Physiotherapy Canada最新文献

Purpose: To identify, select, and validate topic areas for a physical therapy critical care learning needs assessment tool. Method: A scoping review was used to identify knowledge/skill areas relevant to physiotherapy intensive care unit (ICU) practice and develop a survey questionnaire. Physiotherapists rated the relevance of each survey item for practice in the ICU, as well as their knowledge about each item. Descriptive statistics summarized the responses. A statistically based algorithm was used to identify highly relevant items where the level of knowledge/skill was relatively low. Experienced physiotherapists were consulted to agree on the items that should be included. The process was repeated in three additional ICUs to validate the selected items. Results: A total of 238 items, identified from 40 articles, were included in the survey and rated by physiotherapists. From survey results, a statistical-based algorithm identified 113 important topic areas for inclusion (47.48%). A modified triage technique was used to further reduce the selected areas to 90 topics. The validation process further refined the topics to 94 topics along with 13 additional site-specific topic areas. Conclusions: Topics identified in this study will inform the development of a physical therapy critical care learning needs assessment tool. Our survey tool and methodological approach could guide the development of hospital-specific learning needs assessment tools in other clinical settings.

Purpose: The aim of this study was to explore how social support during a pelvic floor muscle training (PFMT) programme, performed in a group or individually, influences the perceptions of older women with urinary incontinence (UI) regarding their condition and self-management. Method: This qualitative study was conducted with a subset of participants (n = 15), who had completed a large randomized controlled trial (RCT) on PFMT for UI. Incontinent older women participated in individual semi-structured interviews about their self-perceptions, self-management, and social support. Interviews were audio recorded and transcribed and content analysis was conducted. Results: Four inter-related categories emerged describing how social support positively influenced UI self-perceptions and self-management. These four categories were: (1) point of entry, (2) safe space, (3) concealment to disclosure, and (4) change in perspective. Conclusions: Social support within a PFMT programme helps women with UI improve their UI self-perception and self-management. The PFMT programme itself can also improve seeking of social supports for women with UI.

Purpose: Physiotherapists need to develop strong business acumen to make informed decisions, drive positive outcomes, and thrive in their practice. Competencies in these areas are partially reflected in the Competency Profile for Physiotherapists in Canada; however, there is little consistency in how these are applied across academic institutions. The purpose of this study was to develop a set of foundational entry-to-practice (ETP) competencies related to business and practice management (BPM) that can prepare physiotherapy students for work in all Canadian health care service sectors upon graduation.

Method: We undertook a modified Delphi study. An online call for participants was circulated via the Canadian Physiotherapy Association's Private Practice and Leadership Divisions, Canadian provincial and territorial physiotherapy regulators, and 15 Canadian university physiotherapy programmes. Individuals in the profession with known expertise in management and/or business were also invited to participate.

Results: Two rounds of the Delphi were necessary to reach consensus. Forty-one participants were included in the first round of Delphi including academics, regulators, registered physiotherapists, and senior students. Twenty-one (51%) participated in round 2 of the study. Sixty-six ETP BPM foundational curriculum competencies, within nine domains, reached consensus (via the Delphi process).

Conclusions: Consideration of the ETP competencies in the areas of business and practice management derived with this national Delphi process may enhance and harmonize the physiotherapy curricula across Canada.

Purpose: To better understand patients' perspectives on virtual care (VC) delivered by advanced practice physiotherapists (APPs) for hip/knee, foot/ankle, shoulder/elbow, and low back related symptoms.

Method: A patient satisfaction questionnaire was developed and distributed electronically to all patients seen by APPs from August 1, 2020 to January 31, 2021. The questionnaire contained quantitative items using a 5-point Likert scale and open-ended questions that yielded qualitative findings. Descriptive statistics were applied to the quantitative data. Qualitative findings were analyzed using a qualitative description approach to identify recurrent themes.

Results: Response rate was 74% (374/505) across all clinics. Videoconference was the most common delivery method (91.7%). Overall satisfaction with VC was very high (4.7-4.8/5). Emergent qualitative themes were related to Personal Connection; Preparatory Materials; Virtual Physical Examination; Practical Advantages of VC; Virtual Waiting Room; and Technical Issues.

Conclusions: Overall, across several facets including personal connection, patient experience with VC for a variety of musculoskeletal conditions was rated high. Clinically, a systematic approach to the physical examination with preparatory patient education materials was key to positive patient experience.

