Experiences Of Physiotherapists Research Articles

An investigation of the experiences of physiotherapists during the Aotearoa New Zealand COVID-19 pandemic 2020

An investigation of the experiences of physiotherapists during the Aotearoa New Zealand COVID-19 pandemic 2020

272 PHYSIOTHERAPISTS' EXPERIENCES OF WORKING IN RESIDENTIAL CARE IN THE REPUBLIC OF IRELAND DURING COVID-19

Abstract Background COVID-19 was officially declared a pandemic in March 2020. Social distancing and visiting restrictions were introduced in Irish residential care units in March 2020. The impact of COVID-19 and associated restrictions on physiotherapists working in residential care in the Republic of Ireland (ROI) is unknown. This study aimed to explore the experience of physiotherapists working in residential care units in the ROI during the COVID-19 pandemic. Methods A qualitative phenomenological study design was used. Physiotherapists working in residential care units were invited to participate in one-to-one semi-structured interviews from December 2021 to March 2022. Participants were recruited via purposive and snowball sampling. Data were analysed using reflexive thematic analysis by two independent reviewers. Results Seven one-to-one semi-structured interviews were conducted among five female and two male physiotherapists. Four major themes emerged: (i) service adaptation (ii) communication (iii) physical and emotional impact of COVID-19 pandemic on staff and (iv) physical and emotional impact of COVID-19 pandemic on residents. A number of subthemes were identified under each theme. Participants experienced changes in service delivery including redeployment, reduced resident contact and social distancing. These changes resulted in innovation, mainly through telehealth. Participants felt communication from managers could be improved through clarity regarding protocol changes. The pandemic stimulated enhanced inter-professional communication among physiotherapists. Some participants contracted COVID-19 resulting in residual physical impairments. Participants were affected emotionally through the increased stress experienced due to COVID-19 restrictions. Residents experienced isolation due to visiting restrictions. Due to reduced physiotherapy input participants observed reduced physical functioning among residents. Conclusion COVID-19 and its associated restrictions had a profound impact on physiotherapists working in residential care units as well as on residents. The extent of this impact is only beginning to emerge. Planning for future pandemics should consider the long-term physical and emotional consequences of restrictions on both physiotherapists and residents.

The experiences of physiotherapists and occupational therapists working as rehabilitation ward leaders

Background/Aims Rehabilitation teams have piloted the deployment of physiotherapists and occupational therapists into the role of ward leader. This was the first research study designed specifically to explore the experiences of physiotherapists and occupational therapists working as ward leaders on wards with a patient rehabilitation focus and how to optimise this workforce transformation. Methods An interpretivist qualitative study was designed to enable the detailed exploration of physiotherapists' and occupational therapists' working experiences during their time as ward leaders. A total of 11 physiotherapists and occupational therapists with between 6 months' and 3 years' experience of working as ward leaders participated in semi-structured interviews. Thematic analysis was undertaken. Results Four themes were derived from the data analysis that related to participants' experiences: becoming a rehabilitation ward leader; responsibilities of physiotherapists and occupational therapists; perceptions of the role; and impact of allied health professionals in ward leader roles. Although taking on the role of a rehabilitation ward leader was reported as ‘challenging’, participants would recommend it. Success was perceived by interviewees to be relative to the presence of personal leadership qualities, the belief of the individual in their unique skill set and the confidence in the leadership team to value the unique and shared skills of the profession or individual and thus reinvent the role. Conclusions This study identifies the key attributes that evidence the unique contribution that physiotherapists and occupational therapists working as rehabilitation ward leaders can make. The findings of this study are significant and highly relevant for the ongoing pandemic, which has seen a need for increased rehabilitation capability.

