Mind-body therapies for people with pain after stroke: physiotherapists’ and educators’ perceptions about the role/scope of physiotherapy and barriers and enablers to use

Background Stroke and persistent pain post-stroke are common, with pain post-stroke associated with poorer biopsychosocial outcomes and limited evidence-based management strategies. Mind-body therapies provide a holistic management option however, physiotherapists’ knowledge and perceptions may limit usage and current entry-level university education for physiotherapists is unknown. Purpose Our objective was to examine perceived knowledge, perceptions and use of mind-body therapies for people with persistent pain post-stroke and associated education and training among Australian physiotherapists working with people post-stroke. Methods Australian physiotherapists (n = 102) and physiotherapy educators (n = 23) completed online study-specific surveys. Descriptive statistics and multiple linear regressions were conducted. Results Physiotherapists’ perceived mind-body therapy knowledge, usefulness, frequency of use and competence were generally low to moderate. Self-practice was the most reported source of knowledge and the only significant predictor of higher knowledge. Mind-body therapies were considered beneficial for pain and pain related biopsychosocial outcomes post-stroke, with physiotherapists’ perceptions of mind-body therapies most influenced by personal experience and scientific evidence. Perceived knowledge and usefulness of these therapies predicted greater use. However, both physiotherapists and educators noted limited pain and mind-body therapy content during entry-level physiotherapy education, particularly for neurological or stroke cohorts. Conclusions Despite physiotherapists considering mind-body therapies beneficial in the management of persistent pain post-stroke, overall perceived knowledge, use, and competence were low. Self-practice, rather than formal education, influences physiotherapists’ perceptions and predicts higher knowledge, and perceived knowledge and usefulness predict greater use of mind-body therapies. More quality scientific literature and learning opportunities during entry-level university education, may be warranted.

Background While stroke survivors with persistent pain consider mind-body therapies useful, physiotherapists have reported that consumers may not see mind-body therapies as within their role. Objective To explore the perceptions and experiences of stroke survivors with pain regarding physiotherapists’ provision of mind-body therapies. Methods Fifteen Australian stroke survivors with pain (11 women/4 men, aged 28–84 years, 5 months to 84 years post-stroke) participated in qualitative semi-structured interviews using a study-specific interview guide comprising eight primary questions regarding their demographics, perceptions and experiences of stroke, pain, mind-body therapies and physiotherapists providing mind-body therapies. Data were analyzed using reflexive thematic analysis and the COREQ guidelines informed the reporting of the study. Results We generated five themes to describe participants’ perceptions and experiences of physiotherapists’ use of mind-body therapies. Theme 1 detailed support for physiotherapists providing or referring for mind-body therapies. Theme 2 described that physiotherapists being trusted health professionals would increase consumers’ use of mind-body therapies. Theme 3 collated perceptions that physiotherapists’ low use of mind-body therapies may be related to limited skills/knowledge regarding the mind-body connection. Theme 4 summarized perceptions about physiotherapists’ training needs. Finally, Theme 5 presented responses regarding the perceived scope of practice for physiotherapists regarding mind-body therapies. Conclusion Stroke survivors with pain see physiotherapists as trusted health professionals and would like them to provide, recommend, or refer for mind-body therapies as guided by scientific literature or past patient experience. Increased training for physiotherapists, including experiential practice and content on psychological aspects of persistent pain and the mind-body connection, could improve physiotherapists’ current low use of mind-body therapies. While many mind-body therapies may be within physiotherapists’ scope of practice, this requires further exploration.

Objective: The effects of stroke are both physical and mental in nature and may have serious implications on the overall well-being of stroke survivors. This analytical review aims to critically evaluate and statistically synthesize the existing literature regarding the effects of mind-body (MB) exercises on mood and functional capabilities in patients with stroke. Methods: A structured literature review was performed in both English (PubMed, PEDro, and Cochrane Library) and Chinese (Wanfang and CNKI (Chinese National Knowledge Information Database)) databases. Sixteen randomized controlled trials were considered eligible for meta-analysis. Based on the random effects model, we used the pooled effect size to determine the magnitude of rehabilitative effect of MB exercise intervention on depression, anxiety, activities of daily living, and functional mobility among stroke survivors. The sum PEDro score ranged from five to nine points (fair-to-good methodological quality), but the absence of concealed allocation and blinded assessors were reported in most studies. Results: The aggregated results showed that MB exercise intervention is associated with significantly improved ADL (Hedges’ g = 1.31, 95% CI 0.85 to 1.77, p < 0.001, I2 = 79.82%) and mobility (Hedges’ g = 0.67, 95% CI 0.25 to 1.09, p < 0.001, I2 = 69.65%), and reduced depression (Hedges’ g = −0.76, 95% CI −1.16 to −0.35, p < 0.001, I2 = 74.84%). Conclusions: as add-on treatments, the MB exercises may potentially improve depression, activities of daily living, and mobility of these post-stroke patients. Future studies with more robust methodology will be needed to provide a more definitive conclusion.

