Australian Physiotherapists Research Articles

Demographics and scope of Australian emergency department physiotherapists

QuestionsTo provide workforce data on the status of Australian Emergency Department (ED) physiotherapy practice, including physiotherapist demographic data, staffing levels and funding sources. Evaluate the scope of practice currently undertaken by ED physiotherapists and alignment of ED physiotherapy service provision with demand levels.DesignCross sectional survey.ParticipantsAustralian physiotherapists working within an Australian ED.Outcome measuresWorkforce data, scope of practice and alignment of physiotherapy service provision to ED presentations and demand.Results94 Australian ED physiotherapists completed the survey, 76.9% were working as primary contact clinicians. They had a diverse scope of practice, 100% perform mobility assessments, 89.9% provide care for paediatric patients and 10.1% were involved in administration of medications. 86.2% of participants (75/87) reported working within a service model that provided seven-day per week physiotherapy coverage to ED.ConclusionThe sample of ED physiotherapists were found to be experienced and highly trained clinicians with a diverse scope of practice, who are well placed to meet the unpredictable and highly variable patient caseload of Australian EDs.

Treatment options used in the management of people with temporomandibular disorders by Australian dentists and physiotherapists.

Studies documenting the treatments used by dentists in the management of temporomandibular disorders (TMDs) have been undertaken in some countries; however, no such research has been conducted in Australia. No similar studies have been documented for physiotherapists. The aim of the study was to determine the treatment options and referral patterns used by Australian dentists and physiotherapists in managing people with TMDs. Prospective nationwide online questionnaires targeting Australian dentists and physiotherapists were created for Australian dentists and physiotherapists. Seventy-eight respondents (27 dentists; 51 physiotherapists) completed all questions in the questionnaires. Sixty respondents reported actively treating people with TMDs. The treatment options used most frequently by dentists included advice and education, oral appliances, physical agents such as moist heat and medications. The treatment options most frequently used by physiotherapists included manual therapy, exercises, electrophysical agents and advice and education. Referrals were most frequently made to dentists and physiotherapists with experience and/or expertise in managing people with TMDs and to general dentists. Commonly used treatment options were mostly conservative, reversible and evidence-based. More responses are required to draw conclusions representative of Australian dentists and physiotherapists in the management of people with TMDs.

Physiotherapy assessment of people with neurological conditions in Australia: A national survey.

Currently there are approximately one billion people worldwide affected by a neurological condition. These conditions may result in a variety of impairments that require assessment and management from a physiotherapist. However, there is a lack of consensus in the literature as to what domains physiotherapists working in clinical settings include in their assessment of this population, with only five domains identified in a recent systematic review. This study aimed to explore current physiotherapy assessments in people with neurological conditions, including barriers, enablers, and influencing factors. A National online survey of Australian physiotherapists who assessed adults with neurological conditions in their clinical practice. A total of 212 respondents from all states in Australia completed the survey. The mean (SD) age was 35.7 (9.6) years, and the majority were female (85.4%). Respondents worked across various settings assessing stroke most frequently (58.0%). Study results demonstrated variability in assessment practice, with a number of assessment domains being assessed more commonly including balance, muscle strength, gait, falls and safety, function, goal setting, range of movement, pain, co-ordination, activity tolerance, postural alignment and symmetry, and the upper limb. Experienced physiotherapists and those in rural and remote settings included fewer domains in their assessments. On the other hand, physiotherapists in the community setting included certain domains more frequently than those in other settings. Barriers and enablers were related to therapist caseload, knowledge, and intrinsic patient factors. There is variability in domains assessed by Australian physiotherapists, with an emerging consensus for a number of assessment domains. Study results suggest that clinical experience, geographical location, and clinical setting may play a role in the assessment patterns observed. There is little evidence to support what physiotherapists assess in practice, in different settings, in different states within Australia. This study indicates that experience, geographical location, and clinical setting affect the number and types of domains included in the assessment. Further research is needed to develop a consensus on best practices.

Australian physiotherapists' knowledge and views on the relationship between climate change, health, and physiotherapy.

