Physiotherapy Practice Research Articles

Physiotherapists' Perception of and Readiness to Use, Telerehabilitation for Musculoskeletal Disorders in Malaysia: A Cross-Sectional Study.

Introduction: Musculoskeletal ailments exert a significant impact on global populations. To address challenges posed by geographical constraints and financial limitations, physiotherapists have explored and found telerehabilitation to be a viable solution. Despite its proven effectiveness in clinical practice, the integration of telerehabilitation has been sluggish. This cross-sectional survey sought to delve into the perspectives and readiness of physiotherapists in Malaysia regarding telerehabilitation for musculoskeletal disorders. Methods: A customized survey instrument was developed and evaluated for face validity and reliability. The 36-item questionnaire was distributed through the Google Form platform, targeting respondents via social media channels such as Facebook and WhatsApp. Data analysis used descriptive statistics (frequency and percentage). Results: The survey garnered responses from 271 physiotherapists. A majority (76.3%, n = 202) expressed agreement regarding the potential benefits of telerehabilitation in physiotherapy practice. About 77% of the respondents also showcased greater readiness for monitoring client progress through telerehabilitation as opposed to assessment and treatment. Notable benefits identified by respondents included preventing cross-infection (98.5%) and reducing travel time for both clients (94.0%) and physiotherapists (90.6%). Conclusion: The study reveals that physiotherapists in Malaysia exhibit positive attitudes and preparedness for implementing telerehabilitation in managing musculoskeletal conditions.

Pediatric rehabilitation delivery: discussion is an antidote to disconnection and discontent

Pediatric rehabilitation is fundamentally different from that of adults. Child physiology differs significantly from that of adults, necessitating specialized rehabilitation approaches. Unique injuries and varying metabolic rates underscore the need for tailored care, which changes over the years as the child grows and develops. Waiserberg’s paper, “When Everyone is Responsible, No One Takes Responsibility”: Exploring Pediatric Physiotherapy Services in Israel,” sheds light on a critical issue. While senior practitioners oversee policy implementation and service delivery, practical physiotherapy treatment lacks continuous monitoring. This is a critical issue. Ideally, every child who requires long-term clinical therapeutic interventions to keep up with peers in mobility, communication and cognitive skills should be assessed by specialists several times throughout the school years, and their personalized rehabilitation plan discussed, reviewed, and adjusted according to their progress. The absence of a standardized protocol for overseeing and directing comprehensive rehabilitation plans leaves therapists feeling alone and adrift, whether working in schools or medical settings. Such an assessment would be an opportunity to create a registry, which is currently nonexistent. The collected data would be a priceless resource in policy decision-making and service planning.

Enhancing physiotherapy department design to prevent work-related musculoskeletal disorders: Vision of future research.

The increasing prevalence of work-related musculoskeletal disorders (WRMSDs) necessitates a reevaluation of physiotherapy department design. Optimizing these spaces is crucial as they serve as primary settings for preventing and managing WRMSDs, highlighting the need for a forward-thinking approach. This study aims to outline a vision for future research by identifying key strategies to prevent WRMSDs and enhance operational efficiency in physiotherapy departments. Ergonomics, workplace safety, and physiotherapy practices formed the basis for this paper in identifying the current challenges and opportunities in departmental design. Expert insights and feedback from healthcare practitioners aiding in the formulation of innovative solutions and recommendations for future research endeavors. Integration of ergonomic principles, advanced technologies, interdisciplinary collaboration, and proactive safety measures into physiotherapy department design improve working environments for physiotherapists. Envisioning the future of physiotherapy department design offers promising avenues for improving patient care outcomes and supporting therapist well-being.

