物理治疗临床教育领导,临床教育中心协调员,临床教师和学生。除调查人员外,还有一个专家顾问小组审查了每一轮的答复,并帮助编制了下一轮的调查表,最后确定了评价表。结果:第1轮的有效率为65.3%(72人中有47人),第2轮为76.6%(47人中有36人),第3轮为100%(36人中有36人)。经过三轮问卷调查,89%的参与者认为评估表满足了他们的需求。结论:我们开发了一份经修订的学生临床实习评估表格,该表格由文献提供信息,对所有利益相关者都有意义。这个表格正在加拿大各地的物理治疗大学项目中实施,使学生能够在临床现场分享他们的经验。
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引用次数: 3
Effect of the Triceps Brachii Facilitation Technique on Scapulohumeral Muscle Activation during Reach and Point in a Healthy Population. 肱三头肌促进技术对健康人群到达点时肩胛骨肌激活的影响。
Pub Date : 2019-11-01 DOI: 10.3138/PTC-2018-0012
O. Lennon, K. Logeswaran, Srushti Mistry, Tara Moore, G. Severini, C. Cornall, C. O’Sullivan, Ulrik McCarthy Persson
Purpose: Neurodevelopmental techniques are commonly used in upper limb rehabilitation, but little evidence supports the facilitation techniques associated with this concept. This exploratory study determined whether a facilitation technique at the triceps muscle affected scapulothoracic muscle activity during reach in healthy participants compared with self-selected posture and reach. The secondary aim was to determine whether muscle activation levels differed between the facilitation technique and the optimized posture or guided movement. We also hypothesized that activity in the scapular stabilizers (lower trapezius [LT] and serratus anterior [SA]) would be increased during the facilitated movement than in the other conditions. Methods: The study included 17 healthy participants (aged 20-70 y). Surface electromyography recorded muscle activity in the upper trapezius (UT), middle trapezius (MT), and LT muscles and in the SA, middle deltoid (MD), and triceps during five performance conditions. We used Friedman's test to explore differences in muscle activity across conditions and Bonferroni's post hoc test to explore the differences between conditions. Results: The facilitation technique produced decreased activity in the SA, MD, and triceps muscles (p < 0.01) compared with the self-executed control condition. Compared with optimized posture with independent reach, facilitated movement again produced similar reductions in MD and triceps activity, with decreased LT activity also noted (p < 0.01). Lower activity levels were noted during facilitation than during manual guidance, with or without optimized posture, in the UT, MT, (p < 0.01), SA, and MD muscles (p < 0.05). Conclusions: Triceps facilitation did not increase scapular stability activity, but the activity levels in several other muscle groups (SA, MD, and triceps) were reduced during triceps facilitation compared with optimized posture or guided movement. Detailed analysis of this technique, including co-registered kinematic data and timing of muscle onset, is needed.