Climate change is an important issue for the health of communities globally and the conduct of health care practice. Little is currently known about the knowledge and views of Australian physiotherapists in relation to the issue of climate change. Thus, the purpose of this study was to investigate Australian physiotherapists' views on, and practice in relation to, climate change and its effects on health. A quantitative cross-sectional study using a modified version of a published survey was undertaken. Using a comprehensive distribution strategy, the survey (23 questions) was disseminated through professional associations, networks of the research team and social media. Data were summarized descriptively. One hundred and thirty physiotherapists accessed the final survey. Ninety-five surveys were eligible for analysis. 90.4% of participants were certain about the existence of climate change. 79.6% of participants thought that climate change was already impacting their patients' health, but only 19.4% of participants felt "very knowledgeable" about the health impacts of climate change. Main barriers to addressing climate change with patients were identified as lack of time and knowledge. 77.2% of participants indicated support for receiving education on climate change and health as continuing professional education. 70.9% of participants agreed that their professional association had a significant advocacy role in climate change and health. Australian physiotherapists are witnessing the impact of climate change and support strategies to mitigate it. These strategies can be implemented at an individual level (e.g., further physiotherapy training) and at a professional organizational level (e.g., guidance from professional associations).

Priorities, needs and willingness of use of nerve stimulation devices for bladder and bowel function in people with spinal cord injury (SCI): an Australian survey

Study designAnonymous online surveyObjectivesTo investigate the priorities, needs and willingness to adopt nerve stimulation devices for managing neurogenic bladder and bowel function in people with spinal cord injury (SCI) living in Australia.SettingOnline survey of people living with SCI in Australia.MethodsThis anonymous online survey used Qualtrics and was advertised via standard communication channels, such as advocacy groups representing the SCI community in Australia, social media, attending SCI sporting events and by word-of-mouth.ResultsResponses from 62 individuals (32% female, 68% male) were included. Bladder emptying through urethra without catheter was the highest priority for bladder function. Reducing time required for bowel routines and constipation were the top priorities regarding bowel function. The highest concern for internal/implanted devices was the 4% chance of device surgical removal, while wearing wires under the clothes was the main concern for external devices. 53% of respondents were willing to trial an implanted nerve stimulation device, while 70% would trial an external device to improve and gain independence in bladder and bowel function.ConclusionThe findings of this study highlighted the potential role in which nerve stimulation can have in addressing bladder and bowel dysfunction in people with SCI, and have also identified that there was a need for Australian physiotherapists to evaluate their role in bladder and bowel dysfunction. Results from this study can help guide further research in nerve stimulation devices for bladder and bowel dysfunction in people with SCI.Sponsorshipn/a

Australian physiotherapists attitudes, perceptions, and behaviours towards psychosocial screening tools: a qualitative interpretive description study

Purpose Psychosocial factors are a barrier to recovery for people with musculoskeletal pain and psychosocial screening tools are consistently recommended by best practice guidelines to assist in identification. However, many physiotherapists do not use these tools. Presently, the perspectives on psychosocial screening tools of Australian physiotherapists are unknown. Exploration of these factors may create targets for increased uptake. The purpose of this paper is to qualitatively explore Australian physiotherapists’ attitudes, perceptions, and behaviours towards psychosocial screening tools for musculoskeletal pain conditions. Materials and Methods An Interpretive description qualitative study design was employed. Seventeen Australian physiotherapists were interviewed about their attitudes, perceptions, and behaviours towards psychosocial screening tools. Interviews were transcribed verbatim and analysed according to interpretive description. Results Analysis highlighted three major themes: (1) understanding the patient through psychosocial screening, (2) confidence and competence with psychosocial factors, and (3) factors outside of my control influence screening. Conclusions This study presents a deeper understanding of Australian physiotherapists’ diverse attitudes and practices regarding psychosocial screening tools. The research highlights not only the variability in perspectives towards the relevance of psychosocial factors in patient assessments, but also the influence of external elements such as patient demographics and clinic culture on the utilization of these screening methods.