Content analysis of current role/job descriptors for Band 5/junior physiotherapists and mapping of these to Physiotherapy Professional standards of practice

BackgroundKNOWBEST was a mixed methods study exploring the KNOWledge, BEhaviours and Skills required of the modern physioTherapy graduate. ObjectivesTo undertake a content analysis of current role descriptors (RDs) for Band5/junior physiotherapists and map these to the knowledge, skills, behaviours and attributes required for contemporary physiotherapy practice. DesignContent analyses and mapping. SettingAll health care settings: ParticipantsAvailable RDs for newly qualified/Band 5 physiotherapists across a representative range of roles and settings for this stage of a physiotherapist’s career across the UK and all health care settings. MethodsJob descriptors were obtained using three approaches 1) via direct upload to the study website, 2) on-line searches of job vacancies, 3) directly emailing managers to fill any gaps in representativeness. Data regarding knowledge, skills, behaviours and attributes were extracted, coded (BC) and checked (CML). Data analysesDocumentary content analyses and mapping of these to Professional Standards of practice. Results19 RDs were analysed. High expectations of behaviours and attributes, and extensive pre-requisite knowledge and skills were identified and detailed. Considerable variability was seen across RDs, at least seven being suited to more highly specialist and/or experienced staff. Equality, diversity and inclusivity concerns were evidenced. Active research was not included in many RDs and not mentioned in any standards. Digital learning and skills were not strongly evidenced. ConclusionsA review of Band 5/Junior post and RD requirements is recommended including a standard template developed to promote equity. Professional standards emphasise some pillars of practice, such as clinical, more than others. Contribution of the Paper•Role descriptors for band 5/junior/recently qualified physiotherapists demonstrated wide heterogeneity in knowledge, skills, attributes and behaviours.•Analysis of RDs revealed high expectations of behaviours and attributes, and extensive pre-requisite knowledge and skills in qualified physiotherapists.•A review of Band 5 post and role descriptor requirements is recommended and a standard template developed and designed to promote equity.•Findings indicate that some areas of physiotherapy practice are featured less strongly in professional standards of practice than others. It is evident that some of the pillars of advanced practice, such as clinical practice, are weighted more heavily than others.

Exploring the association between adherence to home-based exercise recommendations and recovery of nonspecific low back pain: a prospective cohort study

BackgroundAdherence to home-based exercise (HBE) recommendations is critical in physiotherapy for patients with low back pain (LBP). However, limited research has explored its connection with clinical outcomes. This study examined how adherence to HBE relates to changes in physical function, pain intensity, and recovery from LBP in patients undergoing physiotherapy treatment.MethodsData from a multicenter cluster randomized controlled trial in the Netherlands involving patients with LBP from 58 primary care physiotherapy practices were used. Adherence to HBE was assessed with the Exercise Adherence Scale (EXAS) at each treatment session. Previously identified adherence trajectories served as a longitudinal measure of adherence and included the classes “declining adherence” (12% of participants), “stable adherence” (45%), and “increasing adherence” (43%). The main outcomes included disability (Oswestry Disability Index), pain (Numeric Pain Rating Scale), and recovery (pain-free for > 4 weeks), which were measured at baseline and after three months. Linear and binomial logistic regression analyses adjusted for confounders were used to examine adherence–outcome relationships.ResultsIn the parent trial, 208 participants were included. EXAS scores were available for 173 participants, collected over a median of 4.0 treatment sessions (IQR 3.0 to 6.0). Forty-five (28.5%) patients considered themselves to have recovered after three months. The median changes in the Oswestry Disability Index and Numeric Pain Rating Scale were − 8 (IQR − 1 to -20) and − 2 (IQR − 0.5 to -4), respectively. The mean EXAS scores varied among patient classes: “declining adherence” (46.0, SD 19.4), “stable adherence” (81.0, SD 12.4), and “increasing adherence” (39.9, SD 25.3), with an overall mean of 59.2 (SD 25.3). No associations between adherence and changes in physical functioning or pain were found in the regression analyses.ConclusionsNo association between adherence to HBE recommendations and changes in clinical outcomes in patients with LBP was found. These findings suggest that the relationship between adherence to HBE recommendations and treatment outcomes may be more complex than initially assumed. Further research using detailed longitudinal data combined with qualitative methods to investigate patient motivation and beliefs may lead to a deeper understanding of the relationship between adherence and clinical outcomes in patients with LBP.

