Physiotherapists In Primary Health Care Research Articles

Physiotherapists’ barriers and facilitators to the implementation of a behaviour change-informed exercise intervention to promote the adoption of regular exercise practice in patients at risk of recurrence of low back pain: a qualitative study

BackgroundRecurrences of low back pain (LBP) are frequent and associated with high levels of disability and medical costs. Regular exercise practice may be an effective strategy to prevent recurrences of LBP, however, the promotion of this behaviour by physiotherapists seems to be challenging. This study aims to explore physiotherapists’ perceived barriers and facilitators to the implementation of a behaviour change-informed exercise intervention to promote the adoption of regular exercise practice by patients at risk of recurrence of low back pain.MethodsTwo focus groups with primary healthcare physiotherapists were conducted, based on a semi-structured interview schedule informed by the Behaviour Change Wheel, including the Capability, Opportunity, Motivation–Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). All focus groups were held through videoconference, audio and video recorded and transcribed verbatim. A deductive content analysis, using a coding matrix based on the COM-B and TDF, was performed by two independent researchers. A third researcher was approached to settle disagreements.ResultsIn total, 14 physiotherapists participated in the focus groups. The analysis revealed a total of 13 barriers (4 COM-B components and 7 TDF domains) and 23 facilitators (5 COM-B and 13 TDF) to physiotherapists’ implementation of a behaviour change-informed exercise intervention. The most common barriers were the lack of skills and confidence to implement the proposed intervention. These were explained by the fact that it differs from the usual practice of most participants and requires the learning of new skills applied to their contexts. However, for those who had already implemented other similar interventions or whose rationale is aligned with the new intervention, there seemed to exist more positive determinants, such as potential benefits for physiotherapists and the profession, improvement of quality of care and willingness to change clinical practice. For others who did not previously succeed in implementing these types of interventions, more context-related barriers were mentioned, such as lack of time to implement the intervention, schedule incompatibilities and lack of material and human resources.ConclusionsThis study identified modifiable barriers and facilitators to physiotherapists’ implementation of a behaviour change-informed exercise intervention for patients at risk of recurrence of LBP in primary healthcare. The findings of this study will allow the systematic and theory-based development of a behaviour change-informed training programme, aimed at physiotherapists and supporting the successful implementation of the exercise intervention.

A developmental perspective of influences on the onset and early trajectory of chronic pain in children attending physiotherapy in primary health care settings: An integrative review

Chronic pain in childhood leads to long-term social, emotional, physical, and financial impacts, with lifelong heightened pain sensitivities. The prevalence of chronic pain in children has increased over the past 20 years. Physiotherapy is often the place of initial intervention for a child in pain, and initial treatment is predictive of chronic pain and can predict outcomes. Children’s pain experiences and responses are thought to be more modifiable than those of adults; therefore, quality physiotherapy interventions have the potential to positively influence the onset and early trajectory of chronic pain. Using a childhood developmental lens, this integrative review aimed to draw together research literature about biopsychosocial factors influencing chronic pain onset and early trajectory in primary-school-aged children. The results of the review contribute novel understandings for physiotherapists in primary healthcare. A range of biopsychosocial concerns including age at onset and pain duration, neuro-biological aspects, psychological influences, parental impacts, sleep quality, trauma history, and stress interact with children’s learning and development. Taken together, these factors have potential to influence chronic pain onset and early trajectory in children. Adopting a holistic understanding of childhood development in the early management of childhood chronic pain would promote positive physiotherapy interventions and may avoid pathologising what is developmentally normal.

