Physiotherapy Services Research Articles

Availability and barriers to access post-stroke rehabilitation in Latin America

ObjectivesTo describe the availability and barriers to access post-stroke rehabilitation services in Latin America. Materials and methodsWe conducted a multi-national survey in Latin American countries. The survey consisted of three sections: (1) the national state of post-stroke rehabilitation; (2) the local state of post-stroke rehabilitation; and (3) the coverage and financing of post-stroke services. Stroke leaders from the surveyed countries were involved in developing and disseminating the survey. Results261 responses were collected from 17 countries. The mean age of respondents was 42.4 ± 10.1 years, and 139 (54.5 %) of the respondents were male. National clinical guidelines for post-stroke rehabilitation were reported by 67 (25.7 %) of the respondents. However, there were discrepancies between respondents within the same country. Stroke units, physiotherapy, occupational therapy, speech therapy, and neuropsychological therapy services were less common in public than private settings. The main barriers for inpatient and outpatient services included limited rehabilitation facilities, coverage, and rehabilitation personnel. The main source of financing for the inpatient and outpatient services was the national health insurance, followed by out-of-pocket payments. Private and out-of-pocket costs were more frequently reported in outpatient services. ConclusionsPost-stroke rehabilitation services in Latin American countries are restricted due to a lack of coverage by the public health system and private insurers, human resources, and financial aid. Public settings offer fewer post-stroke rehabilitation services compared to private settings. Developing consensus guidelines, increasing coverage, and using innovative approaches to deliver post-stroke rehabilitation is paramount to increase access without posing a financial burden.

"Exercise… to Me, It's Freedom": Motivation, Support, and Self-Management to Keep Physically Active with Parkinson's Disease: A Qualitative Study.

The benefits of exercise have been widely explored among people with Parkinson's (PwP). Exercise can improve non-motor (fatigue, pain, sleep, etc.) and motor features (balance, muscle strength, gait speed, etc.), maintain function, as well as prevent disease progression. Although the benefits are well known, PwP continue to show difficulty adhering to physical activity and exercise. This study aims to explore motivation to exercise, support, and self-management needs among people with Parkinson's, their family members, and physiotherapists. Purposeful and maximum-variation sampling methods (age, sex, geographical setting, and disease severity) were employed. PwP and family members were recruited through physiotherapy services and local support groups. Twelve semi-structured interviews with PwP and two group interviews, one with family members (n = 4) and one with physiotherapists (n = 5), were conducted. Interview guides were informed by patient-public input and a recent systematic review. Interviews were recorded, transcribed, and analysed using thematic analysis informed by the Grounded Theory methodology. Four common themes emerged: (1) The value of an intrinsic connection with exercise, for which there are challenges. A greater connection to exercise led to long-term adherence. (2) Adapting exercise to the needs and preferences of a person is essential. Preferred exercises and environments were mixed, with differences emerging between sexes. (3) Physiotherapists' aim to only maintain physical function led to frustration. Limited self-management opportunities, stigma, and dehumanisation were discussed. (4) Non-motor symptoms, stigma, fear, and determination as well as apathy, pain, and low mood were discussed. Exercise provided physical, emotional, and social rewards. Supports are necessary; however, challenges arise when PwP's motivations are mismatched to family members' and physiotherapists' goals. Co-created goals, tailored to their preferences, and exercise plans with supported self-management are recommended.

Wearable sensor and smartphone assisted vestibular physical therapy for multiple sclerosis: usability and outcomes.