Background and Purpose- Psychological stressors, including poststroke depression, poststroke anxiety, and posttraumatic stress disorder, are highly prevalent in stroke survivors. These symptoms exact a significant toll on stroke survivors. Clinical and research efforts in stroke recovery focus on motor disability, speech and language deficits, and cognitive dysfunction while largely neglecting psychological stressors. Evidence suggests mind-body interventions in other chronic illness populations decrease symptoms of depression, regulate immune responses, and promote resilience, yet similar studies are lacking in stroke populations. This review aims to synthesize evidence of the effects of mind-body interventions on psychological stressors, quality of life, and biological outcomes for stroke survivors. Methods- A systematic search of PubMed, PsycINFO, and CINAHL was conducted from database inception to November 2017. Results- Eight studies were included in the review, with a total of 292 participants. Mind-body interventions included yoga or tai chi. Of the 5 included randomized controlled trials, most were pilot or feasibility studies with small sample sizes. Psychological stressors, including poststroke depression and anxiety, along with the quality of life, improved over time, but statistically significant between-group differences were largely absent. The 3 included studies with a qualitative design reported themes reflecting improvement in psychological stressors and quality of life. No included studies reported biological outcomes. Conclusions- Studies of mind-body interventions suggest a possible benefit on psychological stressors and quality of life; however, rigorously designed, sufficiently powered randomized controlled trials with mixed-methods design are warranted to delineate specific treatment effects of these interventions. Studies with both biological and psychological stressors as outcomes would provide evidence about interaction effects of these factors on stroke-survivor responses to mind-body interventions.

ObjectiveTo describe the psychosocial distress of head-and-neck cancer patients at the completion of therapy and the interest in and the preferred method of delivery of mind–body interventions (MBIs) among head-and-neck cancer patients.Materials and methodsA descriptive, cross-sectional design was used to measure sleep disturbance, depression, anxiety, and the interest in and the preference for MBIs using anonymous, self-report questionnaires among a convenience sample of 30 males at their 3-month follow-up. Questionnaires included the Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale, and the self-created Survey for Preferred Methods of MBI. Frequency distributions and descriptive statistics were used to describe the sample demographic and clinical characteristics.ResultsThe mean age of the sample was 59 years. Oral cancer (63%) was the most common type of cancer. Nineteen participants (63%, 90% CI 47%–78%) had some interest in MBIs. Of interested participants, 8 (42%) preferred participating in MBIs alone, 10 (53%) preferred participating in MBIs at homes, 10 (53%) preferred participating in MBIs using a computer or mobile device, and 8 (42%) preferred participating in MBIs after the diagnosis, but before treatment started. Mean depression, anxiety, and sleep disturbance scores were 8.25 (SD 2.93), 5.41 (SD 3.52), and 6.3 (SD 3.86), respectively. Results from the independent-samples t-test and Mann–Whitney U tests revealed no significant differences in anxiety, depression, and sleep disturbance by MBI interest.ConclusionAsking about depression, anxiety, and sleep disturbances may help to identify head-and-neck cancer patients at risk for psychosocial distress. These findings suggest an interest in MBIs, but further research is warranted.

