Physiotherapy Staff Research Articles

Clinicians' perspectives on remote patient management: A qualitative exploration of physiotherapists using the DiAL (Direct Access Line) programme

BackgroundIn response to the COVID-19 pandemic, face-to-face consultations within healthcare settings were suspended. Remote consultations became crucial for managing musculoskeletal conditions alongside Patient Initiated Follow-ups, leading to the development of the DiAL programme at a large National Health Service Community Trust. Previous research has focused on quantitative data, little is known about staff experiences with this programme. ObjectivesTo explore the perceptions and opinions of physiotherapy staff using DiAL, in order to highlight the benefits and challenges of this service with identification of areas for future development. DesignQualitative focus groups. MethodsTwo virtual focus groups were conducted via Microsoft Teams, involving a purposive sample of physiotherapy staff in the musculoskeletal services known to have used DiAL. Thematic analysis was conducted. ResultsTen clinicians participated in the study, generating two main themes: Clinician Autonomy and Institutional Needs. These themes encompassed several subthemes. ConclusionsClinicians reported higher job satisfaction and improved accessibility for patients, attributing these positive outcomes to the autonomy and flexibility provided by the platform. While the programme met National Health Service targets for Patient Initiated Follow-ups, there was a desire for ongoing improvements and a recognition that previous audits failed to capture all the benefits. DiAL serves as a treatment choice, supporting evidence on the advantages of remote consultations and contributing to the National Health Services’ goal of reducing its carbon footprint. There is a collective desire for the platform to continue with future recommendations including expanding its use and exploring additional audit metrics.

Spreading Standardized Documentation of Pediatric Occupational and Physical Therapy Dose: A Quality Improvement Initiative.

Clinicians and researchers can leverage clinical documentation of therapy services for quality improvement and research purposes. However, documentation is often institution specific and may not adequately capture the dose of therapy delivered, thus limiting collaboration. To implement documentation of pediatric occupational and physical therapy dose from one institution to another institution. Dose documentation includes the frequency, intensity, time, and type of interventions delivered (FITT Epic® Flowsheet) at each session. Prospective time-series quality improvement study. Two large urban pediatric hospitals. Occupational and physical therapy staff members. Staff training and feedback loops utilizing existing groups. The process measure (number of available staff trained and using the FITT Epic Flowsheet over time) and the outcome measure (percentage of FITT Epic Flowsheets used for treatment visits each month) were analyzed using a statistical process control chart. The balancing measure (percentage of notes closed before 7 p.m. on the same day as the encounter) was analyzed using mean per month across three time periods. Fifty-seven staff members (68%) attended formal training. On average, clinicians documented 90% of sessions using the FITT Epic Flowsheet after implementation. There was no change observed in the balancing measure. Documentation of dose was spread from one institution to another. Shared documentation will facilitate future collaboration for quality improvement and research purposes. Occupational therapy practitioners and leaders should consider implementing documentation with common dose elements. Plain-Language Summary: Occupational therapy documentation is often institution specific and may not adequately capture the dose of therapy (frequency, intensity, time) or types of interventions that were delivered, thus limiting opportunities for collaboration between institutions. This article adds to the literature on administrative supports for clinical and quality improvement research by illustrating a specific example of how documentation of dose can be shared from one institution to another. The data show that clinicians at one institution started using a new style of documentation using the FITT Epic® Flowsheet and shared discrete dose elements with another institution, creating new opportunities for collaboration. Shared documentation can facilitate future collaboration for quality improvement and research purposes.

Fidelity, pragmatism and the “grey line” in between—exploring the delivery of a pragmatic physical activity randomised controlled trial—a secondary analysis