Vertigo, dizziness, gaze instability and disequilibrium are highly prevalent in people with MS (PwMS) and head movement induced dizziness is commonly reported. Vestibular physical therapy (VPT) is a specialised, non-invasive and effective therapy for these problems but usually involves travel for the person to a specialist center with both personal and carbon costs. The use of wearable sensors to track head movement and smartphone applications to deliver and track programs has potential to improve VPT in MS. This study investigated the usability and effects of a commercially available digital VPT system (wearable head sensor, smartphone app and clinician software) to deliver VPT to PwMS. A pre/post treatment design was employed and the primary outcome was the System Usability Scale (SUS). Other patient reported outcomes were the Service User Acceptability Questionnaire (SUTAQ), the Patient Enablement Instrument (PEI) and the Dizziness Handicap Inventory (DHI). Physical outcomes measurements included Mini-BESTest (MB), Modified Dynamic Gait Index (mDGI), Gait Speed (GS), Dynamic Visual Acuity (DVA) and head kinematics and symptoms during exercise. Sixteen PwMS (14 female), mean age 44(±14) years were recruited to the study and twelve completed VPT. Mean adherence to exercise, measured digitally was 60% (±18.4). SUS scores were high at 81 (±14) and SUTAQ scores also demonstrated high levels of satisfaction and acceptability of the system. Statistically significant improvements in MB (mean change 2.25; p = 0.004), mDGI (median change 1.00; p = 0.008), DVA (median change -1.00; p = 0.004) were found. Head frequencies significantly improved with concurrent decreased intensity of dizziness during head movements (mean change across 4 gaze stabilization exercises was 23 beats per minute; p < 0.05). Non-significant improvements were seen in DHI (p = 0.07) and GS (p = 0.15). 64.5% of follow up visits were conducted remotely (video or phone), facilitated by the system. This study had two main outcomes and benefits for PwMS. Firstly, we showed that the system used was both acceptable and could be used by PwMS. Secondly, we demonstrated an improvement in a range of dizziness, balance and gait metrics with remotely delivered care. This system has the potential to positively impact on MS physiotherapy service provision with the potential to deliver effective remote care.

Parents' satisfaction with physiotherapy services for neuropediatric outpatients in government and private hospitals in the United Arab Emirates: a cross-sectional study.

Healthcare, like other industries, emphasizes performance, quality, and consumer experience while also attempting to reduce costs. However, high-quality healthcare remains paramount for vulnerable and ill patients. This study aimed to investigate parents' and caregivers' level of satisfaction with physiotherapy services provided to neuropediatric outpatients on the United Arab Emirates (UAE). This descriptive cross-sectional study included 103 parents/caregivers of children with neurological disabilities that were randomly selected from different Emirates Health Services Hospitals in the UAE. Data was collected using the long-form Patient Satisfaction Questionnaire (PSQ-III). The overall mean satisfaction was 159±7.73 (out of 250 points). Communication (20.36/25), interpersonal factors (20.17/35), and doctor-patient time (20.17/35) had the highest mean satisfaction scores (8.06/10). The lowest mean satisfaction scores were for access/availability/convenience (34.60/60), technical quality (33.17/50), and economic elements (23.83/40). Despite participants' overall satisfaction scores being positive, some service domains require improvement to improve satisfaction, specifically the access/availability/convenience, technical quality, and economic elements. These areas should be prioritized by service providers and managers to improve patients' experiences and clinical outcomes.

Factors influencing utilization of physiotherapy services by health care providers at Busia County Referral Hospital in Kenya

BackgroundThe surging trend of noncommunicable diseases complicated by trauma and infectious diseases has left many with marked physical limitations. Physiotherapy component of primary health care could be utilized for management of both communicable and noncommunicable diseases to restore physical functions.ObjectivesTo establish the health care providers’ level of knowledge and factors that influence the utilization of physiotherapy services among community members of Busia County in Kenya. The association between level of knowledge and demographic profile of health care providers at BCRH was also established.MethodDescriptive cross-sectional quantitative study involved 192 participants (nurses, doctors, and clinical officers) who were purposively selected. They completed self-administered questionnaire between August and November 2019. They were both sexes above 18 years of age, drawn from Busia County Referral Hospital. Data was analysed by Microsoft Excel and SPSS version 25.ResultsThe majority (92%) of the health care service providers had adequate knowledge about physiotherapy from their training to working with likelihood ratio chi-square of 7.714 with p-value at 0.01 at 5% level of significant. They had excellent communication (86.03%) with physiotherapists and helped to refer patients at BCRH for physiotherapy (χ2 = 52.02 and p-value = 0.01) at 5% level of significant. They had trust (91.56%) that physiotherapists were knowledgeable enough to handle patients on their own.ConclusionThe health care service providers are knowledgeable about the importance of physiotherapy and have supported its utilization. However, there is need to integrate physiotherapy service at all levels of training and practice of the components of primary health care. This will lead to a holistic patient’s care in terms of preventive, curative, and rehabilitative. Quality of life for the community members will be enhanced for appropriate functionality to meet the population needs. Lower utilization of physiotherapy services in Busia County could be due to factors associated with dynamics within the community and the health care service providers.