INTRODUCTION Dr Geneva R. Johnson (Figure 1) continues to influence physical therapy education as an inspirational participant in the Third Annual Geneva R. Johnson Innovations in Physical Therapy Education Forum (GRJ Forum). Dr Johnson is recognized for her longstanding leadership and mentorship, having contributed to the advancement of physical therapy education, practice, and research for over 60 years. The GRJ Forum started in 2014 through the collaborative efforts of the Academic Council of Academic Physical Therapy (ACAPT) and the Physical Therapy Learning Institute (PTLI).3,12 Once again it was the keynote for the 2016 Education Leadership Conference (ELC) held in Phoenix, Arizona. As expected, the Forum continues to foster creative ideas for positive change to promote excellence in physical therapist education, a hallmark of Dr Johnson's legacy. As in previous years, the Forum set the stage for energy, enthusiasm, and excitement for conference participants as discussions evolved to explore new opportunities to promote excellence in education. The GRJ Forum design is like no other in our profession. Key to its success is provocative speakers who share personal perspectives, immediately followed by active engagement all participants. As Tschoepe shared in her recognition to Dr Johnson and the introduction of the Forum, many remember what has become known as “Dr Johnson's 3 Ps of strong leadership skills”: passion, persistence, and perseverance. Illustrations of these, as well as other essential personal leadership skills, were explored throughout the Forum by many speakers at ELC 2016.FigureGeneva R. Johnson, PT, DPT, PhD, FAPTA, is a national leader in physical therapy education through her search of excellence in patient care, clinical research, clinical specialization, administration, staff development, and postgraduate education. Her main contribution to the advancement of the profession certainly was “to expect physical therapists to be responsible for their actions, to care about themselves and each other, to value their contributions to patient care, and to create their own futures.”1 She envisioned limitless possibilities for the profession and shared that vision with others. Dr Johnson's leadership has been acknowledged over the years by the American Physical Therapy Association (APTA) Mary McMillan Lecture Award and Catherine Worthingham Fellow (1985), the APTA Lucy Blair Service Award (1988), the Army Physical Therapy Program Outstanding Alumni Award (1994,) and the APTA Pauline Cerasoli Education Award (2008). Most recently, her legacy was recognized by the American Council for Academic Physical Therapy (ACAPT), who established the Geneva R. Johnson Annual Forum on Innovation in Physical Therapy Education. 1. Johnson GR. Great Expectations: A Force in Growth and Change. Phys Ther. 1985;65:1690–1695. THE GRJ FORUM: ORGANIZATION AND STRUCTURE The GRJ Forum is designed to: Create a safe environment for key stakeholders in physical therapy education to discuss the infinite possibilities of the future, rather than solving problems of the past. Encourage vision, innovation, creativity, and provocative new ideas that can positively influence the future of physical therapy education. Challenge educators to proactively advance physical therapy education to prepare graduates to meet projected societal and professional needs rather than merely react to external pressures.3 The 2016 GRJ Forum featured Dr Emma Stokes, an international visionary leader and current World Confederation for Physical Therapy (WCPT) president, who energized the over-800 conference participants and set the stage for ongoing conversation and idea development throughout the conference. Her keynote was followed by 3 Ignite Talks from active leaders in physical therapy education in the United States - Dr Michael Majsak, Dr Bob Rowe, and Dr Chris Sebelski. Collectively, they shared individual perspectives of what each believed to be critical to foster graduate success in physical therapist practice that is entrepreneurial in spirit, illustrates personal ownership and accountability, and offers a unique value to the health care team to facilitate optimal, efficient, and effective individual-centered health promotion and management. Discussion by over 200 participants followed these speakers, and they more thoroughly explored the 13 themes presented, and discussed “how might we” or “wouldn't it be great if…” Participants had options to discuss 2 different themes, and table facilitators shared 3 possible highlights that might illustrate innovation and educational change to include education that really matters to better prepare physical therapist graduates for success in their future professional careers THIRD ANNUAL GRJ FORUM HIGHLIGHTS Keynote Address - Walk With the Dreamers Emma Stokes, PT, PhD, is deputy head of the Department of Physiotherapy and a fellow of Trinity College in Dublin, Ireland. She teaches in the university's entry to practice and PhD programs in Dublin and Singapore. Her research focuses on matters related to professional practice; particularly, leadership in the profession. She has received numerous awards and professional recognitions for her contributions to the physiotherapy profession and has been a board member of the World Confederation for Physical Therapy (WCPT) since 2007. She was elected as the president of WCPT in 2015. Dr Stokes opened her inspirational keynote with a quote from John F. Kennedy: “Let us think of education as the means of developing our greatest abilities, because in each one of us there is a private hope and dream, which if fulfilled can be translated into benefit for everyone.” Stokes brought us on a journey, as an outside international colleague looking in, that examined whether the introduction of the DPT fulfilled its desired intentions; whether, in its current design, it meets the needs and ambitions of the profession, and whether it facilitates leadership skills needed for our graduates to be able to respond to, shape, and serve the future health needs of society. Stokes challenged all participants to reconsider curricular priorities and improve balance in our DPT education programs. Stokes reminded us of the original intentions of the move to the DPT as part of Vision 2020. Rothstein11 stated that the move to postbaccalaureate education was “based on a moral authority derived from educational need and the expectation that a profession serves society before itself,” and the “need to prepare physical therapists to exemplify the highest standards of health care, use evidence, skillfully apply techniques, be thoughtful and effective…within the confines of a healthcare system that can promise nothing but chaos for the foreseeable future.” Her review of the stated aims and key expected outcomes of Vision 2020 led her assessment to confirm that not all of the anticipated outcomes have been realized. For example, she noted the matter of reimbursement, fully implemented and available direct access, and the balance of clinical content with leadership and advocacy within DPT curriculum are not yet fully appreciated. While there is a move in countries such as Pakistan, Iran, and Taiwan to move to entrylevel DPT, as well as discourse in Canada and Australia9 suggesting such a need, the global physical therapy community has not followed suit and the baccalaureate degree remains the most common entry-level qualification. Moreover, the country with unquestionably the largest scope of practice in physical therapy—the United Kingdom—achieves this with an entry-level education requirement of a bachelor's degree. She stated unequivocally