目的:神经发育技术通常用于上肢康复,但很少有证据支持与此概念相关的促进技术。本探索性研究确定了三头肌的促进技术是否会影响健康参与者在伸展过程中的肩胸肌活动,并与自我选择的姿势和伸展进行比较。第二个目的是确定促进技术和优化姿势或引导运动之间的肌肉激活水平是否不同。我们还假设肩胛骨稳定器(下斜方肌[LT]和前锯肌[SA])的活动在促进运动期间会比在其他条件下增加。方法:选取17名年龄在20-70岁的健康参与者,通过表面肌电图记录了5种运动状态下上斜方肌(UT)、中斜方肌(MT)、中斜方肌(LT)以及SA、中三角肌(MD)和肱三头肌的肌肉活动。我们使用Friedman的测试来探索不同条件下肌肉活动的差异,使用Bonferroni的事后测试来探索不同条件下肌肉活动的差异。结果:与自我执行的对照组相比,促进技术使SA、MD和肱三头肌的活动降低(p < 0.01)。与独立伸展的优化姿势相比,促进运动再次产生类似的MD和肱三头肌活动减少,LT活动也减少(p < 0.01)。与手动引导相比,在有或没有优化姿势的情况下,在UT、MT、SA和MD肌肉中,促进时的活动水平较低(p < 0.01)。结论:与优化姿势或引导运动相比,三头肌促进并没有增加肩胛骨稳定性活动,但其他几个肌肉群(SA、MD和三头肌)的活动水平在三头肌促进过程中有所降低。需要对该技术进行详细的分析,包括共同注册的运动学数据和肌肉发作的时间。
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引用次数: 0
Reliability, Validity, and Responsiveness of the Mini-Balance Evaluation Systems Test in Ambulatory Individuals with Multiple Sclerosis. 动态多发性硬化症患者迷你平衡评估系统测试的信度、效度和反应性。
Pub Date : 2019-11-01 DOI: 10.3138/PTC-2018-0071
Kirsten Potter, R. Bowling, L. Kavanagh, Ashley Stone, Brittany Witt, A. Wooldridge
Purpose: The purpose of this study was to determine the reliability, validity, and responsiveness of the Mini-Balance Evaluation Systems Test (MBT) in persons with multiple sclerosis (pwMS). Method: A total of 32 pwMS completed a questionnaire on disease severity, the Activities-specific Balance Confidence Scale (ABC), and the MBT. The MBT was re-administered 1 week later. Results: The interrater and test-retest reliability of the total MBT and subscales were excellent. The standard error of measurement for the total MBT, calculated from test-retest and interrater reliability, respectively, was 1.32 and 1.07. The minimal detectable change (MDC) for the total MBT was 3.74; the MDC for the subscales ranged from 0.98 (sensory) to 2.38 (gait). The correlations between individual subscale scores and the total MBT, among subscales, and between the total MBT and disease severity and ABC were excellent. Correlations between the total MBT and age, MS type, and fall and imbalance histories were moderate. Disease severity and ABC scores were the strongest predictors of MBT score. No floor effects were found. Ceiling effects were found for two subscales, but not for the total MBT. Conclusions: The MBT is reliable and valid in pwMS. MDC values will facilitate assessing the effectiveness of treatment. Because ceiling effects were found for two subscales, but not the total MBT, it is recommended that clinicians administer the MBT in its entirety.
目的:本研究的目的是确定Mini-Balance评估系统测试(MBT)在多发性硬化症(pwMS)患者中的信度、效度和反应性。方法:32例pwMS完成疾病严重程度、活动特异性平衡置信度量表(ABC)和MBT问卷调查。1周后再次给予MBT。结果:总量表和子量表的解释信度和重测信度均较好。总MBT的测量标准误差分别由重测和互测者信度计算得出,分别为1.32和1.07。总MBT的最小可检测变化(MDC)为3.74;亚量表的MDC范围从0.98(感觉)到2.38(步态)。个体子量表得分与总MBT、各子量表之间、总MBT与疾病严重程度和ABC之间的相关性均极好。总MBT与年龄、MS类型、跌倒和失衡史之间的相关性中等。疾病严重程度和ABC评分是MBT评分的最强预测因子。没有发现地板效应。在两个子量表中发现了天花板效应,但在总MBT中没有。结论:MBT在pwMS中是可靠、有效的。MDC值将有助于评估治疗的有效性。因为天花板效应是在两个子量表中发现的,但不是在总MBT中发现的,所以建议临床医生在整个MBT中进行管理。
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引用次数: 6
Clinician's Commentary on Mori et al. 临床医师对Mori等人的评论。
Pub Date : 2019-11-01 DOI: 10.3138/ptc-2018-43-cc
M. Hall
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引用次数: 0
Is the Canadian Physiotherapy Association Fulfilling Its Role in Promoting Research? 加拿大物理治疗协会在促进研究方面发挥作用了吗?