BackgroundIntervention fidelity in health services research has been poor with a reported lack of understanding about what constitutes pragmatic adaptation of interventions and what constitutes failure to maintain intervention fidelity. However, the challenges facing those delivering such interventions have not been thoroughly explored.The aims of this study were to critically explore the challenges in maintaining fidelity experienced by physiotherapy staff and support workers when delivering a complex intervention for older people living with frailty.MethodsThis study is a secondary analysis of data from a process evaluation of a large randomised controlled trial (RCT). The process evaluation employed qualitative methodologies with mixed methods including a variety of data collection methods, including participant observation, semi-structured interviews and documentary analysis. Thematic analysis was used to make sense of the data.ResultsMany therapy staff felt ongoing confusion about what was acceptable to adapt and what needed to follow the protocol exactly. We found that some therapy staff were able to embrace the challenges of pragmatically adapting interventions while maintaining intervention fidelity, others stuck rigidly to the protocol and failed to adapt interventions where it was necessary.ConclusionIt was clear that the understanding of fidelity and pragmatism was poor. While pragmatic trials are vital to replicate real world clinical practice, further guidance may need to be developed in order to guide the level of adaptation that is acceptable before fidelity is undermined.

Adductor Canal Block versus Intravenous Patient Controlled Analgesia for Postoperative Pain Control for Primary Total Knee Arthroplasty

Abstract Background Uncontrolled postoperative pain has an adverse sequel of delayed resumption of normal pulmonary function, restriction of mobility, nausea and vomiting, increase in the systemic vascular resistance, cardiac work, and myocardial oxygen consumption through an increase in the catecholamine release induced by the stress response. Aim of the Work to compare efficacy, hemodynamic effects, opiate consumption and side effects of Adductor canal block and intravenous patient-controlled analgesia (PCA) in terms of postoperative primary total knee arthroplasty analgesia. Patients and Methods The study was performed upon 60 patients, randomly distributed into two equal groups: Group I: Patients of this group underwent ultrasound guided single shot adductor canal block after the end of surgery and before extubation with 20 ml of bupivacaine 0.5% and Group II: Patients of this group received intravenous patientcontrolled analgesia (PCA) with Nalbuphine after the end of surgery and before extubation. For each patient, the following data were collected: age, sex, weight, height, ASA, hemodynamic changes, VAS, Nalbuphine extradoses consumption, Side effects such as nausea, vomiting, pruritus, urinary retention and hypotension were recorded. Orthopedic rehabilitation indices were assessed by physiotherapy staff. Results ACB provided more effective analgesia for the first 6 hours but PCA with nalbuphine was superior after and for the rest of 24 postoperative hours. Conclusions Adductor canal block had good control of pain for the first 6 postoperative hours. However, the conventional use of intravenous PCA containing opioids was more effective for the rest of the first 24 postoperative hours.

Cognitive Correlates of a Large Time Differential between Timed Up and Go and Gait Speed during Inpatient Stroke Rehabilitation

Purpose: Cognitive impairment is highly prevalent after stroke but can be difficult to identify acutely. We aimed to study if a large difference between two common, routine physical therapy assessments (Timed Up and Go [TUG] test and 10-Meter Walk Test [10MWT]) could identify patients with subtle cognitive difficulties post-stroke. Method: An observational study was conducted in 141 individuals admitted to acute inpatient rehabilitation after stroke. We computed the percent difference between TUG and 10MWT performance. Cognitive outcome measures were the Trail Making Test A and B (TMT-A and -B) and the Functional Independence Measure (FIM)-Cognition subscale. Linear and logistic regression analyses were conducted to evaluate if the difference between TUG and 10MWT was associated with cognitive functioning. Results: After adjusting for covariates, there was no significant linear association between TUG-10MWT discrepancy and cognition; however, stroke patients with the largest difference between TUG and 10MWT (highest quartile of scores) exhibited significantly worse attention on the TMT-A (adjusted odds ratio = 2.46, p = 0.04). Conclusions: A large difference between TUG and 10MWT may reflect deficits in complex sustained attention in individuals with stroke. Physical therapy staff may use this difference score to identify patients with potential cognitive deficits and refer them for comprehensive neuropsychological evaluation.

Weathering the Storm: Professional Quality of Life in Acute Care Physical Therapy Before and During the COVID-19 Pandemic.