that the current DPT education was shying away from what is critically needed to develop the next generation of leaders to be equipped to advocate and lead the transformative change articulated in the ambitious plan of the American Physical Therapy Association (APTA) and to respond to the health challenges facing our communities, now and in the future. What does the next generation of DPT leaders need to lead the transformation required? Leadership development cannot be a “footnote” in our core values and in our curricula. Drawing on a conversation with Orla Tinsley, a young woman living with cystic fibrosis (CF) and a passionate advocate for people with CF, she recounted Orla's message to participants: “Sometimes in science it can be hard to reach for the marvelous. We are taught that science is a place of precision and parameters when really these are the elements we need to step into the space of the marvelous. Once we know the rules, we must not be afraid to push forward and learn how to bend and even break them in ways that can be calculated and revelatory.” Stokes asked us to reflect and be sure we have a place for both the marvelous and the matter of fact in our DPT curricula. In other words, have we enough space within a curriculum to teach the next generation of leaders the skills and knowledge they need for successful advocacy and leadership? Her view at current continues to be a resounding “no.” Stokes shared that transformative leadership requires new rules, new ways of acting, and new perspectives. It requires that we consider design not only function; story not only argument; symphony not only focus; empathy not only logic; play not only seriousness; and meaning not only accumulation.10 It will require physical therapists who understand themselves, others, and organizational dynamics, and who have the skills, capacity, and willingness to lead.4 Are we shying away? Stokes maintained the answer is yes, we are shying away from providing leadership and advocacy skills in our entry-level education. She cited the Commission on Accreditation in Physical Therapy Education's standards for professional entrylevel education, and noted that unfortunately, leadership is cited only 4 times, and on 3 occasions, it related to the faculty. If this is the behavior we want from graduates, then where is the emphasis on leadership and advocacy in these standards? She encouraged us to consider how might we create a greater urgency of the importance of curricular balance at the accreditation, program, and faculty intention levels. Stokes continued by considering the Delors et al5 report for UNESCO on education—“Learning, the treasure within”—and contends that in our entry-level programs, we teach “learning to know, and learning to do” well. However, she is not convinced that we place sufficient time and emphasis on “learning to live together and learning to be,” key aspects of personal leadership development. At the WCPT Futures Forum, Sefan Jutterdal,8 president of the Swedish Physiotherapy Association, called upon the global physiotherapy community to be more like Pippi Longstocking - responsible, courageous, and imaginative. Stokes asked participants to identify and ensure we build into curricula the responsibility to be courageous and transformative. She closed her keynote with some difficult yet insightful questions for the group: Do we reward behaviors we want? If we want the next generation to be leaders, to be advocates, to be transformative, do we reward these behaviors in the same way that we reward clinical skill performance? Do we clearly define and measure our leadership and advocacy deliverables? Do the organizations that evaluate how well we, as academic programs, achieve our educational outcomes, evaluate, and reward inclusion of leadership and advocacy learning experiences? In closing, she wished the group, “for today, for tomorrow, for the rest of the time that we teach and learn and research and educate the next generation of leaders, to ‘walk on air, against your better judgment.’7 Only in this way is it possible to teach what really matters to our future graduates!” IGNITE TALKS The IGNITE speakers had 5 minutes to share their personal perspectives to the Forum question or to offer a response to the key points of Dr Stokes’ keynote address. Each was encouraged to challenge the status quo, share new ideas and approaches, or raise emotional levels of conference participants in a manner to foster evaluation and action of new practices in physical therapy education. First Ignite Talk - Curious: What Does It Take to Believe and Act? Dr Chris Sebelski, PT, DPT, PhD, OCS, associate professor at Saint Louis University, director of the SLU-SSM Physical Therapy Orthopedic Residency Program, and a fellow of the Education Leadership Institute (ELI), offered her IGNITE TALK from a faculty and residency director perspective. She asked, why are physical therapists perceived to be better advocates for their patients than for themselves and the profession? Also, why are physical therapists comfortable with being quietly competent when the profession is in need of a unifying vision and an identifiable, marketable skill that secures a position as a provider and expert of the movement system and movement dysfunction? To answer these questions, she examined self-efficacy and actions of physical therapists in today's practice environments. Sebelski referenced Bandura,1 who describes self-efficacy as the personal judgment or conviction that one can successfully execute the behavior(s) required or execute a desired course of action to produce certain outcomes. In her recent research, over 600 therapists responded to a request to complete a standardized tool on leader self-efficacy. Through a series of questions, an aggregate score was used to determine an overall rating of perceived self-efficacy in leadership. Physical therapists in her study reported moderate to strong beliefs that they have the skills and behaviors to lead. Although the therapists in the study had moderate to strong self-efficacy leader beliefs, those therapists over 40 years of age had greater beliefs that they knew how to coach and how to inspire others, behaviors recognized by several authors to be critical in personal leadership development. These findings lead her and others to explore explicit directions to encourage attainment of positional leadership by those in our profession. Therapists need to develop skills to coach and inspire not only their patients but each other. Seasoned therapists need to live the performance accomplishments of a leader, thus giving the more novice physical therapists role models, examples, and vicarious opportunities necessary to further develop personal leadership skills early in their professional careers. Younger therapists need to be more consistently exposed to a lens where leadership skills beyond the individual patient interaction is explicitly discussed and expected. Leadership training should be intentionally addressed within curricula at entry-level, residency, and fellowship programs. She encouraged harnessing these beliefs of leader self-efficacy into the attainment of explicit leadership skills and the commitment to act in a manner that will advance our profession. Sebelski ended her IGNITE within the spirt of appreciative inquiry: “What would happen if since we strongly believe that we can lead that we actually feel empowered to act and lead?” Second Ignite Talk - Do Great Students Make Great Physical Therapists? Dr Bob Rowe is the executive director of Brooks Institute of Higher Learning (Brooks IHL) within the Brooks Health System, located in