Physiotherapist competency and quality providing integrated psychological and physical care – Editorial

The Family and Medical Leave Act ("FMLA") recognizes an employee's right to take leave to care for a qualifying family member. In light of the Act's remedial nature, the intended scope of the care provision is broad, but its definitional details are sparse. As a result of the attendant interpretive discretion afforded to courts, the Seventh Circuit announced its rejection of the requirement-- first articulated by the Ninth Circuit--that care provided during travel be related to continuing medical treatment. A facial analysis of the resulting circuit split fails to appreciate the fundamental difference between the Seventh and Ninth Circuits' considerations: the distinction between physical and psychological care. Whereas physical care is readily measurable, psychological care is less defined and, consequently, ripe to facilitate FMLA abuse. Efforts to combat this potential lead courts to impose judicially devised limitations on psychological care, but judicial discretion still infuses some uncertainty into proceedings. For employers, the best remedy lies in the FMLA's optional certification provision, which requires medical validation of an employee’s need for leave. In requiring certification, employers should distinguish between physical and psychological care, maximize the FMLA’s informational requirements, and implement complete and consistent request and approval procedures.

ObjectiveThe main objective of this study was to assess the prevalence of unmet physical and psychological supportive care needs and associated factors among adult patients with cancer in Southern Ethiopia.MethodsA...

A Study on the Nursing Needs and Satisfaction of Primipara During the Early Postpartum Period

This study examined the views on child neglect among African American and White community members of middle and low socioeconomic status and contrasted their views with those of professionals in the field of child maltreatment. Vignettes concerning an imaginary 18-month-old child were factor analyzed into Physical and Psychological Care scales. There were small but significant differences, with both middle-class African American and White community groups showing greater concern for psychological care than the lower class African American group. Both groups of African Americans were more concerned than middle-class Whites about physical care. Overall, there is considerable agreement among the community samples in their views of what circumstances are harmful to children; professionals in the field appear to have a higher threshold for concern.

To explore patient views on participation in treatment, physical care and psychological care decisions and factors that facilitate and hinder patients from making decisions. Qualitative study using semi-structured interviews with patients. Three NHS Trusts in the north-west of England. Theoretical sampling including 41 patients who had been treated for colorectal cancer. For patients, participation in the decision-making process was about being informed and feeling involved in the consultation process, whether patients actually made decisions or not. The perceived availability of treatment choices (surgery, radiotherapy, chemotherapy) was related to type of treatment. Factors that impacted on whether patients wanted to make decisions included a lack of information, a lack of medical knowledge and trust in medical expertise. Patients perceived that they could have a more participatory role in decisions related to physical and psychological care. This study has implications for health professionals aiming to implement policy guidelines that promote patient participation and shared partnerships. Patients in this study wanted to be well informed and involved in the consultation process but did not necessarily want to use the information they received to make decisions. The presentation of choices and preferences for participation may be context specific and it cannot be assumed that patients who do not want to make decisions about one aspect of their care and treatment do not want to make decisions about other aspects of their care and treatment.

Objective: To determine the prevalence of care needs and identify related factors among patients after thyroid surgery at the National Hospital of Endocrinology. Subjects and methods: A cross-sectional descriptive study was conducted on 216 patients who underwent thyroid surgery at the National Hospital of Endocrinology from April to June 2025. Results: The majority of study participants were female (65.7%), with males accounting for 34.3%. The highest care needs were medical care (88.0%), followed by psychological care (83.3%) and physical care (79.2%). Social care needs had the lowest percentage (73.1%). Regarding general care needs, 98.1% of patients had care needs, and only 1.9% did not. The related factors are as follows: Age is associated with the patient’s medical care needs; occupation, education, place of residence, and disease stage are linked to the need for physical care; education level and disease stage are related to the need for mental care; and disease stage is associated with the need for social care. Conclusion: The study shows that the care needs of post-thyroid surgery patients at the National Hospital of Endocrinology are very high, especially for medical, psychological, and physical care. Factors such as age, occupation, education level, place of residence, and disease stage significantly influence the various care needs.

Physical and psychological self care coping styles affect the quality of life among patients with heart failure. Understanding coping styles and related factors is important. 1) To understand coping involved with self care of physical and psychological aspects in chronic heart failure patients and 2) to understand the associated factors with self care coping. A systemic review of databases PubMed, CINHAL, PsycINFO and Airti Library were searched with key terms: 'heart failure', 'coping' and 'self-care' for the period of January 1984 to October 2013. Twenty-six studies were included. Emotion-focused coping (acceptance and disavowal) and problem-focused coping are positively associated with better physical and psychological self care, whereas an emotional approach with escape avoidance was negatively related to adaptive self care. Enhancing the use of emotion-focused coping with acceptance could facilitate problem-focused coping regarding physical self care (medication and dietary adherence) and reduce adverse drug effects. The associated factors in coping styles of physical and psychological self care included socio-demographic factors, health condition-related factors, patient-related factors and spirituality and religion factors. Emotion-focused coping with acceptance and disavowal, as well as problem-focused coping, may positively influence physical and psychological self care. Health care professionals should accept and allow patients to use emotion-focused coping, then help patients to use problem-focused coping skills. The influencing factors have important roles in individuals' coping styles. There is a lack of experimental and qualitative research to determine how the influencing factors affect self care coping, since this review is primarily of revealed correlational studies.

