Perspectives Of Physiotherapists Research Articles

Validation of the International Classification of Functioning, Disability and Health Comprehensive Core Set for Osteoporosis

The "Comprehensive ICF Core Set for Osteoporosis" is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of functioning problems of patients with osteoporosis. The objective of this study was to validate this ICF Core Set from the perspective of physical therapists. Using a 3-round Delphi technique survey, physical therapists, experienced in the treatment of patients with osteoporosis, were surveyed about patient problems, resources, and aspects of the environment relevant to the physical therapy management of individuals with OP. Responses were translated ("linked") into ICF language by using standardized rules. Fifty-seven physical therapists across 25 countries representing each World Health Organization region named 816 factors (patient problems, available resources, and environmental influences). These 816 factors were linked to 160 ICF categories. Twenty-five categories with an agreement among the participants exceeding 75% were not represented in the Comprehensive ICF Core Set for Osteoporosis. Fifteen concepts were linked to the as yet undeveloped ICF component. Personal Factors and 9 concepts were found not to be covered by the ICF. The validity of the Comprehensive ICF Core Set for Osteoporosis was largely supported by the participants. Nine concepts (eg, "posture," "alignment," "ergonomics") identified by participants are not covered by the ICF and require further investigation.

Erratum: The comprehensive ICF core sets for spinal cord injury from the perspective of physical therapists: a worldwide validation study using the Delphi technique

Erratum: The comprehensive ICF core sets for spinal cord injury from the perspective of physical therapists: a worldwide validation study using the Delphi technique

Validation of the comprehensive ICF core set for low back pain: The perspective of physical therapists

The “Comprehensive ICF Core Set for Low Back Pain (LBP)” is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning for patients with LBP. The aim of this study was to validate the Comprehensive ICF Core Set for low back pain from the perspective of physical therapists. Physical therapists experienced in LBP treatment were asked about the patients’ problems, patients’ resources and aspects of environment treated by physical therapists in a three-round survey using the Delphi technique. Responses were linked to the ICF. Eighty-four physical therapists in 32 countries named 1955 concepts that covered all ICF components. Fourteen ICF categories were not represented in the Comprehensive ICF Core Set for LBP although at least 75% of the participants have rated them as important. Most of them belonged to the ICF component “Body Functions”. Twenty-eight concepts were linked to the not-yet-developed ICF component personal factors. Further, 21 issues were not covered by the ICF. The validity of the ICF components “Body Structures”, “Activities and Participation” and “Environmental Factors” was largely supported by the physical therapists. However, several body functions were identified which are not covered and need further investigation.

The Comprehensive ICF core sets for spinal cord injury from the perspective of physical therapists: a worldwide validation study using the Delphi technique

To validate the International Classification of Functioning, Disability and Health (ICF) Core Set for individuals with spinal cord injury (SCI) in the early post-acute and long-term context from the perspective of physical therapists. International. Physical therapists experienced in the treatment of SCI were asked about problems, resources and aspects of the environment treated by them, in a three-round electronic mail survey using the Delphi technique. Responses were linked to the ICF by two researches; κ-coefficient was calculated as statistical measure of agreement. In all, 81 experts from 27 countries named 3694 concepts. They were linked to 187 ICF categories for the early post-acute context. Three ICF categories from the component body function, five ICF categories from the component body structures and two ICF categories from the component activities and participation were not represented in the ICF Core Set for the early post-acute context. In all, 207 ICF categories were linked for the long-term context. Four ICF categories from the component body function, five ICF categories from the component body structures and two ICF categories from the component activities and participation were not represented in the ICF Core Set for the long-term context. Physical therapists addressed a vast variety of problems that they take care of in their interventions in patients with SCI. The Comprehensive ICF Core Sets covered a high percentage of these problems. Further research is necessary on several responses not covered in the ICF.

Does the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Breast Cancer capture the problems in functioning treated by physiotherapists in women with breast cancer?

Objective The Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Breast Cancer is an application of the ICF, and represents the typical spectrum of problems in functioning and contextual factors that may influence functioning of patients with breast cancer. The objective of this study was to examine the content validity of this ICF core set from the perspective of physiotherapists. Design Physiotherapists from around the world experienced in the treatment of patients with breast cancer were interviewed about patients’ problems, patients’ resources and environmental aspects that physiotherapists take care of in a three-round survey using the Delphi technique. The responses were linked to the ICF. The degree of agreement was calculated by means of the Kappa statistic. Participants Physiotherapists experienced in breast cancer treatment. Results Fifty-nine physiotherapists from 19 countries named 769 problems treated by physiotherapists in patients with breast cancer. One hundred and sixty-six ICF categories were linked to these answers. Nineteen ICF categories reached >75% agreement among the physiotherapists but are not represented in the Comprehensive ICF Core Set for Breast Cancer. Ten concepts were linked to the not-yet-classified personal factors component. Eleven concepts are not covered by the ICF. The Kappa coefficient for the agreement between the two persons who performed the linking was 0.66 (95% bootstrapped confidence interval 0.63 to 0.68). Conclusions The content validity of the Comprehensive ICF Core Set for Breast Cancer was largely supported by the physiotherapists. However, several issues were raised which were not covered and these need to be investigated further.

