Physiotherapy Service Delivery Research Articles

Parkinson's disease physical therapy services during COVID-19: A phenomenological study.

Parkinson's disease (PD) is the most rapidly increasing movement disorder globally. Physical therapies improve the motor and non-motor symptoms of PD. During the COVID-19 pandemic, telehealth was the primary method of physical therapy service adaptation in response to restrictions preventing in-person therapy attendance. This study explores the perspectives of people with PD and their therapists who experienced physical therapy service delivery before and during the COVID-19 pandemic in Melbourne, Australia. A phenomenological study that purposively recruited patients and therapists from a movement disorders service at an outer metropolitan rehabilitation hospital. Participants completed in-depth interviews, and data were analysed using reflexive thematic analysis. Ten people with PD and five therapists completed interviews. Six themes were identified: patients value access to therapy, a key mechanism is trust, an opportunity to empower patients, ticking boxes for telehealth, contrasting experiences of telehealth and something is better than nothing. This study explored the experiences of people with PD and their therapists by contrasting their prepandemic and in-pandemic experiences. People with PD valued telehealth access during the pandemic, but extra support was initially required to use telehealth successfully. Empowering aspects of telehealth included patients learning new skills and self-management strategies from telehealth interactions with therapists. Therapists at this health service were motivated to continue with telehealth beyond the pandemic. Despite finding it challenging initially, they were surprised by how well people with PD managed telehealth using locally developed procedures based on clinical judgement and staff training that addressed patient safety while supporting people with PD to utilise telehealth.

INTEGRATING PHYSIOTHERAPISTS INTO PRIMARY HEALTH CARE IN SAUDI ARABIA: A CROSS-SECTION SURVEY

Purpose: This study aimed to explore the experiences of physiotherapists regarding their integration and identify the facilitators and challenges they encountered in primary health care. Understanding the perceived barriers, facilitators, and management strategies for successful integration is crucial in developing an informed framework to support future integration initiatives. Method: The study included eligible participants who were practicing physiotherapists, regardless of gender. Inclusion criteria required active engagement in the profession and possession of a Bachelors degree in physiotherapy. On the other hand, unemployed physiotherapists, individuals above 60 years of age, non-practicing physiotherapists, and those with degrees in technical studies were excluded from the study. Data was collected using a cross-sectional observational design through an Internet-based survey. The survey was conducted using the secure and anonymous Survey Monkey platform, ensuring participant confidentiality and obtaining informed consent. The survey specifically targeted registered physiotherapists in Saudi Arabia, allowing for the collection of valuable data from this specific population. Results: Upon analyzing the survey data, a total of 39 responses were received. The demographic breakdown of the respondents revealed that 46% of the completed questionnaires were filled out by therapists working in the Eastern province. The survey also shed light on the work experience of the participants, with a significant portion (43%) having practiced as therapists for 6-10 years. Regarding their professional environment, 73% of participants strongly agreed on the importance of teamwork, while 68% acknowledged the role of effective communication in their work. Furthermore, a substantial 70% strongly agreed that there is a lack of efficient space for physical therapy within primary healthcare (PHC) facilities. Resources were also identified as a challenge, with 65% of respondents indicating a shortage of necessary equipment and resources for physical therapy in PHC. Conclusions: The survey responses provide valuable insights into the challenges and barriers related to integrating physical therapy into the primary healthcare (PHC) setting. These challenges range from a lack of understanding and clear referral processes to issues with space, resources, and workload. These findings can inform strategies aimed at improving the integration and delivery of physical therapy services within PHC, address the identified challenges, and enhance the overall quality of care.

A Preliminary Study to Develop a Collaborative Tiered School-Based Physical Therapy Service Delivery Model: Results from an International Delphi Consultation

A Preliminary Study to Develop a Collaborative Tiered School-Based Physical Therapy Service Delivery Model: Results from an International Delphi Consultation

Public-private partnership models for rehabilitation service delivery: A scoping review.