Work-related interventions are not commonly included in physiotherapy management of lower limb osteoarthritis: A cross-sectional survey of Australian Physiotherapists

BackgroundLower limb osteoarthritis (OA) is a leading cause of disability and can affect an individual's ability to work. ObjectivesTo explore Australian physiotherapists’ use of work-related interventions in managing patients with lower limb OA, and identify current management practices. MethodsPhysiotherapists with at least two years of experience treating patients with lower limb OA were invited to complete an online survey to understand how physiotherapists manage patients with lower limb OA, specifically regarding interventions related to work. ResultsA total of 132 physiotherapists completed the survey. In free text responses, only 1.5% and 2.3% of physiotherapists nominated work-related items in their key components of treatment or educational topics discussed with patients with lower limb OA, respectively. From a range of work-related activities presented, over half of physiotherapists indicated they regularly/always provided education about the benefits of remaining in work (63.5%) and advice on managing symptoms at work (57.4%). Less than 10% of physiotherapists regularly/always used a validated scale to identify barriers for work (9.6%), discussed absences from work (9.6%), conducted a workplace assessment (4.4%), and discussed submitting workers’ compensation claims (2.6%). Exercise and patient education were the most frequently nominated physiotherapy treatments in free text (96.2% and 86.3%, respectively) and fixed response (99.2% and 93.9%, respectively) questions. ConclusionMany physiotherapists do not address work-related activities in their management of patients with lower limb OA. In light of work-related challenges commonly experienced by individuals with lower limb OA, this is an important aspect of management of this condition.

Falls prevention in people with breast cancer: a survey of current physiotherapist practices

Purpose To examine the current falls prevention knowledge, beliefs and practices of physiotherapists providing clinical care to people with breast cancer. Methods A cross-sectional online survey of currently registered, practising Australian physiotherapists was conducted. The survey was developed and reported using the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) checklist, with data analysed descriptively or using bivariate tests. Free-text responses to open-ended questions were classified into key themes for analysis. Results Forty-two physiotherapists completed the survey, of which 55% (23/42) believed that people with breast cancer had a higher risk of falls compared to the general population. Whilst most respondents received prior training in assessing and managing falls risk factors (30/42; 71%), they reported only moderate confidence in assessing and delivering falls prevention care to people with breast cancer (median 6; IQR 4). Only half of respondents (20/38; 53%) routinely asked about falls history although 61% assessed standing balance (23/38) either through an overall functional assessment (16/38; 42%) or using specific balance measures (7/38; 18%). Conclusions Further resources and training for physiotherapists may be required to optimise their skills and confidence, and to embed best-practice falls prevention strategies into the physiotherapy care of people with breast cancer. IMPLICATIONS FOR REHABILITATION There is an opportunity to better address falls in routine breast cancer care. Falls screening and prevention activities should be included in the care pathways for breast cancer. More resources are required for physiotherapists to optimise their skills and confidence to facilitate the uptake of best-practice falls prevention strategies.

Dry needling perceptions and experiences: A survey of Australian physiotherapists

BackgroundThere is a lack of information on the use of dry needling in Australian physiotherapy practice. ObjectivesOur primary aim was to enhance the understanding of why Australian physiotherapists use dry needling in clinical practice. The secondary aim was to explore Australian physiotherapists experiences with adverse events caused by dry needling. DesignCross-sectional online survey. MethodWe developed a survey and disseminated it through email to physiotherapists from all states and territories in Australia. Participant demographics and responses were reported as frequencies and percentages. Results/findingsWe invited 1006 Australian physiotherapists, of which 232 (23%) viewed the online survey and 203 (20%) consented to participate, of which nearly all completed the survey (n = 198, 98%). Most respondents worked in private practice (n = 164, 83%), with 127 (64%) reporting using dry needling as an intervention within the previous 12 months. Physiotherapists typically used dry needling to decrease pain intensity (n = 105, 85%) and reduce muscle tension (n = 100, 81%). Reports of minor adverse events were common and included discomfort during the treatment (n = 77, 62%) and bruising (n = 69, 56%). Some respondents reported experiencing major adverse events including prolonged aggravation of symptoms (n = 10, 8%) and syncope (n = 16, 13%). ConclusionsWe found that many Australian physiotherapists in private practice use dry needling, usually to decrease pain intensity and muscle tension. Minor adverse events were experienced by more than half the respondents and between 8 and 13% of the Australian physiotherapists surveyed reported experiencing a major adverse event due to dry needling.