Jacksonville, Florida. Currently, he serves as a director on the APTA Board of Directors, and is the immediate past president of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). Bob shared his IGNITE from a clinical practice and residency perspective. He pointed to a lack of passion demonstrated by the majority of physical therapists in today's practice environments, as evidenced by the intent “to do nothing beyond the minimum requirements of employment and licensure,” a challenge in our profession. He encouraged the academic community to develop admission criteria that consider passion and to design intentional efforts to develop passion in thoughtful learning experiences within DPT professional entry and postprofessional residency education. Rowe challenged participants to consider the types of students accepted into DPT education programs. He confirmed that we recruit academically superior students who graduate and pass the national licensure exam. Yet, only 30% of physical therapist licensees in the United States are APTA members and only 10% of these members contribute to the APTA Political Action Committee (PAC). Rowe posed 4 reflective questions: How many physical therapists show up to their employment site at the designated time and then leave at the designated end of the day? How much time do physical therapists spend in daily reflection on their patient's needs and progress or their own professional development? How many physical therapists are committed to being actual lifelong learners versus merely meeting the minimum state requirements for continuing education for licensure? How many physical therapists have ever attended a legislative advocacy hearing, or visited their state legislator or member of Congress to advocate for the profession? Rowe acknowledged that physical therapists often provide skilled services, yet questioned why they are not committed to their profession to the extent that we need them to be and wondered what is missing. Rowe compared his observations of medical students and physical therapist students and shared that medical students’ “passion quotient” does not change significantly during 4 years of medical school. Instead, it is within postprofessional residency training that medical residents become new human beings socialized with passion, an appreciation of their profession, and their role within it, with a particular emphasis on the subculture for their specialty area of practice. Rowe's recommendation to improve passion is requiring mandatory postprofessional residency program immediately after entry-level graduation. He shared his belief that residency training is the most appropriate tool to instill and nurture passion, a recognized critical leadership behavior. He was passionate in his IGNITE to share that it is only through intentional processes that we will be able to successfully instill passion that will lead to transformation of the professional, profession, association, and society. Third Ignite Talk - Walking Towards Our Vision: Are We Over Involved and Under Committed? Dr Michael Majsak, PT, EdD, associate professor and department chair at New York Medical College, recognized for his efforts to establish a DPT/MPH dual degree and for his leadership in integrating IPE curriculum across multiple graduate health professions, offered his IGNITE from an ACAPT representative academic administrator's perspective. He focused his talk on the concept of “education that matters,” a key component of this year's Forum question. Dr Majsak acknowledged that his perspectives are shared by numerous program administrators and confirmed that although we are developing excellent clinical skills in our graduates, we may not be developing reflective practitioners who are prepared to lead, represent our profession to others, and practice effectively in a constantly changing health care system. He encouraged all educators not to “shy away” from these latter essential graduate learning outcomes, but instead reevaluate how we may be over committed in teaching a wide breadth of clinical sciences and under committed to issues of professionalism, leadership, and public health necessary to attain APTA's Vision for the profession, “transforming society by optimizing movement to improve the human experience.” Dr Majsak drew a distinction between being involved versus being committed by sharing the whimsical metaphor that a hen is only involved, but a pig is fully committed in contributing to a breakfast plate of ham and eggs. Similar to the pig, Dr Majsak suggested that being committed means sometimes sacrificing things we intrinsically personally value to achieve higher priority goals, such as visions for future DPT professionals, the profession of physical therapy, and ultimately, the health of society. He challenged all stakeholders involved in physical therapist education to design not only transmissive or transactional learning experiences within DPT programs, but rather transformative learning experiences that result in structural and cultural shifts in how students think, feel, and act as a doctoring professional. Majsak went on to challenge educators to ensure that DPT students have sufficient time and experiences for self-reflection and self-directed learning, interprofessional education, and opportunities in service-based learning to appreciate and value issues in public health policy and management, as well as the social determinants of health that ultimately influence the future success of DPT graduates and our profession. CAFE STYLE DISCUSSIONS Small group café style discussions allowed all participants of the GRJ Forum to have their voices heard in reaction to the keynote address and IGNITE Talks. The discussions were facilitated using an appreciative inquiry approach to inspire purposeful changes based on the best of what currently is and with the potential of generating positive unforeseen outcomes. The focus was not on what was wrong or needed to be fixed but on what worked well. To create positive visioning, participants were encouraged to share success stories related to the discussed topic and to finish sentences such as “How might we…” and “Wouldn't it be great if we could…” Each participant had the opportunity to discuss 2 of 13 topics. The tangible outcomes of the discussions were innovative directions for physical therapy educators to explore. The 13 topics and highlights from the discussions are presented in Table 1. The themes of the discussions were on the intentions for DPT education to graduate physical therapists prepared to lead, and In a of with our group of speakers, and the Forum encouraged all 2016 ELC participants to reflect and consider what each might do to illustrate passion, persistence, and within our own of influence in this we as Dr Stokes with the and as Dr Johnson role for many years, the to act in a manner that will advance physical therapist Dr Johnson the efforts and ideas of the 2016 Forum participants and challenged us to it in some way we can share of actions at where she to evaluate our We for their contribution to the success of the Third Annual GRJ Forum and forward to Education Leadership where we will have opportunities to learn about actions by this year's Forum of this year's GRJ Forum can be on the ACAPT To the Board members of ACAPT and for their collaborative efforts in the To PT, and the for their to the Forum in Dr Geneva R. Johnson's To the table Catherine Mary and to Dr Mary ACAPT Program Committee for the necessary to the GRJ Forum a and to the ELC Program Committee members for keynote conference and space within the Education Leadership Conference for this year's