Public-private partnership (PPP) for the delivery of health services is known to improve access to healthcare, yet little is known about its utilisation for rehabilitation services, particularly in sub-Saharan Africa (SSA). As a first step to generating evidence to develop a PPP model for physiotherapy service delivery in South Africa, our study mapped and described available research evidence on PPP models for rehabilitation services in the global literature. The Arksey and O'Malley framework guided our scoping review. Published research on rehabilitation and PPP was searched in five databases from 2000 to August 2022 using keywords, Medical Subject Headings (MeSH) and Boolean terms. Two reviewers independently completed the titles, abstracts and full-text screening of the articles and data extraction from the included articles. A narrative synthesis was conducted, and summaries of the findings are reported. Nine articles were included from a total of 137 obtained from the evidence searches. Of these, five were from Australia and the others from Hong Kong, Denmark, Bangladesh and the Netherlands. All the included articles showed evidence of PPP models for physiotherapy service delivery. Our study suggests that PPP models for physiotherapy service delivery exist, particularly in high-income countries (HICs). It also highlights limited research in low- and middle-income countries (LMICs). There is a need for primary studies to generate further evidence and develop innovative PPP models for rehabilitation services for the populations who need them most as part of efforts towards improving access to healthcare in LMICs.

Mapping global evidence on public-private partnership for medical rehabilitation services delivery: a scoping review protocol

IntroductionAccess to medical rehabilitation remains poor in Sub-Saharan Africa. This is partly due to inadequate service delivery emanating from ill-defined public health policies. Developed countries have adopted public-private partnership (PPP) agreements between the government and private sectors, thus presenting superior quality and access to rehabilitation services. To help develop a PPP model for physiotherapy service delivery in South Africa, this scoping review will map research linked to PPP for medical rehabilitation services delivery and outcomes in the global context.MethodologyThe Arksey and O’Malley (2005) framework (identify the research question, identify relevant research, select studies, chart the data, collate, summarize, and report findings) will be used to guide this review. Peer-reviewed literature will be searched in PubMed, EBSCOhost, Cochrane library, SCOPUS, and Google Scholar from 2000-2022 using a combination of keywords, Medical Subject Headings, and Boolean terms. Screening of the articles at all stages will be conducted independently by two reviewers using the eligibility criteria as a guide. The reference lists of retrieved articles will be manually searched for relevant studies. Emerging themes and sub-themes will be collated, summarized, and the results reported in the narrative form.DiscussionWe anticipate identifying literature gaps for future research to inform policy on PPP for rehabilitation services delivery in Sub-Saharan Africa and actual practice. The results of this review will contribute to building a model that will enable the provision of equitable rehabilitation services at the district health level using PPP.

Perspectives of International Experts on Collaborative Tiered School-Based Physiotherapy Service Delivery

Aims The purpose of this Phase II study is to identify the perceived strengths and weaknesses of a collaborative tiered school-based physiotherapy (PT) service delivery model, considering its core attributes and tiered interventions identified in the first phase of the study (Phase I), and explore the potential facilitators and barriers to implementing the model internationally. Methods Three focus group discussions were conducted with international experts (n = 16) Discussions focused on the core attributes and tiered interventions of the model in Phase I. Data were analyzed using a framework approach and SWOT (strengths, weaknesses, opportunities, and threats) analysis. Results Themes surrounding the perceived characteristics of the model included comprehensiveness, guiding document, collaborative approach, and inclusiveness. Additional themes were related to the implementation that included governance, professional roles, workload, implementation in different countries, advocacy, and available opportunities. A framework table was tabulated to present the strengths and weaknesses of the service delivery model and available opportunities, and potential barriers to implementation. Conclusions This study revealed international perspectives regarding a proposed collaborative tiered school-based PT service delivery model and presented a framework to guide clinicians, researchers, and policymakers for the implementation of tiered approaches. Relationships between health and education have been more pronounced in recent years, and interactions between healthcare and the education system have evolved (Zajacova & Lawrence, 2018). Recent recommendations of the World Health Organization (WHO) and UNESCO suggest that “every school should be a health-promoting school”, and provided intervention guidelines for the global standards for health-promoting schools (WHO., 2021a). In the meantime, education sectors in different countries have shifted inclusive education policy, with a focus not only on students with disabilities, but all students (Whitley & Hollweck, 2020). In conjunction with the changes in both education and school health services (WHO., 2021b), researchers in the field of speech-language therapy (SLT), occupational therapy (OT) (Camden et al., 2021), and physiotherapy (PT) (Cinar et al., 2021), have been exploring tiered approaches to delivering services in schools, and searching for collaborative strategies to encourage interaction between stakeholders in health and education sectors.