To describe levels of compassion satisfaction and compassion fatigue (consisting of burnout and secondary trauma) among a similar cohort of acute care physical therapy staff prior to and approximately 1 year into the pandemic. Cross-sectional online survey methodology using the ProQOL was completed. A convenience sample of acute care physical therapy professionals employed at a large Midwestern academic medical center was surveyed at separate time points in 2018 (prepandemic) and 2021 (pandemic). A total of 54 (2018) and 53 (2021) acute care physical therapy professionals completed the survey. Overall, respondents reported moderate to high levels of compassion satisfaction with low to moderate levels of burnout and secondary trauma at both periods, consistent with other previously reported health care professionals. However, the respondents exhibited a shift toward worsening compassion fatigue, with increasing levels of burnout and secondary traumatic stress, and a decreased level of compassion satisfaction. Describing the professional quality of life in a cohort of acute care physical therapy professionals before and during the pandemic provides a foundation of further understanding burnout and secondary traumatic stress. Future studies could be completed longitudinally to track changes in acute care physical therapy staff and explore effective support strategies.

Rehabilitation for revision total knee replacement: survey of current service provision and systematic review

BackgroundRevision total knee replacement (TKR) is a major operation with a long recovery period and many patients report suboptimal outcomes. Rehabilitation has the potential to improve outcomes. The aim of this study was to understand current provision of rehabilitation for revision TKR in England and evaluate the existing evidence.MethodsPhase 1: An online national survey of education and rehabilitation provision for patients receiving revision TKR was completed by physiotherapy staff at 22 hospitals across England that were high volume for revision TKR (response rate of 34%).Phase 2: Systematic review to identify studies evaluating rehabilitation programmes for revision joint replacement. Searches were conducted in MEDLINE, EMBASE, PsycINFO, CINAHL, and Cochrane databases from inception to 15th June 2022. Randomised controlled trials (RCTs) and observational studies that evaluated post-operative rehabilitation for adults undergoing revision joint replacement were included. Screening, data extraction and quality assessment was undertaken by two reviewers.ResultsPhase 1: Pre-operative education which aimed to prepare patients for surgery and recovery was provided in most hospitals, predominately involving a single session delivered by a multidisciplinary team. Inpatient physiotherapy commonly commenced on post-operative day 1 and was provided twice daily, with most hospitals also providing occupational therapy. Rehabilitation was often provided in the first four weeks after hospital discharge, either in an outpatient, community or home setting. In most hospitals, the education and rehabilitation provided to patients receiving revision TKR was the same as that provided to patients undergoing primary TKR.Phase 2: Of the 1,445 articles identified, three retrospective cohort studies based on hospital records review were included. The studies evaluated intensive inpatient rehabilitation programmes, consisting of 2–3 h of daily group or individual physiotherapy, with additional occupational therapy in one study. All three studies reported improvement in functional outcomes for patients undergoing rehabilitation after revision TKR. All studies were limited by their retrospective design, short duration of follow-up and lack of sample size calculation. No RCTs evaluating effectiveness of rehabilitation for revision TKR were identified.ConclusionThis study identified the need for future research to develop and evaluate tailored rehabilitation to optimise patient outcomes following revision TKR.

Physiotherapy services in intensive care. A workforce survey of Australia and New Zealand

BackgroundIn Australia and New Zealand, there are currently no recommendations to guide staffing levels for intensive care unit (ICU) physiotherapy services, and there is limited information about the current services provided. ObjectivesThe objective of this study was to document the profile of intensive care physiotherapy services currently offered in Australia and New Zealand. MethodsA binational survey was distributed to physiotherapists. The survey sought information on staffing and service profiles for weekday, weekend, and after-hour services including on-call and evening shifts. ResultsEighty-six sites completed the survey, with responses primarily from Level 3 (47/86, 55%) and public ICUs (74/86, 86%). For weekday services, the ratio of full-time equivalent physiotherapy staff allocated per bed was similar between all intensive care levels (0.11 [0.08–0.15], p = 0.421). Thirty respondents (35%) were satisfied with their staffing and reported higher levels of physiotherapy staff per bed (0.15 [0.1–0.2], p < 0.001). Most sites reported lower levels of staffing for weekend services (76/86, 88%), and many physiotherapists indicated that they were not satisfied with this service (55/86, 64%). Most Level 2, Level 3, and paediatric ICUs had a designated senior physiotherapist, with similar levels of senior physiotherapy staff allocated per bed between all ICU levels (0.05 [0.03–0.08], p = 0.844). Few sites reported dedicated staff attributed to intensive care education, research, tracheostomy service, or outreach roles. On-call physiotherapy services were available in 49 of 86 (57%) hospitals surveyed; however, utilisation of the service by ICUs was mainly reported to be less than once per month (19/49, 39%). ConclusionsPhysiotherapy staffing ratios were similar across different ICU levels. While weekend services are available for most ICUs, staffing levels are reduced. Higher staffing ratios were associated with higher levels of satisfaction to complete professional roles and responsibilities.