Validation of the Comprehensive ICF Core Set for Osteoarthritis: the perspective of physical therapists

Background and purpose Osteoarthritis is a common chronic disease associated with functional impairments and activity limitations, as well as participation restrictions. The Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Osteoarthritis is an application of the ICF and represents the typical spectrum of problems in functioning of patients with osteoarthritis. Objective To validate the Comprehensive ICF Core Set for Osteoarthritis from the perspective of physical therapists. Methods Physical therapists experienced in the treatment of patients with osteoarthritis were asked about patients’ problems, resources and aspects of the environmental factors treated by physical therapists in patients with osteoarthritis in a three-round, electronic-mail survey using the Delphi technique. Responses were linked to the ICF. Results Seventy-two experts from 22 countries named 744 meaningful concepts that covered all ICF components. One hundred and fifty-two ICF categories were linked to these answers, 32 concepts were linked to the not-yet-developed personal factors component, and 14 issues were not covered by a single ICF category. Twelve ICF categories were not represented in the Comprehensive ICF Core Set for Osteoarthritis, although at least 75% of the participants rated them as important. Discussion and conclusion The content validity of the ICF was widely supported by the physical therapists. However, several issues were raised that were not covered and need to be investigated further.

Experiences of the voluntary physiotherapist role in developing nations

Aim Voluntary work is considered to be of benefit both to the community receiving services and to the practitioner providing them. However, much of the current understanding of the physiotherapy volunteer experience is anecdotal. The aim of this qualitative study was to explore the experience of volunteering as a physiotherapist in a developing country in terms of the impact on the volunteer, the nature of the role, and the benefits to the patients as perceived by the participants. Methods In-depth telephone interviews were conducted with a purposive sample of five physiotherapists. The interviews were taped and transcribed manually and verbatim. A framework was used to guide the thematic analytic process. Findings There were four main themes: barriers to practice, adapting to culture, impact on self, and impact on community. These characterize the rewards and challenges of volunteering in developing countries from a physiotherapist perspective. Conclusions The study findings suggest that voluntary physiotherapy in developing nations is most effective and meaningful when there is a genuine interest in the culture, and there is a balance of skill exchange between the foreign and native physiotherapist. Implications for practice and further research are discussed.

Validation of the Comprehensive ICF Core Set for obstructive pulmonary diseases from the perspective of physiotherapists

The 'Comprehensive ICF Core Set for obstructive pulmonary diseases' (OPD) is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of patients with OPD. To optimize a multidisciplinary and patient-oriented approach in pulmonary rehabilitation, in which physiotherapy plays an important role, the ICF offers a standardized language and understanding of functioning. For it to be a useful tool for physiotherapists in rehabilitation of patients with OPD, the objective of this study was to validate this Comprehensive ICF Core Set for OPD from the perspective of physiotherapists. A three-round survey based on the Delphi technique of physiotherapists who are experienced in the treatment of OPD asked about the problems, resources and aspects of environment of patients with OPD that physiotherapists treat in clinical practice (physiotherapy intervention categories). Responses were linked to the ICF and compared with the existing Comprehensive ICF Core Set for OPD. Fifty-one physiotherapists from 18 countries named 904 single terms that were linked to 124 ICF categories, 9 personal factors and 16 'not classified' concepts. The identified ICF categories were mainly third-level categories compared with mainly second-level categories of the Comprehensive ICF Core Set for OPD. Seventy of the ICF categories, all personal factors and 15 'not classified' concepts gained more than 75% agreement among the physiotherapists. Of these ICF categories, 55 (78.5%) were covered by the Comprehensive ICF Core Set for OPD. The validity of the Comprehensive ICF Core Set for OPD was largely supported by the physiotherapists. Nevertheless, ICF categories that were not covered, personal factors and not classified terms offer opportunities towards the final ICF Core Set for OPD and further research to strengthen physiotherapists' perspective in pulmonary rehabilitation.

Preparedness of new graduate Australian physiotherapists in the use of electrophysical agents

Objective To determine the perceptions of physiotherapists concerning the preparedness of new graduates to use electrophysical agents (EPAs) in clinical practice. Design An observational cross-sectional questionnaire was developed and demonstrated to be reliable and valid. Participants The questionnaire was mailed to all registered physiotherapists in Australia in 2005 ( n = 12,893). Results In total, 3538 questionnaires were returned complete. Two forms of non-responder analysis indicated that the sample and their associated responses were representative of the Australian physiotherapy population. Eight out of 10 new graduates felt prepared to use EPAs that are common in Australian clinical practice. However, 80% felt underprepared to use a range of other EPAs. Similar trends were found when new graduate preparedness was examined from the perspective of physiotherapists who were working with or mentoring new graduates. However, experienced physiotherapists rated preparedness lower than the new graduates themselves ( χ 2 = 525.7, P < 0.01). Conclusions These findings raise questions about the adequacy of entry-level education and the level of competence expected of new graduates for the safe and effective application of a range of EPAs upon entry to the workforce. The findings indicate the need for clearer guidelines on the levels of competency expected of new graduate physiotherapists in Australia.