“Another Tool in Your Toolkit”: Pediatric Occupational and Physical Therapists’ Perspectives of Initiating Telehealth during the COVID-19 Pandemic

Aims Pediatric occupational and physical therapy service delivery via telehealth increased during the COVID-19 pandemic. Real-world experience can guide service improvement. This study explored experiences, barriers, and facilitators of initial telehealth implementation from the therapist’s perspective. Methods Qualitative descriptive approach. Semi-structured interviews were conducted with occupational therapists (n = 4) and physical therapists (n = 4) between May-June 2020. Interviews were recorded, and transcribed verbatim. Data were coded inductively to generate themes, then re-coded deductively to classify barriers and facilitators to telehealth acceptance and use using the Unified Technology Acceptance Theory. Results Participants had 16.5 [(2-35); median (range)] years of experience (3 months with telehealth) and predominantly worked with preschool children. Three themes about telehealth were identified: a practical option; requires skill development and refinement; beneficial in perpetuity. Most frequently cited barriers were the lack of opportunity for ‘hands-on’ assessment/intervention and the learning curve required. Most frequently cited facilitators included seeing a child in their own environment, attendance may be easier for some families, and families’ perception that telehealth was useful. Conclusion Despite rapid implementation, therapists largely described telehealth as a positive experience. Telehealth facilitated continued service provision and was perceived as relevant post-pandemic. Additional training and ensuring equitable access to services are priorities as telehealth delivery evolves.

Patients’ Perceptions on Telerehabilitation as a Mode of Physical Therapy Service Delivery

Aim: Since telerehabilitation is a relatively new service in the Philippines translating to a scarcity in related literature, this study determined the perceptions of patients regarding the recorded facilitators and barriers to this mode of physical therapy service delivery. Methods: A quantitative, descriptive, survey type research design was utilized, wherein a self-reported survey questionnaire formulated by the researchers was administered to the respondents. The data gathered were analyzed using frequency, percentage, weighted mean (WM), and class interval. Results: Findings showed that the perceived top facilitators include less travel time and cost (WM = 3.606) and less exposure to external risk (WM = 3.545). In comparison, the top barriers were technical difficulties (WM = 3.273) and internet connectivity (WM = 3.242). The majority of the respondents were highly satisfied (WM = 3.338) and compliant (WM = 2.798) with telerehabilitation. Conclusion and Implications: With the results of this study, it was revealed that telerehabilitation is a viable alternative to conventional rehabilitation, as seen with the respondents' generally positive perception towards this mode of service that ultimately enhances both access and continuity of care, especially during the COVID-19 pandemic.

Physical Therapy Utilization Among Hospitalized Patients with Pediatric Acute Lymphoblastic Leukemia