Experiences of physiotherapists regarding a standard set of measurement instruments to improve quality of care for patients with chronic obstructive pulmonary disease: a mixed methods study

RationaleThe quality of physiotherapy care for patients with chronic obstructive pulmonary disease (COPD) can be improved by comparing outcomes of care in practice.AimTo evaluate the experiences of physiotherapists implementing a standard set of measurement instruments to measure outcomes and improve the quality of care for patients with COPD.MethodsThis sequential explanatory mixed methods study was performed in two parts. In the quantitative part, a survey of 199 physiotherapists was conducted to evaluate their attitudes and knowledge, as well as the influence of contextual factors (i.e., practice policy and support from colleagues), in the implementation of the standard measurement set. In the qualitative part, 11 physiotherapists participated in individual interviews to elucidate their experiences using a thematical framework.ResultsThe survey showed that, on average, 68.4% of the physiotherapists reported having a positive attitude about using the standard set, 85.0% felt they had sufficient knowledge of the measurement instruments, and 84.7% felt supported by practice policy and colleagues. In total, 80.3% of physiotherapists thought the standard set had added value in clinical practice, and 90.3% indicated that the measurement instruments can be valuable for evaluating treatment outcomes. The physiotherapists mentioned several barriers, such as lack of time and the unavailability of the entire standard set of measurement instruments in their practice. Moreover, the physiotherapists indicated that the measurement instruments have added value in providing transparency to policymakers through the anonymized publication of outcomes.ConclusionPhysiotherapists support the use of the standard set of measurement instruments to improve the quality of physiotherapy treatment for patients with COPD.

When worlds collide: Experiences of physiotherapists, chiropractors, and osteopaths working together

BackgroundIn Australia, people with musculoskeletal conditions frequently seek care from chiropractors, osteopaths, and physiotherapists. Intertwined histories, distinct philosophies and practical tensions characterise relationships between these three professions, yet little is known about contact or collaboration between individual clinicians. ObjectivesTo explore the experiences of osteopaths, physiotherapists and chiropractors who work together in the same clinic location and explore their attitudes towards each other. MethodsUtilising a predominantly inductive qualitative research design, semi-structured interviews were undertaken with a total of 13 clinicians (physiotherapists [n=6], chiropractors [n=2], osteopaths [n=4], dual-qualified chiropractor and physiotherapist [n=1]) who work with at least one clinician from the other two professions. Interviews were analysed using reflexive thematic analysis. ResultsData analysis produced two main themes and five sub-themes that characterised clinicians’ experiences and attitudes: collaboration (collaborative practices; benefits of collaboration) and resisting tension (accepting similarities and differences to work towards shared goals; clinic culture; alignment with evidence-based practice). These findings can be understood in the context of the concepts of professional boundary-work and intergroup contact theory. ConclusionsThe findings from this study suggest that physiotherapists, chiropractors and osteopaths that work together in the same clinic may collaborate while simultaneously navigating blurred professional lines. These results suggest that working together in the same clinic is a meaningful form of contact, which in turn allows for collaborative practices that may reduce intergroup tension between professions.

Experiences of physiotherapists involved in front-line management of patients with COVID-19 in Nigeria: a qualitative study

ObjectivesEvidence-based guidelines recommend physiotherapy for respiratory treatment and physical rehabilitation of patients with COVID-19. It is unclear to what extent physiotherapy services are used in the front-line management of COVID-19...

A qualitative exploration of respiratory physiotherapists experiences of lung ultrasound training and its adoption in critical care

A qualitative exploration of respiratory physiotherapists experiences of lung ultrasound training and its adoption in critical care

Impact of COVID-19 on rehabilitation experiences of physiotherapists.

As the COVID-19 pandemic progressed, pressures on almost all health sectors in many countries increased, and physiotherapy interventions were canceled for various reasons. The aim of this study was to determine the status of physiotherapists who interrupted their services due to the pandemic and investigate procedures adopted by physiotherapists during face-to-face practice. The measuring tool was an online survey administered via Google Forms between January 27 and February 27, 2021. In this descriptive cross-sectional study, the sample consisted of 558 physiotherapists, questions about their clinical experience during the pandemic were answered, and descriptive statistics were examined. Of the physiotherapists, 351 (62.9%) suspended their services due to pandemic, while 207 (37%) of all participants worked without suspending their services since the beginning of the process. Among participants, 303 (54.3%) needed education to use telerehabilitation methods, and 315 (56.5%) monitored their patients with remote communication methods. Hand washing (86.6%), disinfectant (85.3%), gloves (76.5%) and masks (86.6%) were the most common protective measures. Most physiotherapists had their face-to-face practice interrupted for a short time due to the COVID-19 outbreak, but they continue to treat all disease conditions in spite of inherent physical intimacy and increased risk of infection.