Proprioception assessment in stroke rehabilitation: A survey of Australian physiotherapists and occupational therapists

BACKGROUND: Proprioception is the awareness of the position, movement, and muscular force generated by the body and its musculoskeletal parts, and is an important somatosensory impairment to assess in people with stroke. We know that rehabilitation clinicians self-report to assess proprioception in approximately two-thirds of people with stroke. What we do not know is what type of assessments are used, or the true frequency of their use in clinical practice. This study aimed to provide a preliminary description of the type and frequency of proprioception assessment used by clinicians working in stroke rehabilitation in Australia, and their knowledge about proprioception impairment. METHODS: We surveyed Australian physiotherapists and occupational therapists who were involved in the rehabilitation of people with stroke. The online cross-sectional survey ran from March to October 2020. While they were blind to the aims of the study, respondents answered questions about clinical decision-making in a case study of a person with stroke and proprioception impairment. Then, they were asked questions about proprioception. RESULTS: There was a total of 165 survey responses, of which 58 contained complete datasets suitable for analysis. Only 55% (n = 32) of respondents selected an assessment of proprioception for the person described in the case study. The majority of respondents defined proprioception to be the sense of joint / limb (n = 38, 65.5%) or body (n = 27, 46.6%) position and used ‘eyeball’ judgements of limb matching accuracy (56%, n = 33) as an assessment. CONCLUSIONS: These preliminary data suggest that proprioception is likely under-assessed in stroke rehabilitation and that clinicians understand proprioception to be the sense of joint position and movement, but lack awareness of other proprioceptive senses, such as the sense of muscle force. These factors may reduce the ability of clinicians to rehabilitate proprioception impairment in people with stroke.

Clinical reasoning in managing chronic hip pain: One in two Australian and New Zealand physiotherapists diagnosed a case vignette with clinical criteria for hip OA as hip OA. A cross-sectional survey.

Using a case vignette of an adult (George) presenting with hip pain consistent with hip OA, this study aimed to describe: (a) whether physiotherapists make diagnoses and identify bodily structures using either patient history and/or physical examination findings; (b) which diagnoses and bodily structures physiotherapists attribute to the hip pain; (c) how confident physiotherapists were in their clinical reasoning using patient history and physical examination findings; (d) what treatments physiotherapists would offer to George. We conducted a cross-sectional online survey of physiotherapists in Australia and New Zealand. We used descriptive statistics to analyse closed questions and content analysis for open-text responses. Two hundred and twenty physiotherapists completed the survey (39% response-rate). After receiving the patient history, 64% diagnosed George's pain and 49% of these as hip OA; 95% attributed George's pain to a bodily structure(s). After receiving the physical examination, 81% diagnosed George's hip pain and 52% of these as hip OA; 96% attributed George's hip pain to a bodily structure(s). Ninety-six percent of respondents were at least somewhat confident in their diagnosis after the patient history, and 95% were similarly confident after the physical examination. Most respondents offered advice (98%) and exercise (99%), but fewer offered treatments for weight loss (31%), medication (11%), and psychosocial factors (<15%). About half of the physiotherapists that diagnosed George's hip pain made a diagnosis of hip OA, despite the case vignette including clinical criteria for a diagnosis of OA. Physiotherapists offered exercise and education, but many physiotherapists did not offer other clinically indicated and recommended treatments, such as weight loss and sleep advice.

Developing spinal cord injury physiotherapy clinical practice guidelines: a qualitative study to determine how physiotherapists and people living with spinal cord injury use evidence.