Primary health care reforms in Estonia: using financial incentives to encourage multidisciplinary care

Abstract Estonia has a historical legacy of large hospital networks and municipality-owned specialist clinics, with a low emphasis on primary health care (PHC). Since the 1990s, a transition towards PHC has occurred, delivering PHC in family physician practices rather than in specialist clinics. The transition has been underpinned by a series of comprehensive healthcare system reforms starting in the late 1990s. The most recent reforms, although lacking a legal basis, have been accompanied by financial incentives including EU structural funds to encourage change. These financial incentives were designed to improve quality of care, encourage working in remote areas, and more. A key focus of PHC reforms has been an emphasis on multidisciplinary care, and the reforms have aimed at increasing the involvement of home nurses, midwives, and physiotherapists in PHC. The reforms have also prioritized PHC centres, with multiple practicing physicians, over single physician practices. Although EU structural funds have supported building the infrastructure for expanded scope of services at PHC level, the uncertainty of long-term funding of expanded services remained a key challenge limiting the success of the reform. Further, the supply of family physicians will be problematic in the future, as the number of permanently vacant positions has quadrupled in the last five years and almost half are 60 years of age or older. As the PHC reform process in Estonia continues until today, it can serve as a case study for other countries interested in strengthening their PHC systems.

Neck and back pain: Differences between patients treated in primary and specialist health care.

ObjectiveTo describe and compare patients with neck or back pain treated by physiotherapists in primary healthcare (PHC) and in departments for physical medicine and rehabilitation in specialist healthcare (SHC) in Norway.DesignCross-sectional study using data from the FYSIOPRIM (FP) database in PHC and the Norwegian Neck and Back Registry (NPR) in SHC. Neck and back pain patients in the period 2014–18 aged ≥ 18 years were included. Demographics, lifestyle and clinical factors were investigated.ResultsA total of 8,125 patients were included: 584 in PHC and 7,541 in SHC. Mean age was 47.1 and 45.5 years, respectively, with more females in PHC (72% vs 56%). Low levels of education and physical activity, high workload and receiving social benefits were associated with treatment in SHC. Treatment in SHC was most common among patients with pain duration 3 to 12 months. Higher pain intensity and lower health-related quality of life were found in patients treated in SHC, no differences were found for psychological distress.ConclusionThis is the first study comparing register data in patients with neck or back pain treated in PHC and SHC. Differences were found in pain and health-related quality of life, but levels of psychological distress were similar between patients treated in PHC and those treated in SHC.LAY ABSTRACTPatients with neck or back pain have high levels of healthcare utilization, both in primary and specialist healthcare. The aim of this study was to investigate patients referred and treated by physiotherapists in primary healthcare and by specialists in specialist healthcare in Norway, to evaluate differences in the demographics, lifestyle and clinical factors of patients treated in each healthcare setting. Included patients had been diagnosed with neck or back pain from 2014 to 2018, and were aged ≥18 years. Patients in specialist care had more pain and lower health-related quality of life, but similar levels of psychological distress to those treated in primary healthcare. Furthermore, patients treated in specialist healthcare had lower socioeconomic status (education, workload, social benefits) compared with those treated in primary healthcare.

Correlation between self-efficacy, fear of movement, empowerment, enablement, and number of visits to physiotherapist among patients with musculoskeletal disorders in primary health care: a feasibility study

BackgroundMusculoskeletal disorders are a costly burden for health care and social care services. Patients with musculoskeletal disorders are often treated by physiotherapists in primary health care. Psychosocial variables can be a significant obstacle to recovering from musculoskeletal injuries.The primary aim of this pilot study was to assess the feasibility of performing a prospective study investigating whether self-efficacy, fear of movement, empowerment, or enablement has any relation to the number of visits to physiotherapists among patients with a musculoskeletal disorder in primary health care.MethodsProspective study with a consecutive selection including eleven female and eight male patients age ranged between 22 and 82 years old seeking physiotherapist for the first time for a musculoskeletal disorder in primary health care. Primary outcome measures included operational and practical feasibility regarding recruitment of participants, use of questionnaires, and key variables to be collected as part of the study. Secondary outcomes included the correlation between self-efficacy (Exercise Self-Efficacy Scale (ESES-S)), fear of movement (Tampa Scale for Kinesiophobia (TSK-SV)), empowerment (Making Decisions Scale), enablement (Patient Enablement Instrument (PEI)), and the number of visits to physiotherapists. Statistical analysis was done using IBM SPSS statistics version 28 with analysis of correlation using Spearman’s rank correlation coefficient.ResultsNineteen patients accepted to participate in the study and were included in the final analysis. Between 14 and 18 completed questionnaires were included.There was a statistically significant correlation between the number of visits to the physiotherapist and self-efficacy, rho=0.692 and p=0.006.ConclusionThe results of the study showed that the design is feasible in terms of recruitment of participants and use of questionnaires. New variables to collect in a large-scale study were identified. In a large-scale study, attention needs to be focused on the improvement of the number of completed questionnaires. The results of this study indicate that the present care of patients with a low level of self-efficacy is not optimal.