Nursing care, encompassing the physical, psychospiritual, sociocultural, and environmental aspects of care, should ensure patients' comfort in both chemotherapy and transarterial chemoembolization (TACE) treatment. The aim of this study was to examine the canonical correlations between perceived symptoms and interferences, barriers to symptom management, and comfort care in nurses caring for chemotherapy and TACE patients. This cross-sectional study surveyed 259 nurses caring for patients undergoing chemotherapy (n = 109) and TACE (n = 150). Fisher exact test, t tests, χ2 tests, Pearson correlations, and canonical correlations were performed. In the chemotherapy nurse group, higher perceived symptoms ( R values = 0.74), higher perceived interference ( R values = 0.84), and higher barriers to pain management ( R values = 0.61) were associated with higher physical ( R values = 0.58) and psychological ( R values = 0.88) comfort care. In the TACE nurse group, the higher the perceived symptoms and perceived interference, the lower the perceived barriers to pain management, and lower barriers to nausea/vomiting management were associated with higher physical, psychological, sociocultural, and environmental care. Nurses caring for TACE patients reported lower perceived symptom interference and comfort care, including physical, psychological, and environmental aspects, than those caring for chemotherapy patients. In addition, there was a canonical correlation among perceived symptoms, symptom interferences, barriers to pain management, and comfort care, including physical and psychological care of nurses caring for chemotherapy and TACE patients. Nurses caring for TACE patients need to provide physical, psychological, and environmental comfort care for their patients. Oncology nurses caring for chemotherapy and TACE patients should coordinate treatment for co-occurring symptom clusters to enhance comfort care.

Background: Limited studies have attempted to identify the care needs of patients with spinal cord injury (SCI) and their professional caregivers at home and after discharge from the hospital. However, little information about these needs has led to increased physical and psychological complications and thus a reduced quality of life in SCI patients. Objectives: This study aimed to explain the experiences of patients and their caregivers regarding physical and psychological care needs at home. Method: This qualitative descriptive study was conducted on 24 SCI patients and their professional caregivers using the conventional content analysis. Data were collected through unstructured and semi-structured interviews. Purposeful sampling was continued until data saturation was reached. The conventional content analysis approach proposed by Graneheim and Lundman (continuous comparison) was used to analyze the data. Results: The age range of the participants was 29 - 48 years, with an average age of 37.8 years. Seven of the participants had paraplegia, and three of them had tetraplegia. The results of data analysis led to the extraction of two main categories, including physical and psychological care needs. Conclusions: By identifying the real needs of patients after discharge from the hospital, we emphasize the need to remove barriers to home health care services and provide more financial support to meet patients' needs. Therefore, policymakers are encouraged to use the results of this study to plan at-home patient care services.

BackgroundUp to 50% of individuals with musculoskeletal road traffic injury (RTI) develop chronic pain, resulting in substantial individual and societal burden. Integrated psychological and physical care, such as StressModex, improves patient outcomes compared to physical treatment alone. However, StressModex is not routinely implemented in physiotherapy practice, due to limited training access and physiotherapists’ lack of confidence in delivering psychological care. To address this gap, we developed a blended learning implementation strategy—Physiotherapist bIopsyChosocial On-line Training (PICOT)—guided by the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. The aims of this trial are to compare: (1) the effectiveness of PICOT versus in-person training on the reach of StressModex in routine community private physiotherapy practice; (2) the effectiveness of PICOT versus in-person training on adoption, implementation fidelity, sustainability, and maintenance of StressModex; (3) the effectiveness of PICOT versus in-person training on patient health outcomes; and (4) the cost-effectiveness of PICOT versus in-person training. Trial outcomes are informed by the RE-AIM framework.MethodsThis is a hybrid type III implementation-effectiveness, cluster randomised, superiority trial with embedded economic and qualitative process evaluations. Thirty primary care physiotherapy clinics across Australia will be randomly assigned to either the PICOT or traditional 2-day in-person training. PICOT includes a 6-week online program, 6 weeks (once/week) of real-time online group training with individualised feedback, then 3 clinical supervision on-line sessions (once per fortnight). All on-line sessions are co-facilitated by a clinical psychologist and expert physiotherapist. Following training, physiotherapists will deliver StressModex to eligible patients (≥ 18 years, ≤ 12 weeks of musculoskeletal spinal pain post RTI, and at risk of poor recovery). The primary implementation outcome is reach, defined as the proportion of eligible patients treated with StressModex over 8 months. Secondary outcomes include adoption (training participation and initial uptake), implementation (dose, fidelity, and sustainability of delivery), patient health outcomes (collected at Time1, 8 weeks, 6-, and 12 months), and cost-effectiveness.DiscussionThis trial will provide critical evidence on scalable training models for embedding integrated psychological and physical care into physiotherapy practice. Findings will inform strategies to improve the implementation and sustainment of evidence-based interventions for musculoskeletal RTIs.Trial registrationACTRN12624001268538. Registered on 18 October 2024. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspxid=388006&showOriginal=true&isReview=true