Generic qualitative design. Australian and New Zealand SCI physiotherapists are developing clinical practice guidelines for the physiotherapy management of people living with spinal cord injury. To guide the development of the guidelines it was important to understand how physiotherapists and people living with spinal cord injury use evidence to choose interventions and the potential barriers and facilitators to the uptake of the clinical practice guidelines. Spinal Cord Injury Centres in Sydney, Australia and New Zealand. Focus groups and interviews with physiotherapists and people living with spinal cord injury were recorded, transcribed, and subjected to thematic analysis. A total of 75 participants took part in the study, 45 physiotherapists and 30 people living with spinal cord injury. Three main themes were identified from the data: (1) Types and sources of evidence that influence treatment choices, (2) the many factors determining treatment choices, and (3) ways in which clinical practice guidelines could influence treatment. Clinical practice guidelines have the potential to reduce the barriers identified by physiotherapists in accessing and interpreting research evidence on interventions for people living with spinal cord injury. Supported implementation of guidelines is required to demonstrate their benefit and encourage physiotherapists to factor in evidence when balancing the multiple factors influencing choice of physiotherapy intervention.

Telehealth-delivered group-based education and exercise-therapy for knee osteoarthritis: A randomised clinical trial interrupted by the COVID-19 pandemic

Introduction: Guidelines recommend education and exercise-therapy as first-line treatments for knee osteoarthritis. The Good Life with osteoArthritis from Denmark (GLA:D®) program provides physiotherapist-led group-based education and exercise-therapy at >500 sites in Australia. It is associated with clinically meaningful improvements in pain and quality of life (QoL). However, inability to attend in-person sessions due to geography, transportation requirements, or other commitments limits access. Telehealth (videoconferencing) may improve the equity of access to GLA:D®. One-on-one telehealth services for knee musculoskeletal pain conditions including osteoarthritis are reported to be non-inferior to in-person care, but there is a lack of research evaluating group-based telehealth services. This randomised clinical trial (RCT) aimed to determine if GLAD® delivered via telehealth was non-inferior to in-person delivery for knee-related burden at 3- (primary timepoint) and 12-months. Methods: This pre-registered (ACTRN12619000235101) two-arm (telehealth, in-person), non-inferiority RCT commenced in April 2019. Knee osteoarthritis clinical diagnosis was based on NICE guidelines. Difference between groups for change in knee-related burden (primary outcome) was evaluated by averaging four Knee injury and Osteoarthritis Outcome Score subscales (KOOS4: pain, symptoms, function in daily living, QoL), measured at 3- and 12-months follow-up. The KOOS-QoL subscale was evaluated to relate findings to GLA:D® Australia registry data. Planned sample size (n=88) was powered at 90% to detect a minimal important difference between groups of 10 (SD=16) points for KOOS4. Results: Forty-four participants enrolled at baseline (22 per group), with no difference between telehealth and in-person groups for sex distribution (female/male: 14/8 v 12:10), age (years: 62±8 v 64±10), or body mass index (kg/m2: 29.8±5.3 v 31.1±5.2). Recruitment ceased in March 2020 due to COVID-19 restrictions on in-person healthcare. Forty-three (98%) and 40 (91%) participants provided 3- and 12-month follow-up data respectively. Primary outcome: There were no between group differences for changes in KOOS4, with outcomes favouring telehealth at 3-months (mean difference, 95%CI = 6, -2 to 15), and neither group at 12-months (0, -9 to 9). The lower limit of the 95%CI was within the non-inferiority margin (i.e. -10 points) at both time points. Secondary outcome: Changes in KOOS-QoL at 3- and 12-months for telehealth (18 and 14 points) and in-person (10 and 15) were comparable to published GLA:D® registry data (13 and 16). Discussion: This RCT was underpowered due to COVID-19 pandemic restrictions causing early cessation, but findings do indicate telehealth-delivered GLA:D® is unlikely to be inferior to in-person delivery for knee-related burden at 3- and 12-months. This finding builds on recently published qualitative findings indicating patient acceptability of telehealth-delivered GLA:D® and positive telehealth outcomes from the GLA:D® registry during the pandemic (submitted to SMA 2022: Ezzat et al). Further supporting implementation, findings are also consistent with published non-inferiority trials of one-on-one telehealth services for knee osteoarthritis and other musculoskeletal pain conditions, and KOOS-QoL outcomes in both groups were consistent with published GLA:D® registry data. Implications and application to the field•Telehealth-delivered group-based education and exercise-therapy for knee osteoarthritis appears unlikely to be inferior to in-person delivery.•Physiotherapists should be supported to implement telehealth-delivered GLA:D® in Australia. Conflict of interest: A/Profs Barton and Kemp lead the ‘not-for-profit’ implementation initiative, GLA:D® Australia, which trains Australian physiotherapists to implement guideline-recommended education and exercise-therapy.