COVID-19: Contrasting experiences of South African physiotherapists based on patient exposure.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has exposed physiotherapists to unique work-related challenges. However, there is a lack of research regarding the mental health and lived experiences of South African physiotherapists during the COVID-19 pandemic.ObjectivesTo determine levels of mental and physical health, burnout, depression, anxiety and resilience and coping strategies used by a sample of South African physiotherapists with and without exposure to patients with COVID-19. Lived work experience, perceived health and sources of support were also explored.MethodA non-experimental, cross-sectional, mixed-method design was used. Physiotherapists completed an online survey comprising: a demographic questionnaire; scales assessing mental and physical health, burnout, depression, anxiety and coping strategies and six open-ended questions. A total of 171 physiotherapists participated in our study, 43.3% of whom were exposed to patients with COVID-19.ResultsThe exposure group scored significantly higher on self-reported mental health, anxiety, depression and burnout than the non-exposure group. No significant differences were reported for physical health and resilience. Significantly more maladaptive coping strategies were employed by the exposure group. Participants’ lived experiences highlighted similar experiences, as well as work-related challenges. Both groups reported that primary sources of support were significant others, but highlighted the lack of organisational support.ConclusionIrrespective of the degree of exposure to COVID-19, the mental health and lived experiences of physiotherapists working in South Africa has been negatively impacted by COVID-19.Clinical implicationsUnderstanding physiotherapists’ well-being and lived experiences during the pandemic may guide workplace interventions. Our findings suggest the need for psycho-educational intervention programmes to be implemented at an organisational level.

Perspectives and experiences of physiotherapists and general practitioners in the use of the STarT Back Tool: a review and meta-synthesis.

Introduction The STarT Back Tool (SBT) is used to triage people with acute low back pain (LBP) into treatment groups, matched to their risk of chronicity. It was developed in the UK where it has been shown to improve clinical outcomes, patient satisfaction, and reduce time off work. Successful implementation of the SBT outside the UK is dependent on health practitioner's attitudes and the healthcare system in which they work. Gaining health practitioners' perspectives on the SBT is an important step in implementation. Methods A computerised search of qualitative literature was conducted across seven databases in March 2021 using keywords to identify studies investigating the perspectives of physiotherapists and general practitioners on the use of the SBT in primary health care. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) tool. Data were coded and analysed using reflexive thematic analysis. Results Eight articles met inclusion criteria and included the views of 76 physiotherapists and 65 general practitioners, working in primary health care in four countries. Three themes were created from the data: 'Making it work', identifies factors that influence implementation and continued use of the SBT. The second 'will I do it?', captured potential consequences of adopting the SBT, and the third, 'it's all about the patient' emphasised how the SBT may affect patients. Discussion Physiotherapists and general practitioners found using the SBT frequently enhanced practice. General practitioners expressed concerns about time constraints and the SBT's potential to undermine clinical experience. Findings from this study will inform modifications to contextualise the tool to each healthcare environment.

Implementation of telerehabilitation in Austrian outpatient physiotherapy – A qualitative study / Implementierung von Telerehabilitation in der ambulanten Physiotherapie in Österreich – Eine qualitative Studie

Abstract Background New technologies, for example, telerehabilitation (TR) tools, can support physiotherapists’ work. Even though studies have demonstrated their potential, TR is not yet fully implemented in Austrian outpatient physiotherapy. As a result of the Coronavirus pandemic and the associated lockdowns, physiotherapists in Austria were confronted with the challenge of offering therapies without physical contact. This study aims to investigate opinions and experiences of physiotherapists in Austria regarding TR and its implementation in different clinical fields. Methods A qualitative research design with expert interviews and a focus group discussion were conducted. Data were analysed using content analysis. The categories were formed following a deductive-inductive approach. Results The interview partners considered opportunities for using synchronous TR in internal medicine as well as orthopaedics and traumatology, especially in later, exercise-dominated stages. In addition, using TR can be supportive for patient education. In the field of neurology, synchronous TR is viewed with some criticism, especially when used for people with severe neuropsychological disorders. Asynchronous TR is considered useful across all disciplines and could support physical therapy from the first therapy session and throughout the treatment. Important questions regarding liability, billing, or data protection still need to be clarified. Interdisciplinary approaches in TR should also be pursued to improve care. Conclusion The use of asynchronous TR in addition to regular physiotherapy is seen as promising in all clinical fields. In general, when implementing TR, the needs and requirements of different fields should be considered. Moreover, various framework conditions still need to be clarified for further implementation of TR.