Comparing rehabilitation outcomes for patients admitted to the intensive care unit with COVID-19 requiring mechanical ventilation during the first two waves of the pandemic: A service evaluation

ObjectivesTo compare rehabilitation outcomes of patients admitted to the intensive care unit with COVID-19 and mechanically ventilated during wave 1 and 2, receiving two different models of physiotherapy delivery. MethodsAdults admitted to the intensive care unit between October–March 2021 (wave 2) with a confirmed diagnosis of COVID-19 and mechanically ventilated for >24 hours were included. During wave 2, rehabilitation was provided by physiotherapists over five days, with only emergency respiratory physiotherapy delivered at weekends. Rehabilitation status was measured daily using the Manchester Mobility Score to identify time taken to first mobilise and highest level of mobility achieved at ICU discharge. Outcomes were compared to data previously published from the same ICU during ‘wave 1’ (March–April 2020) when a seven-day rehabilitation physiotherapy service was provided. ResultsA total of n = 291 patients were included in analysis; 110 from wave 1, and 181 from wave 2. Patient characteristics and medical management were similar between waves. Mean ± SD time to first mobilise was slower in wave 2 (15 ± 11 days vs 14 ± 7 days), with overall mobility scores lower at both ICU (MMS 5 (Step transferring) vs MMS 4 (standing practice) (4), p < 0.05) and hospital (MMS 7 (Mobile > 30 m MMS) vs MMS 6 (Mobile < 30 m MMS), p < 0.0001) discharge. Significantly more patients in wave 2 required ongoing rehabilitation either at home or as an inpatient compared to wave 1 (81 % vs 49 %, p = 0.003). ConclusionThe change in physiotherapy staff provision from a seven-day rehabilitation service during wave 1 to a five day rehabilitation service with emergency respiratory physio only at weekends in wave 2 was associated with delayed time to first mobilise, lower levels of mobility at both intensive care unit and hospital discharge and higher requirement for ongoing rehabilitation at the point of hospital discharge.

Physiotherapy practices when treating patients with COVID-19 during a pandemic: A survey study

Background Specific details pertaining to the clinical and other challenges faced by physiotherapists managing patients with COVID-19 during the pandemic are still largely unknown.Objectives To determine how physiotherapists clinically managed patients with COVID-19 in a hospital-based setting during the pandemic and to identify the personal and professional effects of working as a physiotherapist at this time.Methods Self-administered electronic cross-sectional survey. Participants included physiotherapists from around the world involved in the clinical management of patients with COVID-19.Results Of the 204 participants who returned the questionnaire, 39% worked as senior physiotherapists, 29% as consultant or specialist physiotherapists, 23% as general physiotherapists and 4% as graduate physiotherapists. Seventy-two percent of participants worked in the intensive care unit. The largest barrier to treating patients with COVID-19 was a lack of intensive care trained physiotherapists (70%). Eighty-three percent of participants reported performing activities outside of their typical work duties, including proning patients (55%), tutoring and advising other staff in the intensive care unit (55%) and adjusting or changing ventilator settings (52%). Almost all participants (90%) reported being aware of physiotherapy specific guidelines for treating patients with COVID-19, yet most participants performed techniques that were not recommended.Conclusions The experience of the pandemic highlighted the need for specialist training and availability of experienced cardiorespiratory physiotherapists to manage patients with COVID-19, specifically in intensive care. Furthermore, clear guidelines on the management of patients with COVID-19 should be established to ensure optimal management of patients and ensure the safety of physiotherapy staff.