Pediatric interprofessional education opportunities in entry-level doctor of physical therapy programs

Introduction: Sexual minority (SM; lesbian, gay, bisexual) older adults age 50+ experience a higher prevalence of chronic disease and disability, as well as a poorer physical and mental health status, compared with their heterosexual peers. Many adults use complementary and integrative therapies, particularly mind-body therapies, as health-enhancing approaches and to support well-being. However, no study to date has examined the use of mind-body therapies among SM older adults. Materials and Methods: Data were from the 2017 National Health Interview Survey. Descriptive and summary statistics were calculated to describe use of mind-body therapies by SM older adults (aged 50+). The authors also tested associations between use of mind-body therapies and health and well-being among SM older adults and compared associations with their non-SM counterparts. Results: SM older adults reported higher usage (36%) of mind-body therapies compared with heterosexual adults (22%), with lesbian women reporting the highest use (39.4%). Having a SM identity was associated with mind-body therapy use; SM older adults were 57% more likely to use a mind-body therapy. Conclusion: Mind-body therapies may be a useful tool for SM older adults to enhance their health and well-being. Future qualitative research is needed to investigate more deeply the reasons SM older adults use mind-body therapies. To advance the health and well-being of SM older adults, the authors also need intervention studies that explore the effectiveness of mind-body interventions and the possible need for tailoring these to the unique needs of this population.