Addressing the Paediatric Physiotherapy's Unmet Needs.

This viewpoint emphasises the vital role that paediatric physiotherapy plays in satisfying children's rehabilitation requirements, especially those of children with chronic illnesses and impairments. It highlights issues including inadequate education and a lack of personnel, underscoring the need for individualised care in a variety of paediatric settings. The letter promotes more knowledge, financing, and research to improve the quality and accessibility of paediatric physical therapy services offered worldwide. It urges medical practitioners and legislators to address these significantly unmet needs in order to improve developmental outcomes and assure children's optimal physical well-being through the prioritisation of early intervention and tailored therapy. Key Words: Paediatric physiotherapy, Rehabilitation, Physical therapy.

Effects of Age, Burn, and Amount of Physiotherapy Services on the Developmental Status of Children under 5 Years of Age with Burn Injuries using the Ages and Stages Questionnaire

Effects of Age, Burn, and Amount of Physiotherapy Services on the Developmental Status of Children under 5 Years of Age with Burn Injuries using the Ages and Stages Questionnaire

Comparing and Analyzing the Physical and Functional Concerns of Post Breast Cancer Surgery Patients Who Received Physical Therapy for Lymphedema After Surgery to Those Who Did Not Receive Physical Therapy After Surgery

Objective: This pilot research project examined the physical and functional concerns of patients who had breast cancer surgery followed by receiving skilled physical therapy or lymphedema therapy services for more than or less than three months. Methods: This research study utilized the Qualtrics system to create a survey for the participants to complete. After completing the survey, the researchers divided the participants into two groups. The researchers analyzed the data using SPSS to run independent sample t-tests. Results: The study results show no significant difference in limb size and self-care activities between the two groups who received physical therapy.

The Relationship of Quality On The Level of Satisfaction With Physiotherapy Services Towards Patients: Literature Review

The Relationship of Quality On The Level of Satisfaction With Physiotherapy Services Towards Patients: Literature Review

Strategies for the Development of Physiotherapy in Iran from the Point of View of Physiotherapy Graduates: A Qualitative Study of the Content Analysis Type

Background: Despite the direct access to clients in physiotherapy worldwide, Iran has yet to achieve significant improvements in the educational standards and professional responsibilities of physiotherapists. Currently, Iranian physiotherapists do not have direct access to patients. This study aims to present solutions for the professional development of physiotherapy, based on the perspectives of scholars in this field. Methods: This qualitative content analysis study explored the experiences of 12 physiotherapy scholars from three levels of study (bachelor’s, master’s, and doctorate) through structured and semi-in-depth face-to-face interviews. Data analysis was conducted concurrently with data collection using Granheim and Ludman’s content analysis method. Results: The identified potential solutions include continuous review of the curriculum, strengthening clinical education, elevation of the basic level of physiotherapy education to a professional doctorate or master’s degree, post-graduation competency assessment, revision of educational priorities, establishing a strong presence in hospital and community departments, preventing the influence and interference of other disciplines, raising public awareness of the capabilities and potential of the profession, and paying greater attention to professional ethics. Conclusion: In the absence of entry-level general doctor of physiotherapy and direct access to patients, the quality of physiotherapy services will not improve, leading to suboptimal health outcomes for clients and consequent waste of time and financial resources for both patients and insurance providers.