Physiotherapists\u2019 experiences of osteoarthritis guidelines in primary health care \u2013 an interview study

BackgroundOsteoarthritis is a common joint disease, globally. Guidelines recommend information, exercise and, if needed, weight reduction as core treatment. There is a gap between evidence-based recommended care for osteoarthritis and clinical practice. To increase compliance to guidelines, implementation was conducted. The aim of the study was to explore physiotherapists’ experiences of osteoarthritis guidelines and their experiences of implementation of the guidelines in primary health care in a region in southern Sweden.MethodsEighteen individual, semi-structured interviews with physiotherapists in primary health care were analysed with inductive qualitative content analysis.ResultsThe analysis resulted in two categories and four subcategories. The physiotherapists were confident in their role as primary assessors for patients with osteoarthritis and the guidelines were aligned with their professional beliefs. The Supported Osteoarthritis Self-Management Programme, that is part of the guidelines, was found to be efficient for the patients. Even though the physiotherapists followed the guidelines they saw room for improvement since all patients with hip and/or knee osteoarthritis did not receive treatment according to the guidelines. Furthermore, the physiotherapists emphasised the need for management’s support and that guidelines should be easy to follow.ConclusionThe physiotherapists believed in the guidelines and were confident in providing first line treatment to patients with osteoarthritis. However, information about the guidelines probably needs to be repeated to all health care providers and management. Data from a national quality register on osteoarthritis could be used to a greater extent in daily clinical work in primary health care to improve quality of care for patients with osteoarthritis.

Patients\u2019 health outcomes after an implementation intervention targeting the physiotherapists\u2019 clinical behaviour

BackgroundA behavioural medicine approach in physiotherapy has shown positive effects on increased and sustained activities and participation, including reduced sick leave for patients with persistent musculoskeletal pain. The aim of this study was to explore the health outcomes of patients with persistent musculoskeletal pain treated by physiotherapists who had received active compared with passive support when implementing a behavioural medicine approach.MethodsAn explorative and comparative pre−/post-test trial was conducted. A total of 155 patients with musculoskeletal pain ≥4 weeks were consecutively recruited by physiotherapists in primary healthcare who had received active or passive support when implementing a behavioural medicine approach. Data concerning health outcomes for patients were collected using questionnaires before and after the physiotherapy treatment and at half-, one- and two-year follow-ups. Descriptive, non-parametric and parametric bi- and multivariate statistics were used.ResultsThere were no differences over time between the patients treated by physiotherapists who had received active compared to passive implementation support regarding pain-related disability, pain intensity, self-rated health, self-efficacy in performing daily activities, catastrophic thinking related to pain, and fear of movement. Significant improvements over time were identified in both groups regarding all variables and the effect sizes were large. The percentage of patients on sick leave significantly decreased in the patient group treated by physiotherapists who had received active implementation support.ConclusionIt is very important to include patient outcomes when evaluating the implementation of multicomponent interventions. It seems that the implementation method did not play a major role for the patients’ outcomes in this study. Most of the patients’ health outcomes improved regardless of whether they were treated by physiotherapists who had received active or passive support when implementing a behavioural medicine approach. This was likely because the active implementation support was not extensive enough to enable the physiotherapists to sustain the behavioural medicine approach.Trial registrationThe study protocol was retrospectively registered in ClinicalTrials.gov. ID NCT03118453, March 20, 2017.