Effects of non-pharmacological interventions on depressive and anxiety symptoms in pregnant women: a systematic review and network meta-analysis

Faculty development has been identified as an important initiative in Doctor of Physical Therapy (DPT) education. However, little is known about opportunities available for associated faculty (AF). These unique educators who make notable contributions to physical therapist education often lack formal preparation for teaching. The purpose of this study was to explore AF development opportunities across physical therapist education programs nationally. Formal faculty development programs have been successful in medical and nursing education programs to enhance educator identity, skill, and retention in both core and clinical faculty. No evidence of faculty development programs for AF in physical therapy education was found in the literature. Participants were program directors or identified faculty development leads from CAPTE accredited and in-candidacy physical therapist education programs. Seventy participants completed an anonymous survey and 10 participated in semistructured interviews following the completion of the survey. A parallel, convergent, mixed methods approach was used to assess the national state of formal AF development opportunities. A survey was developed to assess development opportunities available to AF. Descriptive statistics and Chi square analyses were performed to analyze quantitative data. An instrumental collective case study further explored development opportunities. Deductive and inductive thematic analysis techniques were used to analyze qualitative data from interview transcripts. Quantitative and qualitative approaches were integrated in the data analysis. Survey data, aligned with interview outcomes, suggest that despite ideologic support for faculty development, low percentages of AF have access to formal development activities, and even fewer are receiving adequate breadth of educational content related to proficiency in their role. A lack of formal development opportunities exists for AF. Excellence in DPT education requires deeper development across all levels of faculty, including opportunities tailored specifically to the unique needs and role of AF.

BackgroundScientific developments have brought hope to infertile couples; however, the results are not always favorable. This makes women suffer psychological pressure. Therefore, previous studies have investigated the effectiveness of many psychological interventions but no research identified the most common psychological interventions. In this regard, the present review aimed to investigate different psychological interventions that promote mental health in infertile to identify the most frequent (common) ones.MethodsIn the present study, the search was carried out using appropriate keywords Infertility, psychological interventions, mental health, stress, anxiety, depression and women in the Google Scholar، Magiran، SID، Pubmed، Scopus، Science Direct، ProQuest، Web of Science databases and One of the leading websites in health- WHO with Persian and English languages and two operators of “AND” and “OR” between 2000 and 2021.ResultsFirst, 7319 articles were searched, 6948 articles of which were removed due to irrelevant subjects, and 31 articles were removed due to duplication. 340 abstracts were examined and the results of 60 articles were extracted. Two approaches (examining the type and content of intervention) were used to extract findings. The first approach indicated high diversity in psychological interventions, leading to the categorization of the interventions into 4 categories of cognitive behavioral therapy (CBT), mind-body interventions (MBI), stress management skills, and others. CBT and MBI and stress management skills were found as the most frequent promoting interventions for mental health in infertile women. The second approach indicated the differences in protocols (number of sessions and time of interventions).ConclusionDespite differences in protocol of interventions under study, the results of all articles revealed the effectiveness of interventions in improving infertile women’s mental health; therefore, it is suggested to apply the most common psychological interventions based on scientific evidence (CBT, MBI, and stress management skills) along with infertility treatment methods. The results will help the specialists, policy-makers, and planners to select and implement the most appropriate psychological interventions for infertile women.