Obstacles to the Development of Physiotherapy in Iran

Background: Despite the breadth and diversity of physiotherapy healthcare services, the entry of physiotherapists into the field of prevention and also direct access of physiotherapists to patients in the world for 10 years ago, Iranian physiotherapists have not had direct access to clients, yet. One way to overcome the current situation and move towards the growth and development of the profession is to identify the opportunities and threats of the field. The purpose of this study is to explain the obstacles to the professional development of physiotherapy from the point of view of graduates of this field. Methods: In a qualitative study of the content analysis type, the experiences of 12 physiotherapy scholars in three levels of study, bachelor’s, master’s and doctorate were obtained through a structured and semi-in-depth face-to-face interview. Simultaneously, as the data was collected, the data was analyzed based on Granheim and Ludman’s content analysis method. Results: A total of 28 codes were extracted to explain the obstacles to the development of physiotherapy in Iran, which include “low attention to professional ethics”, “inefficient policies of the Ministry of Health, Treatment and Medical Education” and “traditional teaching methods”. Conclusion: If the adherence to the principles of professional ethics is not strengthened, the policies of the Ministry of Health and Medical Education (MHTME) cannot facilitate the growth and development of the profession, and fundamental changes in the education and training of students will not take place, not only will the quality of physiotherapy services be lower than international standards, but many high medical expenses will also be imposed on people and insurances.

Factors Associated with Neuropathic Pain in Cancer Patients Admitted to a Palliative Care Unit

Introduction: Recognizing factors associated with pain in advanced cancer patients may favor a better multidisciplinary approach. Objective: To identify factors associated with the most prevalent type of pain in cancer patients admitted to a palliative care unit. Method: Cohort-study-based cross-sectional analysis of baseline data collected from cancer inpatients at the palliative care unit assisted by the physiotherapy service. Sociodemographic, clinical data and pain characteristics were obtained and analyzed according to the most prevalent type of pain at hospital admission. An odds ratio (OR) logistic regression was utilized as a measure of effect at a 95% confidenceinterval (95% CI). Results: A total of 62 patients were assessed, mostly women (69.3%) with less than 60 years old (67.7%), the most frequent tumor sites were gynecological (25.8%) and breast (16.1%). Local disease progression associated with metastasis was observed in 87.1% of all patients, with 50.0% presenting bone metastasis and 37.1%, a bone event. The most prevalent type was moderate tosevere (69.3%) neuropathic pain (51.6%), associated with the presence of a bone event (OR = 3.16; 95% CI: 1.01-9.90) and less than 60 years old (OR = 4.08; 95% CI: 1.91 -17.52). Conclusion: Neuropathic pain was the most prevalent pain in cancer patients receiving palliative care associated with the presence of bone events and less than 60 years old.

Utilization and Potential Disparities in Access to Physical Therapy for Spine Pain in the Long-Term Care Population

ObjectiveTo determine the frequency of physical therapy (PT) services and potential disparities in receiving PT among Medicare fee-for-service beneficiaries with a history of spine pain who live in long-term care (LTC) settings. DesignSecondary cross-sectional analysis of Medicare administrative data on beneficiaries with a history of spine pain from 2017-2019. We identified LTC residents using a validated algorithm, then identified and described PT episodes that occurred after the LTC index date. To identify potential disparities in access to PT services, we performed multivariable logistic regression to determine resident demographic, clinical, and community factors associated with receiving PT. SettingNot applicable. ParticipantsMedicare fee-for-service LTC residents aged ≥65 years. InterventionsNot applicable. Main Outcome MeasuresReceiving PT services. ResultsOf the 999,495 LTC residents with a history of spine pain, 49.6% received PT. Only 12.1% of PT episodes specifically treated spine pain. The odds of receiving PT were higher for residents with pain in multiple spine regions or neuropathic pain (OR, 1.27; 95% confidence interval CI, 1.26-1.29) and for residents with inpatient admissions (OR, 1.76; 95% CI, 1.75-1.78). Odds of receiving PT were lower for residents from minoritized racial and ethnic groups, and for residents with dementia (OR, 0.89; 95% CI, 0.88-0.90), depression (OR, 0.95; 95% CI, 0.94-0.96), or who lived in urban or more socioeconomically deprived areas. ConclusionsAlthough nearly half of LTC residents with histories of spine pain received PT services, most PT was not for spine pain. There are potential disparities in access to PT for LTC residents from minoritized groups living in urban and more deprived areas. Further work should examine PT outcomes and remove barriers to PT for LTC residents with histories of spine pain.