Physiotherapists perspectives on leadership in cross-disciplinary roles

Purpose: The purpose of this study was to explore the experiences of physiotherapists currently working in cross-disciplinary leadership roles.

COVID-19: Contrasting experiences of South African physiotherapists based on patient exposure

Background: The coronavirus disease 2019 (COVID-19) pandemic has exposed physiotherapists to unique work-related challenges. However, there is a lack of research regarding the mental health and lived experiences of South African physiotherapists during the COVID-19 pandemic. Objectives: To determine levels of mental and physical health, burnout, depression, anxiety and resilience and coping strategies used by a sample of South African physiotherapists with and without exposure to patients with COVID-19. Lived work experience, perceived health and sources of support were also explored. Method: A non-experimental, cross-sectional, mixed-method design was used. Physiotherapists completed an online survey comprising: a demographic questionnaire; scales assessing mental and physical health, burnout, depression, anxiety and coping strategies and six open-ended questions. A total of 171 physiotherapists participated in our study, 43.3% of whom were exposed to patients with COVID-19. Results: The exposure group scored significantly higher on self-reported mental health, anxiety, depression and burnout than the non-exposure group. No significant differences were reported for physical health and resilience. Significantly more maladaptive coping strategies were employed by the exposure group. Participants’ lived experiences highlighted similar experiences, as well as work-related challenges. Both groups reported that primary sources of support were significant others, but highlighted the lack of organisational support. Conclusion: Irrespective of the degree of exposure to COVID-19, the mental health and lived experiences of physiotherapists working in South Africa has been negatively impacted by COVID-19. Clinical implications: Understanding physiotherapists’ well-being and lived experiences during the pandemic may guide workplace interventions. Our findings suggest the need for psycho-educational intervention programmes to be implemented at an organisational level.

Experiences, barriers and needs of physiotherapists with regard to providing self-management support to people with low back pain: A qualitative study

BackgroundA person-centred, biopsychosocial approach focused on self-management and a healthy lifestyle is recommended for managing non-specific low back pain (LBP). ObjectiveWhat are the experiences of physiotherapists with regard to providing self-management support to people with non-specific LBP? DesignExploratory qualitative. MethodsFourteen semi-structured interviews were conducted with physiotherapists in the Netherlands using a semi-structured and pilot tested interview guide. Data were analysed using inductive thematic analysis. ResultsPhysiotherapists believe that self-management has added value in the management of people with non-specific LBP. Motivational interviewing, providing advice and exercise were most frequently used to facilitate behaviour change aimed at enhancing patients’ self-management. Support regarding self-management skills was not frequently mentioned. Physiotherapists are not fully aware of and do not fully integrate support with regard to important self-management skills. The most important barrier participants experienced with regard to integrating self-management was patient expectations. Another important barrier was addressing psychosocial factors. Most participants expressed a need to better integrate self-management support in their treatment. They explained that they needed more knowledge (courses, knowledge clips), opportunities to exchange experiences (peer review group) and tools for patients (app). ConclusionsPhysiotherapists do not fully integrate support with regard to important self-management skills in people with non-specific LBP. We recommend that physiotherapists address the identified barriers and needs and better include self-management support in their treatment of people with non-specific LBP. We recommend important stakeholders to collectively work on diminishing barriers to integrating self-management support.

Encounters between physiotherapists and clients with suicidal thoughts and behaviours: A narrative literature Review

This narrative review examined the literature relevant to encounters between physiotherapists and clients with suicidal thoughts and behaviours (STBs). The review was conducted in response to a growing international movement to make suicide prevention everyone’s business. The Framework for Suicide Risk Assessment and Management for NSW Health Staff (New South Wales Department of Health, 2004) informed the review as it requires all New South Wales Department of Health practitioners, including physiotherapists, to be able to assess and manage clients with STBs. The review identified 23 peer-reviewed articles and four non-peer-reviewed articles that mentioned encounters between physiotherapists and clients with STBs. The results suggest that physiotherapists may encounter clients with STBs given the conditions they manage, the increased risk of suicide associated with these conditions, and the pattern of contact between health professionals and clients with STBs. Future research is required to explore the prevalence of STBs among physiotherapy clients, the experiences of physiotherapists who have identified clients with STBs, and whether physiotherapists are adequately trained and competent in suicide risk assessment.