Family supports is an effort to help and supporting someone if necessary. In elderly period, someone will having physical, psychology and social deteriorations. If the elderly getting older, they will have physically deterioration especially physical ability so it will influence their health. Otherwise, Elderly needs the family support to their health care. The purpose of this study was to indentify the family support in health care of elderly is Simpang Tiga Public Health Care Area’s. This was a quantitative study with descriptive design. Population were the elderly family. Sample were 97 peoples which taken by purposive sampling technique. The reserach instrument was used questionnaire. The data analyze was used univariate. The result showed that majority of elderly got physical care from family was good amount 55 peoples (56,7%), got psychology care from family was good amount 56 peoples (57,7%), got social care from family was good amount 55 peoples (56,7%) and got spiritual care from family was good amount 56 peoples (57,7%). It is recommended to family with elderly too increase the health care needs especially spiritual and social needs so influence betterquality of life in elderly. Keywords : Physical Care Needs, Psychological Care Needs, Social Care Needs, Spiritual Care Ceeds.

Preventing the ITU syndrome or how not to torture an ITU patient! Part I

BackgroundThere is scarce knowledge on the health care follow-up of parents of terror attack survivors. This study focused on the mothers and fathers of survivors and examined (1) their perceived health care needs relative to their psychological reactions, physical health problems (unmet health care needs), and adaptation to work; (2) whether sociodemographic characteristics, health problems and social support were associated with unmet health care needs; and (3) how unmet health care needs, sociodemographic characteristics, and experiences with health services associated with overall dissatisfaction during the health care follow-up.MethodsInterview and questionnaire data from three waves of the Utøya parent study were analyzed (n = 364). Chi-square tests and t- tests were used to compare unmet physical and psychological health care needs, sociodemographic factors and post-terror attack health reported by mothers and fathers. Logistic regression analyses were used to examine whether sociodemographic characteristics, unmet health care needs, and health care experiences were associated with overall dissatisfaction among mothers and fathers of the survivors during the health care follow-up.ResultsAmong the mothers, 43% reported unmet health care needs for psychological reactions, while 25% reported unmet health care needs for physical problems. Among the fathers, 36% reported unmet health care needs for psychological reactions, and 15% reported unmet health care needs for physical problems. Approximately 1 in 5 mothers and 1 in 10 fathers reported “very high/high” needs for adaptation to work. Poorer self-perceived health, higher levels of posttraumatic stress and anxiety/depression symptoms, and lower levels of social support were significantly associated with reported unmet psychological and physical health care needs in both mothers and fathers. Parents with unmet health care needs reported significantly lower satisfaction with the help services received compared to parents whose health care needs were met. Low accessibility of help services and not having enough time to talk and interact with health care practitioners were associated with overall dissatisfaction with the help received.ConclusionsOur findings highlight that parents of terror-exposed adolescents are at risk of having unmet psychological and physical health care needs and thus need to be included in proactive outreach and health care follow-up programs in the aftermath of a terror attack.

Life quality is various among patients. In this article, it is shown that several progresses of both physical and psychological care for those patients during resent 15 years which we have had Japanese National Project for the quality of life in intractable diseases. Of course total cure of the disease is the best for the patients, but the second best is continuous better patient care. Total respiratory care of amyotrophic lateral sclerosis including non-invasive positive pressure ventilation and systematic approach of respiratory rehabilitation are good examples of better physical care. The approach with SEIQoL-DW is another good trial to evaluate and maintain their psychological condition. These should be also useful to another intractable diseases such as multi-system atrophy, spino-cerebellar atrophy or Parkinson disease. Long term contribution of multi-disciplinary care team of individual patient has to be needed to make the better effort for the patient support now. We should have more options of treatment, rehabilitation or social life support those with which the patients could decide to have their favorable life with intractable disease.

Letter to the Editor