Background: Pediatric acute lymphoblastic leukemia (ALL) patients have excellent survival outcomes, yet remain at increased risk for impaired physical function due to multiple chemotherapy-associated conditions including myopathy, peripheral neuropathy, bone toxicities, and fatigue. While initiating physical therapy (PT) early in treatment is likely to improve physical function and overall health of children with ALL, there are no published recommendations to guide PT service delivery for this population. In fact, utilization of PT and factors associated with utilization during planned and unplanned hospitalizations are not known. We sought to determine patterns of inpatient PT utilization in pediatric ALL patients, and its association with patient and hospital factors.Methods: Leveraging the Premier Healthcare Database, we conducted a cohort study that included participants hospitalized with ALL at 0-21 years of age from January 1, 2010 through March 31, 2017. Patients who underwent bone marrow transplant or had traumatic injuries unrelated to ALL therapy were excluded. The primary outcome was receipt of inpatient PT, identified by billing claims, within one year of first hospitalization. A multivariable logistic regression model was used to estimate odds ratios (OR) and 95% confidence intervals (CI) of sociodemographic and clinical variables associated with PT.Results: Our cohort included 5,488 pediatric ALL patients admitted to 330 hospitals (42.3% female, 56.0% White, median age 7 years). Among these patients, 1,491 (27.2%) received PT within one year of their first admission, with 840 (15.3%) receiving PT during their first admission (Figure). For inpatient hospital stays in which participants received PT, the median length of stay was 9 (interquartile range [IQR] 4-18) days, and the median number of PT encounters per stay was 2 (IQR 1-4). Of 426 patients who had a diagnosis of peripheral neuropathy (n=334), myopathy (n=35), or avascular necrosis (n=74), 251(58.9%) received PT within a year of their first ALL admission.Compared with patients 0-4 years old, those aged 5-9 were less likely to receive PT (OR=0.71, 95% CI: 0.60-0.84), while those aged 10-14 (OR=1.38, 95% CI: 1.15-1.66) and 15-21 (OR=1.44, 95% CI: 1.20-1.73) were more likely to receive PT (Table). Patient factors associated with receiving PT included Hispanic ethnicity (OR=1.22, 95% CI: 1.01-1.46) and a history of an intensive care unit stay (OR=2.67, 95% CI: 2.28-3.11). Patients at teaching hospitals (OR= 1.64, 95% CI 1.39-1.89) were more likely to receive PT than those at non-teaching hospitals, while patients at rural hospitals (OR=0.39, 95% CI: 0.27-0.56) were less likely to receive PT than those at urban hospitals. Compared to patients treated by a pediatric hematologist/oncologist, patients treated by a non-hematology/oncology pediatric (OR=0.53, 95% CI:0.44-0.63) or adult (OR=0.46, 95% CI:0.37-0.57) specialist were less likely to receive PT. PT utilization also varied significantly by geographic region, and hospital size, while patient sex and insurance coverage did not appear to impact PT utilization (Table).Conclusions: Less than 30% of pediatric ALL patients receive inpatient PT within a year of their first hospitalization. Interventions to increase inpatient PT services to pediatric ALL patients and address disparities in PT utilization would be desirable to improve the physical function and long-term health of survivors. [Display omitted] DisclosuresMa: Celgene/Bristol Myers Squibb: Consultancy, Research Funding.

Promoting Participation in Physical Activity in Children and Adolescents With Down Syndrome.

Physical therapists are experts in exercise and physical activity and are thus uniquely qualified to promote participation in children with Down syndrome. Instead of focusing on impairments or "correct" movement patterns, physical therapists are encouraged to allow the child and the child's environment to direct the treatment plan.

Participation-Based Student Goals in School-Based Physical Therapy Practice: Influence on Service Delivery and Outcomes

Aims: Legislation, perspectives, and guidelines support the use of goals that address student participation in school. The purpose of this study was to determine if students with participation-based goals receive school-based physical therapy services differently and demonstrate better outcomes than students with non-participation-based goals. Methods: Secondary data analysis. School-based physical therapists (n = 109) provided services to students (n = 294) over 20 weeks. The physical therapists determined a primary goal for each student and classified this goal based on if it was (n = 181) or was not (n = 113) performed and measured within a school activity or routine (participation-based versus non-participation-based). The physical therapists documented the proportion of services provided within a school activity, on behalf of the student, and consisting of activity-focused functional activities. They also measured goal attainment and assessed participation via the School Function Assessment at the beginning and end of the study. Results: Students with participation-based goals received a significantly greater proportion of services within a school activity than those with non-participation-based goals (p < 0.001). There was no significant difference for the remaining service variables, nor for the outcome variables. Conclusions: Use of participation-based goals may promote school-based physical therapy service delivery within a school activity, thus supporting best practice.