Validation of the Comprehensive International Classification of Functioning, Disability and Health Core Set for Rheumatoid Arthritis: The Perspective of Physical Therapists

The Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Rheumatoid Arthritis (RA) represents the typical spectrum of problems in the functioning of patients with RA. The objective of this study was to validate this ICF Core Set from the perspective of physical therapists. Physical therapists were asked about their intervention goals in a 3-round Delphi survey. Intervention goals were compiled, and the physical therapists were asked whether they considered the goal classes to be relevant. The goal classes then were linked to the ICF. A total of 82 physical therapists in 12 countries named 562 intervention goals. A total of 45 goal classes covering all ICF components were identified. The goal classes addressing muscle tone, balance and coordination, and psychological distress were not represented in the ICF Core Set for RA. The validity of the ICF Core Set for RA was largely supported. However, some categories currently not covered by the ICF Core Set for RA will need to be investigated further.

Diagnostic Criteria for Temporomandibular Joint Disorders: A physiotherapist's perspective

Summary Temporomandibular disorder is of unknown aetiology and is generally diagnosed using research diagnostic criteria, comprising two axes. The first axis describes clinical temporomandibular disorders and is divided into three groups, representing muscle diagnoses/myofascial pain (also known as myofascial pain syndrome); disc displacements; and arthralgia, arthritis and arthrosis. The second axis is assessed using a 31-item pain-oriented disability and psychological status questionnaire completed by the patient. The aim of this article is to present a physiotherapist's perspective of groups 1 and 2 of the first axis of the research diagnostic criteria. Two patients, one with a diagnosis of myofascial pain syndrome, and the other with disc displacement, were assessed using a modified Maitland assessment procedure to establish a diagnosis. Their treatment consisted of Maitland and McKenzie manual mobilisation techniques, and pulsed short-wave diathermy and ultrasound as and when indicated. The outcome of this study suggests that the symptoms presented by these two patients who fulfilled the research diagnostic criteria were of cervical origin. Further research on temporomandibular disorders and the assessment criteria is recommended.

Exploring the power balance in physiotherapy

All social interactions involve an element of power negotiation. In the physiotherapeutic situation, there are a number of interesting opportunities to exercise power to a greater extent than would be possible in normal day-to-day life. The power balance of the clinical encounter is explored from both the patient’s and the physiotherapist's perspective.

Interaction Between Patient and Physiotherapist in Psychiatric Care ? the Physiotherapist's Perspective

The aim of the study was to investigate what factors the physiotherapy experts in psychiatric physiotherapy believed to be important in the interaction between the patient and the physiotherapist (PT). The objective was to obtain a deeper insight into their reasoning concerning interaction and treatment outcomes. Eleven nominated ''expert'' PTs were each interviewed twice. Triangulation of important events, an exemplar (critical incident) and a key informant interview were used in the data collection. A qualitative design with crosscase analysis was used in the data analysis. Important interaction factors were divided into a ''prerequisites dimension'', ''interaction dimension'' and ''outcome dimension''. In the prerequisites dimension there were three themes: ''prerequisites of the PT'', ''prerequisites of the patient'' and ''external factors''. In the interaction dimension there were also three themes: ''ways of contact'', ''therapeutic process'' and ''structure of treatment''. In the outcome dimension ...

Interaction between patient and physiotherapist: a qualitative study reflecting the physiotherapist's perspective.

The interaction between patient and physiotherapist (PT) is central in physiotherapeutic treatment. The purpose of this study was to investigate expert physiotherapists' perception of important factors influencing the quality of the interaction in physiotherapeutic treatment. Ten experienced PTs working in primary healthcare were interviewed twice, triangulating a sort of important events, an exemplar and a key informant interview. The data were transcribed, coded and analysed for main themes and categories according to the qualitative technique described by Shepard et al. (1993) and Merriam (1988). Important factors in interaction could be divided into the 'Prerequisites dimension' and the 'Interaction dimension'. In the former, the most dominant theme was 'Internal prerequisites of the PT'. The most-cited category in this theme was 'Practical professional skills and patient experience'. In the latter, the themes 'Establishing contact', 'Ways of contact', 'Frames' and the 'Therapeutic process' emerged. Here, the most-cited categories were 'Establishing contact and confidence', having a 'Therapeutic role', 'Being sensitive and intuitive', 'Encountering', 'Listening' and 'Identification of patient resources'. These factors were seen as essential for promoting a positive patient outcome. Interaction skills were reinforced by reflection on patients' experiences. Interaction skills of the expert PT were thought to enhance the resources of the patient and lead to a positive patient outcome. Within professional development more emphasis ought to be put on reinforcing the reflective process of the PT, for instance by the use of supervision by an experienced colleague.