Perceived barriers and facilitators to the provision of physiotherapy in residential aged care facilities: A national survey of Australian physiotherapists.

To identify and explore physiotherapists' perceived barriers and facilitators to the provision of physiotherapy in Australian residential aged care facilities (RACFs). A national cross-sectional survey was conducted with physiotherapists who worked in Australian RACFs for at least 50% of their working week. A variety of methods, such as social media, direct contact with aged care providers, and the Australian Physiotherapy Association, were used to advertise the survey. A rigorous design was used to develop the online survey to collect views on barriers and facilitators to provision of physiotherapy in Australian RACFs. Descriptive analysis was conducted using SPSS to analyse participant characteristics. Inductive framework analysis was conducted using NVivo 12 to identify key themes. One hundred and sixty-five qualified and registered physiotherapists (mean age 39.5 years, 74% female) who worked predominantly in Australian RACFs participated in this study. Five themes were identified: individual physiotherapist, collaborations, organisational, RACF community, and public policy. Each had associated barriers and facilitators to provision of physiotherapy as perceived by physiotherapists. Individual, collaborative, and RACF community factors were the main facilitators of physiotherapy in Australian RACFs. Organisational and public policy factors were identified as the main barriers of physiotherapy. This study highlighted what factors are perceived by RACF physiotherapists to facilitate provision of physiotherapy, and what areas of improvement should be considered to potentially provide more effective care in Australian RACFs. Due to the varied responses in this study, further research is warranted to determine the degree of impact of the identified factors.

Physiotherapists have some hesitations and unmet needs regarding delivery of exercise programs for low back pain prevention in adults: A qualitative interview study

BackgroundAlthough there is some qualitative research on physiotherapists’ experiences of delivering low back pain treatment, we do not know the extent that these findings apply to low back pain prevention. ObjectiveTo explore physiotherapists’ understanding, attitudes and experiences related to delivering low back pain prevention programs. DesignQualitative interview study. MethodInterviews from 25 Australian physiotherapists (56% female; 44% male) were analysed using framework thematic analysis. ResultsTheme 1 explored physiotherapists' hesitancy about ‘low back pain prevention,’ raising concerns this term might inadvertently entrench unhelpful beliefs. They preferred language about minimising the risk and impact of recurrences, and promoting an active lifestyle. Theme 2 emphasised that as pain receded, engaging patients could be challenging. Some discussed that person-centred care and individualised programs helped overcome this challenge. Several wanted more training in counselling skills, and more consistent external messaging about low back pain prevention. Theme 3 highlighted uncertainty about delivering high-value prevention care. Some perceived the programs as potentially placing unnecessary financial burden on some patients. Many physiotherapists were uncertain about how to support patients when they weren't in pain (i.e., remission) and wanted training in tailored exercise prescription. ConclusionsMany of the physiotherapists had some hesitations and unmet needs regarding delivery of exercise programs for secondary prevention of low back pain. Clinicians may find it useful to ask patients directly about their interest in prevention programs and work with interested patients to develop tailored, progressive programs that continue to be motivating, even during periods when there is no pain.

Barriers and facilitators to achieving competence in lung ultrasound: A survey of physiotherapists following a lung ultrasound training course