Physiotherapy staff experiences during COVID-19: A service evaluation, framework analysis and recommendations for a future physiotherapy service

Physiotherapy staff experiences during COVID-19: A service evaluation, framework analysis and recommendations for a future physiotherapy service

Measuring the impact of an equipment bag for on call physiotherapy staff

Measuring the impact of an equipment bag for on call physiotherapy staff

Intensive physical therapy after emergency laparotomy: Pilot phase of the Incidence of Complications following Emergency Abdominal surgery Get Exercising randomized controlled trial.

Postoperative pneumonia and delayed physical recovery are significant problems after emergency laparotomy. No randomized controlled trial has assessed the feasibility, safety, or effectiveness of intensive postoperative physical therapy in this high-risk acute population. The internal pilot phase of the Incidence of Complications after Emergency Abdominal Surgery: Get Exercising (ICEAGE) trial was a prospective, randomized controlled trial that evaluated the feasibility, safety, and clinical trial processes of providing intensive physical therapy immediately following emergency laparotomy. Fifty consecutive patients were recruited at the principal participating hospital and randomly assigned to standard-care or intensive physical therapy of twice daily coached breathing exercises for 2 days and 30 minutes of daily supervised rehabilitation over the first 5 postoperative days. Interventions were provided exactly as per protocol in 35% (78 of 221 patients) of planned treatment sessions. Main barriers to protocol delivery were physical therapist unavailability on weekends (59 of 221 patients [27%]), awaiting patient consent (18 of 99 patients [18%]), and patient fatigue (26 of 221 patients [12%]). Despite inhibitors to treatment delivery, the intervention group still received twice as many breathing exercise sessions and four times the amount of physical therapy over the first 5 postoperative days (23 minutes [interquartile range, 12-29 minutes] vs. 86 minutes [interquartile range, 53-121 minutes]; p < 0.001). One adverse event was reported from 78 rehabilitation sessions (1.3%), which resolved fully on cessation of activity without escalation of medical care. Intensive postoperative physical therapy can be delivered safely and successfully to patients in the first week after emergency laparotomy. The ICEAGE trial protocol resulted in intervention group participants receiving more coached breathing exercises and spending significantly more time physically active over the first 5 days after surgery compared with standard care. It was therefore recommended to progress into the multicenter phase of ICEAGE to definitively test the effect of intensive physical therapy to prevent pneumonia and improve physical recovery after emergency laparotomy. Therapeutic/Care Management; Level II.

Reduce the patient's waiting time and improve the patient's flow using lean six sigma in physiotherapy department

Background: Lean Six Sigma (LSS) is the latest generation of improvement approaches. The amount of waiting time directly impacts in patient experiences in physical therapy outpatient care. Patient waiting time data supports, patients referred to the physical therapy department for an appointment waited a minimum of 3 weeks. The physical therapy staff found this frustrating as patient's conditions often became more chronic during the wait and they often needed to take prolonged periods of sick leave. Physical therapists felt that to provide a better quality service they should reduce the waiting time of the patients. Aim: The aim of this study was to reduce the patient waiting time and improve the patient flow with optimized patient experience to using LSS methodology in an Outpatient Physical therapy Department (OPD). Subjects and Methods: LSS define–measure–analyze–improve–control methodology was adopted with using different quality tools. Results: A number of nonvalue added activities were identified within the process, and actions were initiated to systematically eliminate different forms of waste using the principles of lean thinking. The Non value added activities of Rework, Rejections, delayed approval Process leads to revenue loss were identified and eliminated from the process. Cause-and-effect analysis was carried out to identify the potential causes for unacceptable waiting times, and data were collected to validate these causes by the GEMBA investigation. As a result of this project, the average waiting time was reduced from 13.5 days (2 weeks) to 4 days to execute the first physical therapy session from the insurance approval. The Action plans were implemented on different levels of the process and specifically allocated to team members of Physicians, Physiotherapists, Patient's Administrators & Insurance Coordinator. Conclusion: There was a significant reduction in waiting time and improving the patient flow was achieved in the outpatient services of the physical therapy department using the LSS approach.