Physiotherapists and patients report positive experiences overall with telehealth during the COVID-19 pandemic: a mixed-methods study.

QuestionWhat were the experiences of physiotherapists and patients who consulted via videoconference during the COVID-19 pandemic and how was it implemented?DesignMixed methods study with cross-sectional national online surveys and qualitative analysis of free-text responses.ParticipantsA total of 207 physiotherapists in private practice or community settings and 401 patients aged ≥ 18 years who consulted (individual and/or group) via videoconference from April to November 2020.MethodsSeparate customised online surveys were developed for physiotherapists and patients. Data were collected regarding the implementation of videoconferencing (cost, software used) and experience with videoconferencing (perceived effectiveness, safety, ease of use and comfort communicating, each scored on a 4-point ordinal scale). Qualitative content analysis was performed of physiotherapists’ free-text responses about perceived facilitators, barriers and safety issues.ResultsPhysiotherapists gave moderate-to-high ratings for the effectiveness of and their satisfaction with videoconferencing. Most intended to continue to offer individual consultations (81%) and group classes (60%) via videoconferencing beyond the pandemic. For individual consultations and group classes, respectively, most patients had moderately or extremely positive perceptions about ease of technology use (94%, 91%), comfort communicating (96%, 86%), satisfaction with management (92%, 93%), satisfaction with privacy/security (98%, 95%), safety (99% both) and effectiveness (83%, 89%). Compared with 68% for group classes, 47% of patients indicated they were moderately or extremely likely to choose videoconferencing for individual consultations in the future. Technology was predominant as both a facilitator and barrier. Falls risk was the main safety factor.ConclusionPatients and physiotherapists had overall positive experiences using videoconferencing for individual consultations and group classes. The results suggest that videoconferencing is a viable option for the delivery of physiotherapy care in the future.

Are patient reported outcome measures (PROMs) useful in low back pain? Experiences of physiotherapists in primary health care in Sweden

BackgroundPhysiotherapists in primary health care are required to use patient reported outcome measures (PROMs) to manage patients with low back pain (LBP). ObjectiveOur aim was to explore and describe how physiotherapists in primary care managing patients with LBP, experience the use of PROMs with a focus on facilitating and hindering factors. MethodsWe undertook a qualitative study with semi-structured interviews. Fifteen physiotherapists (9 female and 6 male) were included. The interviews were audio-recorded and transcribed verbatim and analysed by inductive manifest content analysis. ResultsOur findings resulted in eight main categories: PROMs give structure and increase patient involvement; Patients' motivations to use PROMs; Time and the physiotherapist's clinical priorities; Physiotherapists' routines steer their use of PROMs; Physiotherapists' competences in using PROMs; Organizations and managers steer the use of PROMs; Prerequisites for future use of PROMs; Using PROMs develops the physiotherapy profession. ConclusionOur findings show that using PROMs gives structure and increases patient involvement, but the patient's motivation to use PROMs needs to be taken into consideration. Time and routines influence the use of PROMs and these factors depend on organizational and managerial levels. Using PROMs is believed to help develop the physiotherapy profession. Prerequisites for future use, such as digitalization and increased competence, need to be fulfilled. Future studies should focus on increasing physiotherapists' knowledge about relevant PROMs, and study implementation in clinical practice, thereby improving the physiotherapy profession's quality of care.