Background and purposeLung ultrasound (LUS) is an emerging tool for acute respiratory physiotherapists. In Australia, there are a select few LUS training courses run for physiotherapists. Research to date has evaluated LUS training courses for physiotherapists in terms of knowledge and skill acquisition. The impact of LUS training on user competence and confidence and whether LUS is used in clinical practice has yet to be evaluated. This study therefore explored the impact of attending a physiotherapy LUS training course on acquisition of competence and confidence and the barriers and facilitators for physiotherapists in achieving competence in LUS. MethodsA quantitative survey containing 21 questions was distributed to 77 Australian physiotherapists. ResultsOf the invited physiotherapists, 39 (50%) completed the survey. Most participants were working in intensive care, in the public hospital setting. Binary logistic regression was performed and demonstrated no significant difference in the relationship between years of clinical experience and having confidence in performing or interpreting LUS images. There was also no statistical significance in the relationship between years of clinical experience and gaining competence and accreditation in LUS. Of the 39 responders, 20 physiotherapists had performed at least one LUS scan since completing training; however, most identified they never use LUS to inform clinical decision-making. Only one physiotherapist had gained accreditation through an ultrasound-governing body. The most frequently reported barriers to achieving competence were lack of clinical time to devote to training and lack of an LUS supervisor. ConclusionA majority of physiotherapists who participated in an LUS training course did not attain competence or accreditation, nor were they confident in performing LUS and interpreting images. Barriers exist that prevent intensive care physiotherapists from being able to use LUS in clinical practice. LUS is also not frequently used by acute respiratory physiotherapists to make clinical decisions.

Treatment preferences and use of diagnostic imaging in midportion Achilles tendinopathy by Australian allied health professionals

ObjectivesThe objectives of this study were to examine the treatment preferences and use of diagnostic imaging by Australian allied health professionals in the management of midportion Achilles tendinopathy. DesignCross-sectional survey of Australian allied health professionals. MethodsAn online survey was distributed to registered Australian physiotherapists, podiatrists, myotherapists, exercise physiologists, osteopaths, and chiropractors between September 2018 and October 2019. This survey captured information on clinician demographic, treatment modalities, frequency of use and the reasons for their preferences. A descriptive analysis of the data was employed with nominal and ordinal data analysed using frequency counts. ResultsValid responses were captured from 283 respondents, the majority (229, 80.9%) being physiotherapists. Exercise-based therapy and education were the most commonly used treatments (98.6% and 92.6%, respectively), with the majority of respondents (91.8% and 89.3%) stating that they “always” provided these interventions. Respondents stated that they utilised a number of exercise modalities within the last three years (median = 3, IQR = 3 to 4). Other interventions used as adjunct treatments included heel lifts for shoes (70.0%), massage (59.4%), and taping (40.3%). The majority of respondents (76.7%) never or rarely used diagnostic imaging, citing its limited impact on treatment decision-making and potential for negative impact on patient outcomes. ConclusionsAustralian allied health professionals predominantly use exercise and education, but also use adjuncts such as heel lifts and massage, in the management of midportion Achilles tendinopathy. The results of this study may inform research priorities to generate high quality evidence that best reflects clinical practice.

What do physiotherapists believe is important to educate people with knee osteoarthritis about? A concept mapping study

Introduction: Patient education is recommended by guidelines for people with knee osteoarthritis, and is commonly provided by physiotherapists. However, guidance on what patient education topics to provide is limited. This study aims to identify and categorise education topics that physiotherapists think should be provided to people with knee osteoarthritis, including perceived importance of, and capability to provide, each topic. Methods: Physiotherapists working in Australia participated in this mixed-methods concept mapping study to (i) generate (brainstorm) education topics they thought were important for people with knee osteoarthritis; (ii) group (sorted into clusters) topics into themes; and (iii) rate each topic on perceived importance and capability to provide (0–5 Likert: 0 = lowest/least; 5 = highest/most)). Multidimensional scaling and hierarchical cluster analysis were used to produce a cluster map of related topics from participant sorting data. Overall domains were identified. Rating outcomes were reported descriptively. Results: Brainstorming by 41 physiotherapists identified 56 unique patient education topics. Thirteen additional topics were added from published clinical practice guidelines and previous expert consensus, resulting in 69 topics to sort and rate. Sorting and rating led to an eight-cluster map emerging as the most appropriate representation of the data: Exercise-therapy (23 statements), Radiology misconceptions (5), Understanding and managing pain and disability (12), Lifestyle modification and general health (9), Weight management (4), General beliefs and understanding about osteoarthritis (8), Surgery (6), and Medications (2). Statements in the ‘Exercise-therapy’ cluster received the highest mean importance (3.84/5) and perceived capability to provide (4.00) ratings. Statements in the ‘Medications’ and ‘Weight management’ clusters received the lowest average importance (2.54) and capability to provide (2.82) ratings. Overarching domains were; i) first-line care, ii) knowledge formation and countering misconceptions and, iii) decision making for medical management. Most statements added from clinical practice guidelines and clinical research were rated below the all-statement average for importance (61%, 8/13) and capability (69%, 9/13). Discussion: Australian physiotherapists in this study believe a diverse range of patient education topics are important for people with knee osteoarthritis. Education about exercise-therapy was considered most important and was also the topic participants reported they were most capable at providing. Conversely, education about other commonly recommended osteoarthritis treatments including medications and weight management were considered least important, and participants felt least capable to provide. In future, clinical practice guidelines should consider including guidance on how to implement patient education to cover topics identified by physiotherapists in this study. Conflict of interest statement: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.