Physiotherapy service provision in a specialist adult cystic fibrosis service: A pre-post design study with the inclusion of an allied health assistant.

What is the impact of including an allied health assistant (AHA) role on physiotherapy service delivery in an acute respiratory service? A pragmatic pre-post design study examined physiotherapy services across two 3-month periods: current service delivery [P1] and current service delivery plus AHA [P2]. Clinical and non-clinical activity quantified as number, type and duration (per day) of all staff activity categorised for skill level (AHA, junior, senior). Physiotherapy service delivery increased in P2 compared to P1 (n = 4730 vs n = 3048). Physiotherapists undertook fewer respiratory (p < 0.001) and exercise treatments (p < 0.001) but increased reviews for inpatients (p < 0.001) and at multidisciplinary clinics in P2 (56% vs 76%, p < 0.01). The AHA accounted for 20% of all service provision. AHA activity comprised mainly non-direct clinical care including oversight of respiratory equipment use (e.g. supply, set-up, cleaning, loan audits) and other patient-related administrative tasks associated with delegation handovers, supervision and clinical documentation (72%), delegated supervision of established respiratory (5%) and exercise treatments (10%) and delegated exercise tests (3%). The AHA completed most of the exercise tests (n = 25). AHA non-direct clinical tasks included departmental management activities (11%). No adverse events were reported. AHA inclusion in an acute respiratory care service changed physiotherapy service provision. The AHA completed delegated routine clinical and non-clinical tasks. Physiotherapists increased clinic activity and annual reviews. Including an AHA role offers sustainable options for enhancing physiotherapy service provision in acute respiratory care.

A Paradigm Shift in the Delivery of Physical Therapy Services for Children With Disabilities in the Time of the COVID-19 Pandemic.

With the COVID pandemic, the delivery of rehabilitation services has been greatly affected across lifespan, especially towards children with disabilities. The significant physical and mental health stressors of prolonged home confinement coupled with discontinuation of rehabilitation services can lead to several long-term concerns among children with disabilities. In light of the current events, our approach towards rehabilitation needs to be re-evaluated and revamped. The point of view highlights the potential ways in which we could continue to provide physical therapy services for children with disabilities. Use of family-centered and home-based models of care can be considered to reach out to children with disabilities using telerehabilitation and digital physical therapy by adopting a modified framework of care. The implications of the point of view may help aid clinician’s world-over to continue providing rehabilitation services to children with disabilities.

Mechanisms to achieve a successful rural physiotherapy public-private partnership: a qualitative study.

Longstanding gaps in physiotherapy service delivery exist in rural areas across Australia. In response to this, a large public rural health organisation contracted a private physiotherapy business to implement a public-private partnership (PPP) to supply physiotherapy to hospital inpatients, aged care facility residents and outpatients in four outer regional Australian towns. Treatment rooms were provided by the health organisation for the private physiotherapists to see clients. This study explored how stakeholders defined the success of a PPP model of service delivery in a rural setting and examined if the model was successful according to stakeholder definitions. Barriers and enablers (mechanisms) were identified and linked to stakeholder-defined success measures. A qualitative study was conducted using a constructive inquiry design. Participants were purposively recruited, via email invitation and telephone follow-up. Participants comprised managers and clinicians from the rural public health organisation and the private physiotherapy business involved in setting up, working within or alongside the partnership. Semi-structured interviews were undertaken with all participants. Data were transcribed verbatim and analysed using framework analysis. Program logic was used to synthesise all information. Individual interviews were conducted with five staff from each partnering organisation, including managers and clinicians (total n=10). Two main themes and three subthemes were identified. All participants described the model as being successful. Elements of success included improved access to local services, and satisfied stakeholders. There were three mechanisms identified to successfully implement the service delivery model. The first mechanism was the provision of human and several other resources, which included the workforce model and the use of several resources for the partnership. The second mechanism was stakeholder engagement, which included having motivated stakeholders and consistent stakeholders. The third mechanism was streamlined processes, which included the content of the contract and referral schedule, streamlined administration processes for contracting and accounting, having processes for managing private therapists in a public setting as well as processes for communication. This study demonstrates that an innovative physiotherapy PPP model of service delivery can be a successful way to improve access to physiotherapy services in rural areas. Success of service models varies depending on the viewpoint of the stakeholder and achieving success for all stakeholders is contingent on mechanisms such as those identified in this study. PPPs have potential to address service gaps in hospitals, residential aged care and primary care in rural areas.