Mental health content in the physiotherapy undergraduate curriculum in South Africa.

Knowledge about mental health in physiotherapy practice is essential as mental health can impact physical health. Little is known about the mental health content in the South African physiotherapy undergraduate programme. Our study explored the mental health content in the undergraduate physiotherapy programme at eight universities and the perceptions of academic staff at an identified training institution in South Africa and stakeholders about the relevance of mental health in the undergraduate physiotherapy programme. Our study employed a concurrent-mixed method design, which consisted of: (1) the administration of a survey to academic leaders or lecturers undertaking mental health teaching at universities and (2) an online interview that included stakeholders and a focus group to gauge perceptions of academic staff at an identified institution in South Africa. Seven of eight universities participated in our study. All the universities had a psychology module and agreed that it is crucial to have mental health content in the curriculum. There is diversity in the mental health content between the universities. There is a need for consistency in the mental health content at all universities to ensure that all students receive the same skill set to have an impact on the quality of care. There is a need to include mental health content at universities offering theoretical and practical undergraduate programmes.

Reevaluating the Drucebo Effect: Implications for Physiotherapy Practice

Reevaluating the Drucebo Effect: Implications for Physiotherapy Practice

Kinésithérapie effectivement basée sur le placebo : comment les recherches de ces deux champs s’alimentent

Beginning by exploring the historical links between physiotherapy and placebo, we examine how placebo research can help physiotherapy. Focusing on three original contributions, we look at how placebo treatments work and how placebo effects might be used in clinics by modulating contextual factors. The first study demonstrates that open placebos are non-inferior to deceptive placebos. The second examines the acceptability of placebo treatments and the third how physiotherapists use placebo effects in their daily work by manipulating contextual factors. We close by examining at the importance of placebo research in the design of relevant control groups in rehabilitation research. Taken together, these results reflect on the epistemological basis for determining the efficacy of physiotherapy, and motivate the practice of ethical physiotherapy rooted in an in-depth understanding of placebo effects and contextual factors.

Shoulder osteoarthritis: A survey of current (2024) UK physiotherapy practice.

Shoulder osteoarthritis can cause significant pain and disability. It is thought that the wider principles of osteoarthritis management can be applied in the management of people with shoulder osteoarthritis, but most prior research has been conducted with people experiencing osteoarthritis of the hip and knee. There is a paucity of evidence to guide the non-surgical management of shoulder osteoarthritis and limited understanding of current physiotherapy practice. We aimed to investigate the current treatment recommendations by physiotherapists in the UK for people with shoulder OA. An online survey using a clinical vignette was designed and distributed to UK registered physiotherapists with experience of managing people with shoulder osteoarthritis, via social media and professional networks. Descriptive statistics were used to analyse demographic and multiple-choice questions, and free text responses were summarised narratively. 114 respondents accessed the survey with 110 valid responses; 105 (95%) respondents would offer face-to-face consultations, with 89 (81%) respondents expecting to offer 2-4 appointments. 108 (98%) respondents would offer advice/education; 79 (72%) would offer weight management; 82 (75%) prescribed exercises to improve movement; and 101 (92%) offered exercises to increase strength. If a person lived with obesity or had a treatment preference, the majority of respondents would change their recommendations. This is the first survey of NHS physiotherapy practice for people with shoulder osteoarthritis. The responses largely align with NICE guidelines; despite this alignment, it is not known whether such guideline-based care is acceptable to people with shoulder osteoarthritis or clinically effective.