Staff experience of rapid implementation of telemedicine: informing future service redesign

Background/Aims In response to the COVID-19 pandemic, many services in the NHS suspended face-to-face appointments and transitioned to remote consultations. Best practice advocates for evaluation of what was implemented, and the lessons learned, to guide future service redevelopment. This evaluation explored the experienced of physiotherapy staff, aiming to inform future service development and ensure that the staff perspective is taken into account. Methods A survey was distributed to all staff involved in the initial running of the integrated musculoskeletal physiotherapy service at Guy's and St Thomas' NHS Foundation Trust. Questions consisted of Likert scales, multiple choice questions, scales of 1–100 and open questions. Overall, 22 staff members from the new remote clinic and 10 from the follow-up clinic responded. Content analysis was performed to draw themes from responses. Results Overall, 75% of responses indicated a positive experience of the implementation of telemedicine. However, improvements in training and procedural matters were highlighted as fundamental to supporting staff in these clinics. There was considerable variation between staff in the new patient clinic and those in the follow-up clinic, with the former feeling less confident about running remote patient clinics. Conclusions Remote consultations are an accepted medium for staff to deliver physiotherapy consultations. However, future development of telemedicine services must be informed by this experience and take staff experiences into consideration.

ONCALLbuddy: Using digital innovation to support workforce changes in response to COVID-19

Purpose: The response to COVID-19 has placed unprecedented demands on the physiotherapy workforce. Changing models of care have required physiotherapists to work across new models of care. In many cases, staff have returned to respiratory and critical care roles. Although many organisations have provided staff training where required, there is no widely available, easy to access resource, that summarises the knowledge and skills required to support these workforce changes. The aim of the ONCALLbuddy project was to provide physiotherapy staff with easy access to knowledge and information to support the changes in roles and clinical requirements.

Evaluation of the outcomes of adjunctive awake-proning as a novel approach to the management of COVID-19 pneumonitis in a level 1 hospital ward setting

In response to pressure on United Kingdom healthcare services due to the COVID-19 pandemic, a decision was made to pre-emptively awake-prone hypoxic patients with COVID-19 pneumonitis in a non intensive care unit (ICU) setting, with the aim of improving oxygenation and patient outcomes. This approach was trialled over 30 days from 30th March 2020, awake-proning patients for up to 15 hours a day in the first 72 hours of commencement. This case series was retrospectively analysed to characterise patients who tolerated the intensive regime (group A) versus those who ceased awake-proning early (group B). Additionally, length of stay in days was evaluated in the two groups. In total, 36 patients were proned – with an average of 2% point increase in oxygen saturations. Of these, 21 patients tolerated the intensive regime (average 1878 minutes/72 hours). Of the 15 people who ceased early (971 minutes/72 hours), only 4 were due to intolerable side effects. There were no major significant differences in baseline clinical characteristics between the two groups. Length of stay was significantly reduced in group A over group B even when adjusted for confounding of ICU stay (7.2 compared to 15.2 days p = 0.049). In conclusion awake-proning was successfully delivered in a level 1 setting, requiring the addition of 2 extra physiotherapy staff only. Further exploration is needed to explore the association of intensive regimes with reduced length of stay.

EP.TU.23Impact of a multi-disciplinary team teaching programme on understanding of roles and communication among the multi-disciplinary team

Abstract Background Multidisciplinary teamwork is a critical aspect of patient care. It has a well recognised impact on patient healthcare outcomes. Communication among the multidisciplinary team (MDT) is paramount for effective collaboration, joint care planning and co-ordinated assessments of patients. Aim To evaluate the impact of an MDT teaching programme on understanding of roles, and communication among the MDT. Methods A questionnaire was distributed among ward staff who rated their understanding of roles and experience of communication for 8 teams within the MDT. An MDT teaching programme was designed and ran weekly over 6 weeks, aimed at improving understanding of roles and communication among the MDT. Sessions were attended by various members of staff including junior doctors, occupational therapy, physiotherapy, junior and senior nursing staff, consultants, and ward clark. The questionnaire was repeated and results were compared. Results Understanding of MDT roles was rated 15-32% higher after the teaching programme. For MDT teams not involved in the teaching programme, understanding of roles was rated the same or lower than before the programme. Staff experience of communication among the MDT was rated higher by 18% after the teaching programme. Additionally, the teaching programme provided an opportunity for MDT members to organise weekly MDT-based activities aimed at improving patient healthcare outcomes. Conclusion In conclusion, MDT teaching programmes are an effective way of improving understanding of roles and communication among the MDT.