Management of Undergraduate Community-Based Rehabilitation Programmes in the Philippines: A Cross-Sectional Survey

Purpose: The survey aimed to identify common strengths and weaknesses regarding the characteristics, management and implementation of Community-Based Rehabilitation (CBR) training in the undergraduate curriculum of Schools of Physical Therapy in the Philippines, and make recommendations for improvement. Method: A survey was conducted with the academic heads of CBR departments in 10 Physical Therapy schools. The institutions were selected through cluster sampling according to regional location. Nine of these were private institutions. Data was collected through a 24-item self-assessment survey distributed to the heads of the participating colleges /departments. Results: A number of strengths and weaknesses were identified. The strengths were: all schools had a 1 to 2-month clinical CBR course integrated into their undergraduate curriculum; CBR courses were supported by a course syllabus, learning outcomes, student assessment and clinical training manual; 80% of institutions had implementing policies and guidelines governing management of the CBR programme(s); at least one physiotherapist was involved in the management of the CBR programme(s); and, CBR activities were delivered in coordination with key stakeholders management, with emphasis on delivery of physical therapy services, disability prevention, health education, participation of persons with disabilities and community awareness. The weaknesses were: no head/programme coordinator for 30% of CBR programmes; 40% did not have clinical coordinators as designated management positions in the CBR programme; only 50% of academic staff received formal CBR training, of which 80% was provided through CBR summits and professional interaction with other physical therapists; and, only 50% of schools adopted a multidisciplinary approach to service delivery which was focused on the Health domain of the CBR Matrix. Conclusion: The CBR component of the undergraduate physical therapy curriculum in the Philippines can be improved. A shift in the teaching to transdisciplinary care and inter-professional learning is recommended. Regular review of the CBR indicators should be done by the schools, including the key stakeholders. Challenges for CBR implementation were recruitment of community volunteers as CBR workers, availability of indigenous resources and finances to support CBR activities, and family participation in the rehabilitation of a relative with a disability. Each school should determine whether current human resources and training are adequate. Schools must be encouraged to jointly identify common problems in CBR education and share solutions.

Collaborative service delivery to address public health issues within a musculoskeletal setting: evaluation of the Healthy Mind, Healthy Body project

Background/Aims There is a need for greater focus on public health and its impact on musculoskeletal conditions within healthcare delivery. Physiotherapists are well positioned to support this. Outpatient physiotherapy musculoskeletal services traditionally focus on rehabilitation and physical exercise, yet many service users require support to improve both their mental and physical health. This innovative service improvement aimed to embed integrated health promotion within musculoskeletal physiotherapy service delivery. Methods A physiotherapy-led multidisciplinary team introduced patients to other community-based support services to address wider health needs. Results Service evaluation demonstrated a high uptake of self-referral to community services, validating the potential benefit for musculoskeletal condition management. Positive patient feedback indicates that patients valued the service and were well-supported to engage with health improvement. Conclusions Musculoskeletal physiotherapy services need to consider the wider aspects of health, putting public health at the heart of musculoskeletal service delivery.