Introduction: Fall is a common clinical problem for people after stroke, which can impact their functional recovery and cause physical and psychosocial disturbances. Mind-body intervention may be beneficial for fall management. This review aimed to assess the effects of mind-body intervention on fall-related outcomes for stroke survivors. Methods: Seven English databases and four Chinese databases were searched from inception to August 2023. Two reviewers independently conducted study screening, risk of bias assessment and data extraction. Cochrane Risk of Bias Tool 2.0 and Grading of Recommendations Assessment, Development and Evaluation were adopted to assess the risk of bias and certainty of evidence. Meta-analyses were performed using Review Manager 5.4 and narrative syntheses were adopted if necessary. Results: Twenty-two randomised controlled trials were included. The included interventions consisted of meditative exercise (e.g., Tai Chi, yoga), imagery and biofeedback approaches. The pooled results showed that mind-body intervention reduced the incidence of falls (RR = 0.28, 95% CI: 0.15 to 0.54, I 2 = 0%) and the number of fallers (RR = 0.43, 95% CI: 0.22 to 0.85, I 2 = 0%) over the study period. Despite not reducing the number of survivors having fear of falling, it could significantly increase fall efficacy at short- (&lt;1 month: SMD = 0.84, 95% CI: 0.38 to 1.30, I 2 = 88%) and medium-term post-intervention (1 to &lt; 6 months: SMD = 0.37, 95% CI: 0.05 to 0.69, I 2 = 0%). Mind-body intervention could significantly improve balance (SMD = 1.56, 95% CI: 0.85 to 2.28, I 2 = 95%), but had non-significant effects on mobility, functional independence and quality of life. Besides, meditative exercise and imagery showed greater effects on fall efficacy and balance than biofeedback intervention. For all outcomes, we judged the evidence as very low or low certainty. Conclusions: Low- to very low-certainty evidence suggests that mind-body intervention, especially meditative and imagery approaches, can be effective in improving fall-related outcomes for stroke survivors, e.g., reducing fall incidence and fallers, and increasing fall efficacy and balance. Further rigorous large-scale randomised controlled trials are recommended to strengthen the existing evidence.

Generative artificial intelligence (AI) is rapidly gaining popularity across health care, education, and society. The purpose of this study was to assess perceptions and use of generative AI in academic physical therapy (PT). Generative AI became one of the fastest-growing technologies ever after the public release of ChatGPT in November 2022. Early data indicate that attitudes toward generative AI in higher education are mixed and rapidly evolving, with significant ethical concerns around use and potential misuse. There are no published studies investigating perceptions and use of generative AI in PT education. A total of 175 surveys were completed and analyzed. Respondents included PT educators, administrators, and students. An anonymous, online survey on use and perception of AI was distributed through email and social media. Descriptive statistics and cross-tabulations were performed to analyze respondent characteristics and responses to survey questions. Most respondents (61.1%) reported they did not use generative AI during the 2022-2023 academic year, whereas 35.4% were generative AI users. More than 40% of respondents were optimistic or very optimistic toward generative AI. Users of AI were more likely to report an optimistic or very optimistic disposition toward AI compared with nonusers. AI users were more likely to agree or completely agree that generative AI has more benefits than drawbacks compared with nonusers. Results of this survey suggest that, despite the rapid uptake of generative AI in society, many PT educators and students harbor reservations and uncertainties toward its use. Artificial intelligence users were less likely to hold negative perceptions toward it and were more likely to find it useful. Understanding use and perceptions of generative AI in PT education may inform strategies to promote innovation, policy-making, and ethical integration of this new and rapidly evolving technology.

Stress-related illnesses are on the rise among medical students and doctors in Germany and internationally. Mind-Body Medicine (MBM) methods are increasingly being used to reduce stress. MBM courses are now being offered to students at medical faculties in Germany, including Charité - Universitätsmedizin Berlin and e.g. at the universities of Magdeburg, Witten-Herdecke, Essen and Ulm. The courses offered in Berlin and Magdeburg are presented as examples in this article. In addition, the Charité course was also conducted with employees (doctors and nurses) of a Charité intensive care unit. The student courses at both medical universities were evaluated at the same time. The results of the analyses showed a reduction in perceived stress and an increase in self-efficacy, mindfulness, self-reflection and empathy in 117 Charité students, and an improvement in mindfulness (Freiburg mindfulness inventory (FFA)) and self-compassion (Self Compassion Scale - German Version (SCS-D)) in 69 students from Magdeburg. In the qualitative focus groups, the students at Charité also reported better abilities to self-regulate stressful experiences, personal growth and new insights into integrative medicine. The further implementation of MBM courses at German-speaking medical universities appears to make sense. In addition, MBM courses should be networked across different locations in order to coordinate their content and carry out a joint evaluation using standardised measurement instruments on a larger group of participants. In addition, the implementation of randomised controlled studies to investigate the effectiveness of MBM courses would be beneficial.

Use of Complementary And Alternative Medicines (Cam) In Diabetics Patients In Quetta