Clinical Sports physiotherapy practice in India- it’s time to upgrade with technology and evidence based practice

In India, the job of a sports physiotherapist is very demanding because, due to the increased number of injuries in all sports, it is claimed that athletes require complete care to recover and prevent injuries. At present, the general population in India, looking to lead a healthy life, also participates in recreational sports activities. So sports physiotherapy is also recommended for the general population.After finishing their education, physiotherapists play a crucial and essential role in the recovery of sports players. Sports physiotherapists' main duties include handling on-field injuries, preventing injuries, treating injuries in the outpatient setting, helping patients recover from arthroscopic surgery, and travelling with sports teams or individuals for short or infrequently longer contract periods. This article summarize the suggestions and solutions to improve the standards of sports physiotherapy practice in india.

Navigating the 'Pits and Perils' of Analgesic Therapy in Advanced Liver Disease and Cirrhosis.

The role of the liver in drug metabolism makes individuals with hepatic dysfunction more susceptible to adverse drug reactions, necessitating careful consideration in analgesic selection and dosing. Acetaminophen, despite being a common cause of liver failure, is considered safe within recommended dosages. Nonsteroidal anti-inflammatory drugs (NSAIDs), while effective, pose risks in cirrhosis due to complications like renal failure and gastrointestinal bleeding. Cyclooxygenase-2 inhibitors have limited data, and their use is discouraged due to cardiovascular concerns. Opiates, though potent, require cautious use in cirrhosis due to altered metabolism, potential adverse effects, and the risk of addiction. Tricyclic antidepressants like nortriptyline and desipramine can be utilized for neuropathic pain, while SSRIs and SNRIs are not recommended. Anticonvulsants such as gabapentin and pregabalin are preferred for neuropathic pain, with gabapentin being the first-line choice. Topical analgesics, including NSAIDs, lidocaine, and rubefacients, are deemed safe for use in cirrhosis, offering localized relief with minimal systemic effects. Nonpharmacological approaches addressing medical, psychological, and socio-economic factors are crucial adjuvants to analgesic therapy in advanced liver diseases. Physiotherapy, psychotherapy, behavioral therapy, relaxation techniques, acupuncture, and traditional practices like yoga and massage, as well as novel modalities, contribute to a holistic pain management strategy. This review provides healthcare professionals with valuable insights into the complex landscape of analgesic therapy in cirrhosis. Meticulous consideration of drug metabolism, hepatic safety, and individual patient factors is paramount in optimizing pain management strategies for this challenging patient population.

Promoting running as the best treatment for lower back pain in physiotherapy practice: a best practice implementation project.

This project aimed to promote running as the best treatment for lower back pain (LBP) in an outpatient setting. LBP is one of the most prevalent conditions worldwide. Sixty-two percent of all Germans experience episodes of non-specific back pain at least once a year, with one-fifth developing chronic conditions. Intervertebral disc (IVD) degeneration is a natural process, contributing to periods of acute LBP. However, the scientific literature and guidelines partially overlook the significance of water management in IVD. This implementation project sought to address this gap by educating patients about this process. Running and/or walking were chosen as general approaches for treatment rather than specific disease-related approaches. This implementation project was conducted in an outpatient physiotherapy clinic in Brandenburg, Germany, utilizing the JBI Evidence Implementation Framework. An evidence-informed clinical audit and feedback strategy was used to measure compliance with ten audit criteria. Five physiotherapists and 20 patients took part in the audits. At baseline, only 20% of participating physiotherapists screened for yellow flags regarding psychological issues. However, after project implementation, this criterion scored 100% compliance. Some patients performed exercises independently, but confusion persisted regarding the choice of beneficial exercises. Patients continued running, but those who took a break due to pain expressed uncertainty about resuming. The project highlighted the effectiveness of collaborative efforts between patients and therapists to address the issue. The project team's conviction in action and solution strategies serves as the foundation for this collaboration. This implementation strategy provided "running" patients with the confidence to either resume or reintegrate running after an extended break. http://links.lww.com/IJEBH/A222.