CSP2023: 187 - Understanding physiotherapy and physiotherapy services: exploring the perspectives of adults living with cerebral palsy

CSP2023: 187 - Understanding physiotherapy and physiotherapy services: exploring the perspectives of adults living with cerebral palsy

CSP2023: 72 - Facilitators and barriers regarding the implementation and interprofessional collaboration of a first contact physiotherapy service in primary care in Wales

CSP2023: 72 - Facilitators and barriers regarding the implementation and interprofessional collaboration of a first contact physiotherapy service in primary care in Wales

CSP2023: 499 - Physiotherapists’ experiences of delivering First Contact Physiotherapy services: A qualitative study

CSP2023: 499 - Physiotherapists’ experiences of delivering First Contact Physiotherapy services: A qualitative study

CSP2023: 52 - Influence of Patient Initiated Contact Rates on a First Contact Physiotherapy Service

CSP2023: 52 - Influence of Patient Initiated Contact Rates on a First Contact Physiotherapy Service

CSP2023: 458 - Development of a digital first contact MSK physiotherapy service

CSP2023: 458 - Development of a digital first contact MSK physiotherapy service

Current Status and Prospects of Physical Therapy Services Using Telerehabilitation

Current Status and Prospects of Physical Therapy Services Using Telerehabilitation

Appropriateness of exercise therapy delivery in chronic low back pain management: cross-sectional online survey of physiotherapy practice in Germany

BackgroundIn Germany, exercise therapy represents the most commonly prescribed physiotherapy service for non-specific, chronic low back pain (NSCLBP). So far, little is known about current practice patterns of German physiotherapists in delivering this intervention. Thus, the aim of this study was to investigate the appropriateness of exercise therapy delivered to NSCLBP patients in German physiotherapy care and to identify practitioner-related drivers of appropriate exercise delivery.MethodsWe used a vignette-based, exploratory, cross-sectional, online-survey study design (76-items; data collection between May and July 2023). Eligible participants were required to hold a professional degree in physiotherapy and were required to be practicing in Germany. Access links to anonymous online surveys were spread via established German physiotherapy networks, educational platforms, social media, e-mail lists, and snowball sampling. Appropriateness of exercise therapy was calculated by an equally weighted total score (400 points) including scales on shared-decision-making, exercise dose selection, pain knowledge and self-management promotion. “Appropriate exercise delivery” was determined by a relative total score achievement of > 80%. “Partly appropriate exercise delivery” was determined by a relative total score achievement of 50–79%, and “inappropriate exercise delivery” by a score achievement of < 50%. Practitioner-related drivers of exercise appropriateness were calculated by bivariate and multiple linear regression analyses.Results11.9% (N = 35) of 298 physiotherapists’ exercise delivery was considered “appropriate”, 83.3% (N = 245) was “partly appropriate”, and 4.8% (N = 14) was “inappropriate”. In the final multiple regression model, most robust parameters positively influencing appropriate delivery of exercise therapy were increased scientific literacy (B = 10.540; 95% CI [0.837; 20.243]), increased average clinical assessment time (B = 0.461; 95% CI [0.134; 0.789]), increased self-perceived treatment competence (B = 7.180; 95% CI [3.058; 11.302], and short work experience (B = − 0.520; 95% CI [-0.959; − 0.081]).ConclusionAppropriate exercise delivery in NSCLBP management was achieved by only 11.9% of respondents. However, the vast majority of 95.2% of respondents was classified to deliver exercise therapy partly appropriate. Long work experience seemed to negatively affect appropriate exercise delivery. Positive influences were attributed to scientific literacy, the average clinical assessment time per patient as well as the perceived treatment competence in NSCLBP management.RegistrationOpen science framework: https://doi.org/10.17605/OSF.IO/S76MF.