Immersive virtual reality in children with upper limb injuries: Findings from a feasibility study.

PURPOSE:Children who sustain Upper Limb Injuries (ULIs), including fractures and burns, may undergo intensive rehabilitation. The discomfort of therapy can reduce their compliance, limit their range of motion (ROM) and lead to chronic pain. Virtual Reality (VR) interventions have been found to reduce anticipated and procedural pain.This feasibility study aimed to explore perceptions and impacts of a custom-made, fully immersive Head-Mounted Display VR (HMD-VR) experience within a United Kingdom (UK) National Health Service (NHS) outpatient rehabilitation service for children with ULIs.METHODS:Ten children aged 9–16 in one UK Children’s hospital trialled HMD-VR during one rehabilitation session. They, their parents (n = 10), and hospital physiotherapy staff (n = 2) were interviewed about their perceptions of pain, difficulty, enjoyability, therapeutic impacts, benefits, and limitations. Children rated the sessions on enjoyability, difficulty, and pain compared to usual rehabilitation exercises. Physiotherapists were asked to provide range of motion readings.RESULTS:Inductive thematic analysis of interview data generated three themes, ‘Escape through Engagement’; ‘Enhanced Movement’; and ‘Adaptability and Practicality’. Children rated the session as more enjoyable, less difficult and painful than their usual rehabilitation exercises. Findings suggested that HMD-VR was an engaging, enjoyable experience that distracted children from the pain and boredom of therapy. Also, it seemed to enhance the movement they achieved. Participants perceived it was useful for rehabilitation and adaptable to individual needs and other patient groups. Suggestions were made to increase adaptability and build in practical safeguards.CONCLUSION:Findings from this small-scale feasibility study suggested HMD-VR was perceived as usable, acceptable, and effective with potential for further development. Future work could include larger scale trials.

Despite maintaining a high daily training availability, a quarter of athletes start the season injured and three quarters experience injury in an Australian State Academy of Sport

ObjectivesTo 1) investigate the incidence, prevalence, burden and characteristics of injuries; and 2) explore the frequency of physiotherapy and medical servicing for elite sports academy athletes over a 12-month season. DesignProspective cohort study. MethodsMedical attention and time-loss injuries were prospectively recorded by Physiotherapy and Medical (Sports Physician) staff for 94 athletes (72.3% females). The number of linked physiotherapy and medical servicing appointments was also recorded. Injury incidence rates (IIR), point and period prevalence, and injury burden were calculated and compared by athlete gender, sport, and categorisation (performance level) using incidence rate ratios (IRR). ResultsThe number of injuries reported was 193 in 71 (75.5%) athletes. The IIR was 2.1 (95%CI: 1.8 to 2.4) injuries per 365 days, with no gender difference observed (IRR: 1.1, 0.8 to 1.4). The injury burden was 43.5 (95%CI: 37.8 to 50.1) days absent per 365 days. More than one-quarter (point prevalence, 26.6%) of athletes commenced the season with an injury. In-season injury risk was 2.5 fold greater in athletes who started the season with an injury compared to athletes who started the season without an injury (IRR: 2.5, 1.9 to 3.4). The majority (81.2%) of the 1164 appointments recorded were physiotherapy, with an overall 4.3:1.0 physiotherapy to medical appointment ratio. ConclusionsOne in four athletes began the elite pathway season with a pre-existing injury, while also demonstrating a 2.5 fold greater risk of subsequent injury in the scholarship period. Sports should not assume their athletes are uninjured at the beginning of their scholarship. Injury profiles, and physiotherapy and medical servicing varied across sports. To reduce health as a barrier in the successful transition of talented young athletes to elite athletes, injury management strategies at the commencement of recruitment and throughout the scholarship should be prioritised in the development pathway.