Social support from the physiotherapist and the therapeutic relationship in physiotherapy: bridging theory to practice

ABSTRACT Background/Purpose Therapeutic relationship and social support are critical components in physiotherapy that shape patient outcomes. However, defining these constructs, discerning their similarities and differences, and measuring them pose challenges. This article aims to facilitate scientific and clinical advancement on social support and the therapeutic relationship in physiotherapy by (a) providing conceptual clarity, (b) discussing measurement tools, and (c) offering practical recommendations for the deliberate incorporation of these constructs in clinical practice. Methods This is a perspective paper drawing on examples from existing research. Key Results Assessing the nature and strength of social support and promoting naturally occurring social support networks are practical ways for physiotherapists to foster social support in physiotherapy clinical practice. Physiotherapists can offer direct support, facilitate the development of an individual’s social skills, and promote participation in group activities. To strengthen the therapeutic relationship, it is important to maintain good communication, foster connectedness with the patient, demonstrate professional skills, and adopt a reflective practice. Physiotherapists are encouraged to establish clear roles and responsibilities, prioritize individualized patient-centered care, and involve patients in shared decision-making, ensuring congruence in goals and expectations. Willingness to dedicate time and energy within and beyond direct patient-therapist interactions can foster connections. Moreover, using the body – which is the main point of contact with patients – and physical touch can help physiotherapists to connect with patients. Finally, physiotherapists must be prepared to address and mend any conflicts which can impact the relationship’s trajectory. Conclusion Social support and therapeutic relationships are complementary aspects of one’s health care, and it is crucial to purposefully account for both in physiotherapy practice to optimize person-centered care and rehabilitation outcomes.

Description of Specialty Practice-10 Years Onward: The Changes in Geriatric Physical Therapy.

An analysis of practice is conducted by the American Board of Physical Therapy Specialties (ABPTS) every 10 years to revalidate, update, and revise the description of specialty practice (DSP) for each specialty. The Geriatric Specialty Council recently conducted an analysis of practice and revised its content consistent with established procedures by the ABPTS. The purpose of this article is threefold: first, to describe the process of the most recent practice analysis; second, to report revisions to the description of specialty practice based on the analysis of practice; and third, to identify elements of practice that define current specialist practice in geriatric physical therapy. A 10-member committee of subject matter experts (SMEs) and a psychometric consultant developed a survey instrument addressing geriatric physical therapy specialty practice areas. The survey was initially pilot-tested and subsequently administered online to a sample of 801 board-certified geriatric clinical specialists. The consultant facilitated the consensus process to determine decision rules in selecting the final competencies describing current geriatric physical therapy specialty practice. A total of 372 respondents fully or partially completed the survey, resulting in a response rate of 46.4%. Based on a priori decision rules regarding survey data, consensus of the group of SMEs, and input from the ABPTS, the DSP for geriatric physical therapy specialty practice was revised. Revisions (elimination [-] of prior items and addition [+] of new items) were made in Section 1: Knowledge Areas (-8 and +6), in Section 2: Professional Roles, Responsibilities, and Values (-14 and +4), and Section 3: Practice Expectations (-53 and +28). The revised DSP will be used as the basis for the development of the examination blueprint for the specialist examination in geriatric physical therapy and the curricula for residency programs in geriatric physical therapy.

The impact of physical therapy intervention of dysphagia on preventing pneumonia in acute stroke patients: A randomized controlled trial.