Should the physiotherapy outcomes airway clearance, physical activity and fitness be recorded on the Australian Cystic Fibrosis Data Registry? A consensus approach

BackgroundPhysiotherapy is a cornerstone of cystic fibrosis (CF) management, yet the Australian CF Data Registry (ACFDR) currently does not record physiotherapy-related data. This study aimed to gather opinions from lead Australian CF physiotherapists regarding the importance and feasibility of collecting physiotherapy-related data on the ACFDR.MethodsA three-round online Delphi survey was conducted to gather expert stakeholder opinion and consensus agreement. Lead physiotherapists from all 23 Australian CF centres were invited to participate. Round one explored the potential benefits, barriers and importance of recording three physiotherapy-related domains on the ACFDR: airway clearance, physical activity and fitness. Subsequent rounds were developed based on the findings from the previous round and sought consensus (80% agreement) for the inclusion of physiotherapy-related data on the ACFDR and for the most appropriate methods of collecting such data.ResultsThe response rate was > 80% for all rounds. Participants agreed that collection of airway clearance, physical activity and fitness data on the ACFDR was important and feasible. Findings suggested that airway clearance and physical activity should be collected using self-reported questionnaires, while fitness should be measured using a field-based test.ConclusionsAustralian lead CF physiotherapists believe that collection of airway clearance, physical activity and fitness on the ACFDR is important and feasible. Future work is needed to pilot the data collection procedure to examine its feasibility in real-world clinical settings. This study demonstrates how Delphi methodology can provide a contemporary summary of expert clinicians’ opinion that may underpin nation-wide health service improvement.

Perceptions and work-readiness of Australian physiotherapists in cancer care: a national evaluation

ObjectivesPhysiotherapy interventions can improve health outcomes for people across the cancer continuum yet little is known of the work-readiness and perceptions of physiotherapists working in cancer care. This study described perceptions of Australian physiotherapists. DesignElectronic, national cross-sectional survey. SettingOne hundred nineteen Australian hospitals and 35 rehabilitation programmes in July 2019 were invited. ParticipantsClinical physiotherapists responsible for the provision of cancer care. Main outcome measuresCustom-designed survey targeted clinical knowledge, physiotherapy management, physical activity/exercise, and learning/preparedness. Relationships between domains and demographic characteristics eg: clinical experience and work setting, were analysed. ResultsOne hundred twenty eight surveys were completed. Median [IQR] experience was 8 [4 to 19] years (2 [0.5 to 5] years specifically in oncology). Most participants (99/128, 77%) felt poorly prepared to commence work in oncology. Confidence was consistently lower among physiotherapists in their first year compared to others. Confidence and knowledge was rated high for people with early stage cancers (median 4 [3 to 5]) and lower for prescribing exercise for patients with cardiotoxicity and knowledge of precautions/contraindications regarding hormone and targeted therapies (median 2 [1 to 3]). High importance ratings (Likert scores 4 or 5) were reported for exercise (115/127, 91%) and physical activity (120/126, 95%). Learning needs were identified for medical management, treatment side-effects/precautions and management of cancer-related pain and fatigue. ConclusionAustralian physiotherapists feel underprepared to work in cancer care, but report good confidence and knowledge. Professional development opportunities appear indicated.