Navigating diagnostic uncertainty in musculoskeletal practice: The perspectives and experiences of new graduate physiotherapists

BackgroundDiagnostic uncertainty in musculoskeletal pain presents as a frequent and challenging dilemma encountered by health professionals. Current literature indicates that diagnostic uncertainty impacts the clinical decision making of experienced physiotherapists. Despite this, the experiences and navigational strategies of new graduate physiotherapists, pertaining to this dilemma, are widely unknown. ObjectivesThe aim of this study was to explore how new graduate physiotherapists experience and navigate diagnostic uncertainty when managing individuals with musculoskeletal pain. MethodsA qualitative study using a thematic analytical research approach was undertaken. A randomized sample of new graduate physiotherapists, working in musculoskeletal settings (n = 17), participated in semi-structured telephone interviews. Interview data was subsequently subject to thematic analysis. ResultsFour key themes emerged from the data: 1) diagnostic uncertainty is fraught with challenges; 2) diagnosis is not the end game; 3) intrinsic strategies and extrinsic actions and 4) the imperative role of clinical practice. ConclusionNew graduate physiotherapists frequently experience diagnostic uncertainty within musculoskeletal practice and are commonly challenged by this dilemma. Despite this, new graduates utilize several strategies to mitigate challenges including focusing on patient-centered care, maintaining transparency and relying on senior colleagues. Most strategies are directly attributed to clinical experiences. This study further outlines implications for physiotherapy curricula and workplace support.

Experiences of training and delivery of Physical therapy informed by Acceptance and Commitment Therapy (PACT): a longitudinal qualitative study

ObjectivesPhysiotherapy informed by Acceptance and Commitment Therapy (PACT) is a novel intervention that is related to improved disability and functioning in people with chronic lowback pain. This study explored physiotherapists experiences over time of the PACT training programme and intervention delivery. DesignA longitudinal qualitative study using semi-structured, in-depth, individual interviews at three time points was conducted. MethodsA phenomenological approach underpinned the methods. Interviews followed topic-guides developed a priori. Transcribed interviews were coded inductively to generate themes. Data were member checked by participants and validated by two researchers. ParticipantsEight clinical physiotherapists from three secondary care centres in the United Kingdom (n = 5 female; age, 24 to 44 years; duration of practice, 3 to 14 years) were included. ResultsFive themes emerged from the data. Experiential learning techniques were challenging but valued because they bridged theoretical principles and concepts with practice. Ongoing individual and group supervision was beneficial, but required tailoring and tapering. PACT delivery extended physiotherapy skills and practice, including techniques that acknowledged and addressed patient treatment expectations. With experience, participants desired greater flexibility and autonomy to tailor PACT delivery. ConclusionsPACT training and delivery were acceptable to physiotherapists. Existing skills were developed and additional, applicable approaches were provided that addressed psychosocial and behavioural aspects of chronic low back pain.

Encountering suicide in primary healthcare rehabilitation: the experiences of physiotherapists

BackgroundSuicide is a serious public health issue and one of the most common causes of death globally. Suicide has long-lasting impact on personal, relational, community and societal levels. Research has shown that patients often seek help in the primary healthcare system preceding a suicide. Studies exploring the experiences of encountering patients at risk for suicide have been performed among various categories of healthcare personnel, such as nurses and psychiatry residents as well as emergency room staff. There is a lack of research regarding primary healthcare rehabilitation staff, despite the fact that physiotherapists are the third largest health profession in the Western hemisphere and often work with patients experiencing mental health symptoms. The aim of this study was to explore the experiences of encountering patients at risk for suicide among physiotherapists working in a primary healthcare rehabilitation setting.MethodsSemi-structured interviews were conducted with 13 physiotherapists working in primary healthcare rehabilitation clinics in the Gothenburg area, Sweden. The interviews were recorded on audio and transcribed into written text. A qualitative content analysis was performed on the material collected.ResultsThe analysis of the material revealed an overarching theme, Through barriers and taboos – the physiotherapist finds a way, with five main categories: possibilities for identification, obstacles in meeting suicide, workplace environment matters, where does the patient belong? and education and experience are keys.ConclusionsThe present study indicates that physiotherapists in the primary healthcare system encounter patients experiencing suicidality, and they expressed a strong desire to care for both the physical and mental wellbeing of the patients. Despite reporting many barriers, the physiotherapists often found a way to form a meaningful therapeutic alliance with the patient and to ask about possible suicidality in their clinical practice. The result suggests that physiotherapists could play a larger role in working with patients experiencing suicidality in a primary healthcare setting and that they could be viewed as possible gatekeepers in identification as well as referral of these patients into other parts of the healthcare system.