Dysphagia is a common complication following stroke. It corresponds to the development of pneumonia, which is always associated with bad prognosis, longer hospital stays and increased mortality. The aim of the study was to assess the impact of physical therapy intervention of dysphagia on preventing pneumonia in acute stroke patients. A single-blind randomized controlled trial was carried out on 70 ischemic stroke patients with oropharyngeal dysphagia, age ranged from 49 to 65years. They were randomly assigned to two groups (control and study) of equal number. Patients in the control group received oral care and nasogastric tube feeding, while patients in the study group received the same program in addition to the designed physical therapy program (exercises and neuromuscular electrical stimulation). The intervention program was applied for 40min/session, 1 session/day, and 5days/week for 4weeks. Gugging swallowing screen (GUSS), and stroke associated pneumonia (SAP) control and prevention criteria were used to assess dysphagia and incidence of pneumonia at baseline, after two and 4weeks of intervention for both groups. Before treatment, all patients were susceptible to pneumonia after two and 4weeks of intervention; there were a significant increase in GUSS score in both groups with more improvement in favor of the study group (p<0.05) and a statistically significant increase in incidence of SAP after 2weeks of intervention only in the control group (p<0.05). The results also showed a significant negative correlation between GUSS score and SAP (r=- 0.3662, p=0.0018) IMPLICATIONS FOR PHYSIOTHERAPY PRACTICE: adding physical therapy (exercise therapy and neuromuscular electrical stimulation) to oral care and nasogastric tube feeding is effective in improving oropharyngeal dysphagia and decreasing the incidence of aspiration pneumonia in acute ischemic stroke patients.

About a person with a missing limb and a clubfoot in one of their legs (congenital talipes equinovarus, or CTEV)

The Ponseti technique has a higher success rate than any other method now used in physiotherapy practice for the treatment of congenital talipes equinovarus or clubfoot. The study’s objective was to discover proof that using the Ponseti approach for clubfoot challenging functional results and missing limb by prosthetic shoes. A baby girl who was 1 month and 6 days old and had no prior history of complications for either her mother or herself visited Centre for the Rehabilitation of the Paralysed (CRP). We identified her as having unilateral normal clubfeet (left) and missing limb in right, and throughout the casting process, her midfoot scored higher than her hindfoot. On the first casting day, feet had a total Pirani score (PS) of 5.5. Total casting was necessary, and the right feet’s PSs were 1.5 and 1, respectively. Just before the casting, she had manipulation (exercise therapy). After nine casting, Pirani’s score was zero. Afterward, the patient was given the brace and prosthetic in the 4 size. This study’s findings suggest that using the Ponseti approach yields comprehensive clinical and functional results and missing limb by prosthetic shoes.

Evaluating the impact of a 2-week Peer Enhanced E-Placement (PEEP) on pre-registration physiotherapy students’ attitudes, self-perceived confidence, and competence in delivering telerehabilitation.

The COVID-19 pandemic brought about rapid digital transformation of physiotherapy practice and education. Previous studies have suggested a lack of knowledge, beliefs, and clinical acceptance of telerehabilitation as barriers to implementation and sustainability of telerehabilitation. Providing pre-registration specific teaching and practical experience of telerehabilitation may improve physiotherapy student confidence and competence in delivering telerehabilitation and support clinical acceptance of telerehabilitation in practice. A 2-week Peer Enhanced E-Placement (PEEP) was developed and evaluated to explore its impact on third year physiotherapy student attitudes, and perceived competence and confidence in delivering telerehabilitation. Students completed a Likert scale questionnaire, immediately pre and post the PEEP placement, rating their perceived confidence and competence in four key areas of telerehabilitation: assessment, intervention, communication, and problem solving. In addition, students participated in group discussions to explore the impact of the PEEP on their attitudes towards telerehabilitation. 59 students completed the PEEP, 49 (mean age 25±6.6 years, 41% male) completed both the pre and post placement questionnaire. 55 students participated in group discussions (n=8). Following the PEEP, self-perceived confidence and competence increased in all four key areas assessed. Analysis of the group discussions identified three core themes: Prior experience and assumptions of telerehabilitation, Opportunities and barriers, and Experience of the PEEP. Participation in a 2-week PEEP had a positive impact on physiotherapy student confidence and perceived competence in delivering telerehabilitation. Student attitudes towards telerehabilitation generally improved, with increased acceptance and recognition of its clinical value for physiotherapy practice. Students’ concerns echoed those of clinicians identified in prior research related to the opportunities and barriers facing telerehabilitation. The intensive structure of the PEEP, peer interaction and simulation appeared to positively impact on outcomes related to confidence and acceptance of telerehabilitation. Further research is required to understand and evaluate the effectiveness of pre-registration telerehabilitation training as a means of preparing students for practice and supporting sustainability of telerehabilitation in the post-COVID era.