Pub Date : 2019-11-01 DOI: 10.3138/ptc-71-4-gee
C. Richards
Over the past 100 years, the Canadian Physiotherapy Association (CPA) has played an important role in promoting research activities to support the remarkable transformation of the physiotherapy profession from its beginnings in World War I to the evidence-based profession of today. In this editorial, I question whether the CPA is poised to continue to fulfill this role in the present and future research environments. It is useful first to review CPA’s past role in fostering research. As early as 1923, the first issue of Physiotherapy Canada was published to provide a means of communication for the fledgling association. In the early 1960s, the CPA leadership promoted research activities in two ways. First, it set up a Projects and Studies Committee “to encourage physiotherapists interested in doing simple research.”1(p.91) Over the years, this committee became the Clinical Studies Council, then the Clinical Studies Division, and finally the Research Division. Unfortunately, as confirmed by a nationwide survey in 1973, few physiotherapists had the qualifications to carry out credible research, and it was very difficult for them to obtain research funding.1 Second, Physiotherapy Canada published two articles, the first on the use of surveys and questionnaires and the second on the basic elements of a scientific paper and how to prepare a manuscript.2,3 An editorial also made the case for “comparative studies” and suggested that the CPA create an advisory council, consisting of consultants with methodological expertise, to help physiotherapists design simple projects.4 Later, physiotherapists with master’s and doctoral degrees joined the Physiotherapy Canada board to help drive its scientific evolution. A series of articles and editorials were published in 1980–1981 on subjects such as why research should be done, the contents of a scientific paper, manuscript review and the editing process, and a five-part series on research methodology and applied statistics.1 In 1981, the journal inaugurated the Silver Quill Award to encourage the publication of high-quality articles. This emphasis on scientific excellence, however, did not please all members of the CPA; many preferred a more clinically oriented approach. Thus, the association now also publishes a member magazine, Physiotherapy Practice. Throughout the 1980s, the Research Division promoted articles on the how-to of carrying out research as well as information on courses and abstracts of current physiotherapy research in its newsletter “Research News and Views.”1 In response to the lack of funds available to physiotherapists, the board created the Physiotherapy Foundation of Canada (PFC) in 1983 to provide funds to “support research which will add to the scientific base for the practice of physiotherapy.”1(p.97),5 The PFC has had its funding problems over the years, but it continues to play an important role in promoting physiotherapy research. University physiotherapy programmes evolved rapidly i