A Preliminary Study to Develop a Collaborative Tiered School-Based Physical Therapy Service Delivery Model: Results from an International Delphi Consultation

Background: Physical therapy (PT) is increasingly provided at schools to help students participate in educationalactivities. Recent rehabilitation models emphasized the benefits of using collaborative tiered services for serviceprovision, yet no model is available to guide how these services should be delivered. Therefore, this study aims to determine the core attributes and PT interventions of a collaborative tiered school-based PT model that could guide how PT services are delivered in schools worldwide.Methods: A modified Delphi method was used to identify the core attributes and the PT interventions that would be part of the model. An introductory webinar followed by three Delphi rounds with 24 international experts was conducted. Similar ideas generated in Round 1 were combined into statements; the statements reaching the predetermined consensus level in Rounds 2 or 3 were retained. Categories were created to present core attributes and Tiered interventions that were retained.Results: 41 core attributes were identified and grouped under seven categories. Tiered interventions were grouped under 15 categories which included 37 interventions for Tier 1, 24 interventions for Tier 2, and 60 interventions for Tier 3.Conclusion: The recommended core attributes and interventions will support the development of an international framework for school-based PT services, fostering health promotion for all children, and supporting those with disabilities.

European region of the WCPT statement on physiotherapy in primary care.

This statement has been produced by the European Region of the World Confederation for Physiotherapy (ER-WCPT) to promote the role of the physiotherapy profession within primary care, to describe the health and economic benefits to health systems and populations of having a skilled, appropriately resourced and utilised physiotherapy workforce in primary care services, and to illustrate how different models of physiotherapy service delivery are contributing to these health and cost benefits.

Physical therapy practice in intensive care units in Jordanian hospitals: A national survey.

A national survey was conducted to determine the current status of physical therapy practice in the intensive care units (ICUs) of Jordanian hospitals. An online survey was sent via email to physical therapists working at Jordanian hospitals. Questions of the survey addressed the physical therapy demographics, staffing, education, training, and barriers of practice. The responses were compared among four different hospital sectors in the country. The response rate was 31% (50/161). Thirty-six percent of participants had more than 10years of experience in physical therapy, and 26% had less than 1year of experience in the intensive care practice. Staffing of physical therapists working in ICUs relative to the total ICU beds was the highest in public hospitals compared with other hospital sectors. Among all participants, only 4% had received specialized postgraduate ICU training. The barriers to ICU physical therapy practice in Jordan included insufficient staffing, inadequate training, and lack of understanding of physical therapy role for ICU patients. The study showed the main barriers to ICU physical therapy practice in Jordan. There is a need for well-structured strategies to overcome these barriers to help improve the delivery of physical therapy services in Jordan.

Quality Changes after Implementation of an Episode of Care Model with Strict Criteria for Physical Therapy in Ontario's Long-Term Care Homes.

To describe the proportion of residents receiving rehabilitation in long-term care (LTC) homes, and scores on activities of daily living (ADL) and falls quality indicators (QIs) before and after change from fee-for-service to an episode of care model; and to evaluate the effect of the change on the QIs. Secondary data were collected from all LTC homes in Ontario, Canada, between January 1, 2011 and March 31, 2015. Variables of interest were the proportion of residents per home receiving physical therapy (PT), and the scores on seven ADL and one falls QI. Retrospective, longitudinal study. All data were extracted from the Resident Assessment Instrument Minimum Data Set. Fewer residents received PT after the policy change (84.6 percent, 2011; 56.6 percent, 2015). The policy change was associated with improved performance on several ADL QIs. However, having a large proportion of residents receive no PT or little PT was associated with poorer performance on two of the QIs measuring improvement in ADLs [No PT: -0.029 (-0.043 to -0.014); -0.048 (-0.068 to -0.027). PT <45minutes per week: -0.012 (-0.026 to -0.002); -0.026 (-0.045 to -0.007); p<.01]. While controversial, the policy and subsequent PT service delivery change appears to be associated with improved performance on several ADL QIs, except in homes where a large proportion of residents receive no PT and low time-intensive PT.