Purpose: To determine the cost-effectiveness of physiotherapy (PT) to manage individuals with chronic conditions.

Method: Design: Systematic review of randomized controlled trials (RCTs). Eligibility: RCTs with adult participants diagnosed with ≥1 chronic condition, an intervention delivered or supervised by a physiotherapist, including an economic evaluation of the intervention provided. Procedure: Eight databases were searched. Title/abstract screening, full-text review, and data extraction were performed in duplicate. The quality of included studies was assessed using Cochrane's Risk of Bias Assessment 2.0.

Results: Fifty-three articles were included in this review. Fifteen compared PT to no PT; 38 compared novel PT to conventional PT. Of the studies comparing PT to no PT, 53% found PT to be cost-effective. Of the studies comparing novel to conventional PT, 55% found novel interventions were cost-effective. Overall, PT was cost-effective in most studies related to arthritis, chronic low back pain, and chronic neck pain. The heterogeneity of study characteristics limited the ability to perform a meta-analysis.

Conclusions: Over half of included studies reported PT to be cost-effective. Future high quality RCTs performing rigorous economic evaluations are needed to determine the cost-effectiveness of different interventions delivered or supervised by a PT to prevent disability for those with chronic conditions.

Purpose: The COVID-19 pandemic resulted in a rapid change in ways clinicians deliver physiotherapy services, leading to an important uprise in telerehabilitation implementation. Sharing the experiences of physiotherapists in clinically adopting this technology during this initial wave of the pandemic can influence future implementation. This mixed-method study aimed to identify the barriers and new facilitators of telerehabilitation clinical implementation.

Method: Canadian physiotherapists with and without telerehabilitation experience, working in various clinical settings, were recruited during the first wave of the COVID-19 pandemic. Participants completed the Assessing Determinants of Prospective Uptake of Virtual Reality instrument (ADOPT-VR) adapted for telerehabilitation and participated in online focus groups to explore their experiences with telerehabilitation implementation. Demographic data and ADOPT-VR responses were analyzed descriptively. Qualitative data were analyzed using content analysis.

Results: Sixteen physiotherapists completed the study. Scores on the Likert scale showed that physiotherapists enjoyed telerehabilitation (7.5/10) and perceived it as being useful (7.3/10). Physiotherapists disagreed with the necessity to use only minimal mental efforts (4.4/10) and feeling familiar with the evidence (4.7/10). Limited access to telerehabilitation implementation evidence, a reduced hands-on approach, and a lack of validated remote assessments were reported as barriers. Clinical practice guidelines, validated remote neurological assessments, changes in physiotherapy curriculum, and policy-making are critical to improving telerehabilitation implementation within physiotherapy practices.

Conclusions: Participants positively experienced the quick use of telerehabilitation from the beginning of the COVID-19 pandemic, but some important barriers remain.

Purpose: To quantify a perceived barrier to physical activity participation (proximity to exercise facilities) by investigating the distance a population-based cohort of young people with cerebral palsy aged 13-30 years lived from community gyms.

Method: We developed a web-based application using open-access software that could be used to complete a geospatial analysis by simultaneously visualizing, describing, and estimating the location of young people with cerebral palsy, using deidentified data from a cerebral palsy register, in terms of distance and travel time to all available community gyms in one metropolitan city. The suitability of facilities for individuals was not investigated. Distance to the closest gym for participants was measured using the "as the crow flies" and "street network" methods. The proportion of the cohort living 5, 7, and 9 km from a community gym was calculated using the "as the crow flies" method. Distances and travel times to the closest gym for each person were calculated using the "street network" method. Data analysis used one-dimensional (median, quartiles) and two-dimensional (spatial median, bagplot) dispersion measures.

Results: Of 568 young people with cerebral palsy, 97% lived within 7 km of a community gym, with a median absolute distance to their closest gym of 3.6 km (1^st and 3^rd quartiles 2.4, 5.1) and median travel time of 6.6 minutes (1^st and 3^rd quartiles 4.4, 8.8) by car. For the two-dimensional analysis, the spatial medians were 3.7 km and 6.5 minutes.

Conclusions: The open-access, web-based application that was developed can be used by physiotherapists and others to study proximity of clinical and community infrastructure for other populations in other cities and regions. In this study, most young people with cerebral palsy living in one metropolitan city had reasonable access by car to a community gym.