Adesão aos guias e consensos para pessoas com atrofia muscular espinhal tipo 1: prática clínica da fisioterapia motora

Objective: To investigate adherence in the clinical practice of motor physiotherapy to consensuses and guides for people with SMA type 1. Method: This is a quantitative cross-sectional exploratory study carried out with 59 Brazilian physiotherapists with experience in caring for patients with SMA type 1, from the application of a quantitative questionnaire prepared by the authors. Sample characterization data and responses to care are presented using absolute and relative frequency. Percentage adherence was obtained by calculating the number of adherence responses, divided by the total number of physiotherapists and multiplied by 100. Subsequently, stratification was carried out into weak, moderate, strong and very strong adherence. Results: The responses about assessment, objectives and conduct indicated strong or very strong adherence, from more than 69.49% of professionals, but regarding the use of some types of scales, orthoses and equipment, adherence was lower. Conclusion: Physiotherapists strongly adhere to consensus recommendations and guides specifically for assessment, goal development and therapeutic approaches. However, it is still necessary to understand why there was less adherence to recommendations related to the choice of motor scales, types of orthoses and equipment.

New-Graduate Physiotherapists’ Reflections on Training Experiences for Clinical Documentation

Background: Clinical documentation is a core component of physiotherapy practice and a required competency for professional accreditation in Australia, however there is a gap in understanding how physiotherapists’ documentation skills are developed. Objective: To explore new-graduate physiotherapists’ experiences and perspectives of learning clinical documentation in Australian entry-level physiotherapy programs. Methods: A qualitative study, featuring inductive reflexive thematic analysis of semi-structured interviews with new-graduate physiotherapists who graduated less than two years prior from Australian higher education institutions. Results: Sixteen new-graduate physiotherapists from six different entry-level physiotherapy programs participated. Four themes were generated to describe the data: 1) mixed experiences of learning documentation, 2) clinical placements are highly influential for skill development, 3) documentation education affects engagement in clinical settings, and 4) exposure, practice, feedback – repeat. Conclusion: Strong views were expressed amongst all participants regarding the importance of documentation training, with high value placed on early and repeated opportunities for exposure, practice and feedback when learning documentation skills. Authentic or ‘realistic’ settings for skill development were most influential, such as practical classes, simulation activities and clinical placements. Concerns were raised regarding inconsistencies in training experiences. Implications for enhancing entry-level physiotherapy training in clinical documentation are discussed.

Primary Ciliary Dyskinesia Associated with Rheumatoid Lung at The Koulikoro Reference Health Center, Mali

Primary ciliary dyskinesia is a cause of bronchial dilatation, associated with rheumatoid lung is rare. This is why we report a case with the aim of discussing the clinical, diagnostic characteristics and therapeutic possibilities of ciliary pathology and showing the link between it and rheumatoid arthritis. Observation: This is a 40-year-old African patient, married without children, from a consanguineous couple, with a family history of a brother who died in adulthood in a picture of respiratory failure and productive cough. She presented with recurrent rhinorrhea since childhood and bronchorrhea in a picture of progressively worsening dyspnea and clubbing. During the evolution of the disease, inflammatory polyarthralgia was associated. The ultrastructural ciliary study by electron microscopy and the measurement of nasal nitrogen oxide are the confirmatory examinations of primary ciliary dyskinesia. They are not achievable in our practice. However, based on the history and clinical findings, the patient presented several elements in favor of this pathology. additional investigations, notably the rheumatoid factor and the chest CT scan, allowed us to suggest rheumatoid lung. Our therapeutic conduct was the administration of antibiotic therapy, oxygen therapy, immunosuppressant, anti-inflammatory and the practice of respiratory physiotherapy. Conclusion: Primary ciliary dyskinesia associated with pulmonary involvement in rheumatoid arthritis increases the risk of developing respiratory failure.