在过去的100年里,加拿大物理治疗协会(CPA)在促进研究活动方面发挥了重要作用,以支持物理治疗专业从第一次世界大战开始到今天的循证专业的显著转变。在这篇社论中,我质疑CPA是否准备在当前和未来的研究环境中继续履行这一角色。首先回顾注册会计师过去在促进研究方面的作用是有用的。早在1923年,第一期《加拿大物理疗法》就出版了,为这个羽羽未丰的协会提供了一种交流手段。在20世纪60年代初,CPA领导层以两种方式推动研究活动。首先,它成立了一个项目和研究委员会,“以鼓励对简单的研究感兴趣的物理治疗师。”多年来,这个委员会变成了临床研究委员会,然后是临床研究部,最后是研究部。不幸的是,正如1973年的一项全国性调查所证实的那样,很少有物理治疗师有资格进行可信的研究,而且他们很难获得研究经费第二,加拿大物理治疗协会发表了两篇文章,第一篇是关于调查和问卷的使用,第二篇是关于科学论文的基本要素和如何准备手稿。一篇社论也提出了“比较研究”的理由,并建议注册会计师成立一个咨询委员会,由具有方法学专业知识的顾问组成,以帮助物理治疗师设计简单的项目后来,拥有硕士和博士学位的物理治疗师加入了加拿大物理治疗委员会,以帮助推动其科学发展。1980-1981年出版了一系列文章和社论,主题包括为什么应该进行研究、科学论文的内容、手稿审查和编辑过程,以及关于研究方法和应用统计的五部分系列文章1981年,该杂志设立了银笔奖,以鼓励发表高质量的文章。然而,这种对科学卓越性的强调并没有使CPA的所有成员满意;许多人更倾向于临床导向的方法。因此,协会现在还出版会员杂志《物理治疗实践》。在整个1980年代,研究部在其通讯“研究新闻与观点”中推广有关如何进行研究的文章,以及有关课程和当前物理治疗研究摘要的信息。1为了应对物理治疗师缺乏可用资金的问题,董事会于1983年创建了加拿大物理治疗基金会(PFC),以提供资金“支持将增加物理治疗实践的科学基础的研究”1(第97页),5 PFC多年来一直存在资金问题,但它继续在促进物理治疗研究方面发挥重要作用。大学物理治疗课程在20世纪70年代和80年代迅速发展,以应对内部和外部的压力物理治疗师取得其他学科的硕士或博士学位后,回校任教物理治疗课程,从而提升大学教师的资历;这提高了他们在大学中的地位。第一批康复科学硕士课程于1970年代开办;在20世纪80年代和90年代开设了博士课程。前50年的物理治疗项目发展迅速,拥有博士学位的物理治疗师在其中授课,从事研究,并为发展物理治疗知识库做出了贡献。今天,受希斯洛普开创性文章的启发,支撑物理治疗专业的临床科学是病理运动学:人类运动障碍的评估、治疗和预防20世纪80年代和90年代初是理疗专业的一个激动人心的时期。每年的大会都有很多人参加,包括越来越多的研究人员展示了他们的研究成果。当时在研究和临床实践中都非常重视结果测量来评估
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引用次数: 1
An Investigation of Occupational Therapists' and Physical Therapists' Perspectives on the Process of Change That Occurs among Clients during Rehabilitation, Including Their Use of Response Shift and Transformative Learning. 职业治疗师和物理治疗师对康复过程中来访者变化过程的看法,包括他们对反应转移和转化学习的使用。
Pub Date : 2019-11-01 DOI: 10.3138/PTC-2018-0047
J. King, Ruth Barclay, J. Ripat, C. Dubouloz, C. Schwartz
Purpose: A significant change in one's health status creates a process of change that has an impact on one's health-related quality of life. This process has been conceptualized in several theories, including response shift (RS) and transformative learning (TL). The purpose of this study was to investigate occupational therapists' and physical therapists' perspectives on the process of change that occurs in clients during rehabilitation. Method: An interpretive description approach guided this study. Five profession-specific focus groups were conducted. Participants were asked about their ideas, thoughts, and understanding of processes of change. Focus group discussions were recorded and transcribed. Data analysis was carried out using both inductive and deductive methods. Results: Participants were 14 physiotherapists and nine occupational therapists with 5-30 years of experience in rehabilitation settings. Participants recognized personal change in clients and noted that it involves many steps. They tried to facilitate this change by identifying signs of readiness. Without using theory-specific terminology, participants described observing and using concepts of RS and TL. Conclusions: Occupational therapists and physiotherapists play an important role in helping people learn to live with their chronic illnesses and disabilities. Further studies are needed to investigate how therapists can facilitate the process of change, including using RS and TL concepts and how this facilitation could improve clients' health-related quality of life.
目的:一个人健康状况的重大变化会产生一个变化过程,影响到一个人与健康有关的生活质量。这一过程已经在几个理论中被概念化,包括反应转移(RS)和转化学习(TL)。本研究的目的是探讨职业治疗师和物理治疗师对康复过程中来访者变化过程的看法。方法:采用解释性描述方法指导本研究。进行了五个针对专业的焦点小组。参与者被问及他们的想法、想法和对变化过程的理解。对焦点小组的讨论进行了记录和转录。数据分析采用归纳和演绎两种方法进行。结果:参与者为14名物理治疗师和9名具有5-30年康复工作经验的职业治疗师。与会者认识到客户的个人变化,并指出这涉及许多步骤。他们试图通过识别准备就绪的迹象来促进这一变化。在没有使用理论专用术语的情况下,参与者描述了观察和使用RS和TL概念的情况。结论:职业治疗师和物理治疗师在帮助人们学会与慢性疾病和残疾一起生活方面发挥着重要作用。需要进一步的研究来调查治疗师如何促进改变的过程,包括使用RS和TL概念,以及这种促进如何改善来访者与健康相关的生活质量。
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引用次数: 3
Peer Reviewers for 2018. 2018年同行评审。
Pub Date : 2019-11-01 DOI: 10.3138/ptc-71-4-peerrevs
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引用次数: 0
What Does Cochrane Say about … Respiratory Physiotherapy for Children? 关于儿童呼吸物理治疗,科克伦说了什么?
Pub Date : 2019-11-01 DOI: 10.3138/ptc-71-4-cochrane
The Cochrane Collaboration is an international not-for-profit and independent organization dedicated to making up-to-date, accurate information about the effects of health care readily available worldwide. It produces and disseminates systematic re­ views of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of inter­ ventions. For more information, visit https://www.cochrane.org.
Cochrane协作网是一个国际性的非营利性独立组织,致力于在全球范围内提供最新、准确的医疗保健效果信息。它产生和传播对卫生保健干预措施的系统回顾,并促进以临床试验和其他干预研究的形式寻找证据。欲了解更多信息,请访问https://www.cochrane.org。
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引用次数: 0
Interrater Reliability of the Modified Ashworth Scale with Standardized Movement Speeds: A Pilot Study. 修正Ashworth量表与标准化运动速度的互估者信度:一项初步研究。
Pub Date : 2019-11-01 DOI: 10.3138/PTC-2018-0086
Erica Zurawski, K. Behm, Charlotte Dunlap, James Koo, Farooq Ismail, C. Boulias, S. Reid, C. Phadke
Purpose: The purpose of this study was to estimate the interrater reliability of the Modified Ashworth Scale (MAS) using consistent movement speeds guided by a metronome when measuring wrist flexor and ankle plantar flexor spasticity in patients with an upper motor neuron (UMN) lesion. The MAS has been found to have inconsistent interrater reliability for scoring the degree of spasticity. Method: This quantitative cross-sectional pilot study occurred in the outpatient spasticity clinic of a community rehabilitation hospital. Participants were a convenience sample of 20 patients with UMN lesions receiving botulinum toxin type A injections for focal spasticity. For each of the muscle groups tested, different pairs of evaluators scored spasticity on the MAS at a velocity of 130° per second. Evaluators were physical therapy students trained by an experienced physical therapist in MAS assessment. Weighted κ values were calculated to measure interrater reliability for each muscle group. Results: The weighted κ values for the wrist flexors and ankle plantar flexors were, respectively, moderate (κw = 0.54; 95% CI: 0.21, 0.87) and slight (κw = 0.08; 95% CI: -0.34, 0.50). Conclusion: Using consistent movement velocity, novice evaluators were able to score spasticity with reasonable interrater reliability when assessing the wrist flexors but not the ankle plantar flexors.
目的:本研究的目的是评估改良Ashworth量表(MAS)在测量上运动神经元(UMN)病变患者腕屈肌和踝关节足底屈肌痉挛时使用节拍器引导的一致运动速度的相互可靠性。MAS已被发现在痉挛程度评分方面具有不一致的判读可靠性。方法:在某社区康复医院痉挛门诊进行定量横断面初步研究。参与者是20例UMN病变患者的方便样本,接受a型肉毒杆菌毒素注射治疗局灶性痉挛。对于每个测试的肌肉群,不同的评估者以每秒130°的速度在MAS上对痉挛进行评分。评估者是由经验丰富的物理治疗师培训的物理治疗学生。计算加权κ值来衡量每个肌群的互译可靠性。结果:腕屈肌和足底屈肌的加权κ值分别为中等(κw = 0.54;95% CI: 0.21, 0.87)和轻微(κw = 0.08;95% ci: -0.34, 0.50)。结论:使用一致的运动速度,新手评估者在评估腕屈肌而不是踝关节足底屈肌时,能够以合理的可信度对痉挛进行评分。
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引用次数: 11
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Physiotherapy Canada. Physiotherapie Canada
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