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

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

Profile of children referred to primary health care physiotherapy: a longitudinal observational study in Norway

BackgroundPhysiotherapy services are an important part of the primary health care services for children, serving a broad spectrum of children referred from different sources and for a variety of reasons. There is limited knowledge about their characteristics and outcome. The aim of this study was to describe the profile, i.e. referral patterns, baseline demographical and clinical characteristics, as well as treatment outcome at follow-up 6 months after baseline, of children receiving physiotherapy in primary health care.MethodsChildren referred to primary health care physiotherapy in a large municipality in Norway were invited to participate in this longitudinal observational study. The children’s demographics, referral sources, causes of referral, functional diagnoses, influence on their daily activities, main goals and planned treatments were registered at baseline. Goal attainment and treatment compliance were registered at follow-up maximum 6 months after baseline.ResultsThe physiotherapists registered baseline characteristics for 148 children. Parent-reported data at baseline were available for 101 (68.2%) of these children. Children were mainly referred from child health care centres (n = 74; 50.0%), hospital (n = 25; 16.9%) and kindergarten (n = 22; 14.9%). The most frequent causes of referral were concerns for motor development (n = 50; 33.8%), asymmetry (n = 40; 27.0%) and orthopaedic conditions (n = 25; 16.9%). Eighty-one (54.7%) children were below the age of 1 year. There was partly agreement between causes of referral and the physiotherapists’ functional diagnoses. Parents of 69 (71.1%) children reported that their child’s daily activities were little to not at all affected by the problem or complaint for which they were referred. Follow-up data were registered for 64 children. The main treatment goal was achieved in 37 (57.8%) and partly achieved in 26 (40.6%) children and the treatment was carried out as planned in 55 (87.3%) children.ConclusionsThe large variation in the profile of children receiving physiotherapy in a primary health care setting in Norway shows how primary health care physiotherapists can contribute to fulfil the broad purpose of the primary health care services.Trial registrationClinicalTrials.gov Identifier: NCT03626389. Registered on August 13th 2018 (retrospectively registered).

Physiotherapy practices in primary health care

Abstract Introduction: Physiotherapy was included in primary health care (PHC) in order to expand access and provide comprehensive care to the population. Objective: To understand the routine and tools used by physiotherapists in primary health care and analyze the determining factors in providing care in a municipality where every basic health unit (BHU) has a physiotherapist. Methods: This is a qualitative study of nineteen physiotherapists conducted in a city of Southern Brazil, using a semistructured interview and a methodological framework for discourse analysis. Results: The main tools routinely used in the physiotherapy service are individual appointments, home visits and group work. Physiotherapy practices are influenced by public health, municipal management and BHU policies, physiotherapy profile in addition to the characteristics of the coverage area and the population being treated. Introducing health promotion measures and implementing relational technologies are the main challenges for physiotherapists, and many of these professionals already recognize their importance in promoting comprehensive care. Conclusion: Physio-therapy practices and the tools used are in line with the Primary Care Family Health Support Center (NASF-AB) model of action recommended by public policies and have been effective for many health conditions. Knowing the routine of PHC physiotherapy services may help professional training and service management, with a view to producing physiotherapy care aimed at the principle of comprehensiveness and consolidating the role of physiotherapists at this level of care.

Kinesio Taping and Strength Recovery of Postnatal Abdominal Muscles after Cesarean Section

Background: Physiotherapists in primary healthcare often encounter Post-cesarean health problems as, it affects abdominal muscles strength. But there are few studies on the contribution of decrease of abdominal muscle strength after cesarean section and very little guidance in the literature for health professionals on the management of abdominal muscle strength recovery after cesarean section. Objective: To assess the effect of Kinesio Taping on the recovery of abdominal muscle strength in postnatal women after cesarean section. Methods: Forty cesarean section women participated in this study after two months of delivery. They were divided into two equal groups; Group(A) performed abdominal exercises and group(B) received Kinesio Taping (KT) in addition to performing abdominal exercises as group (A). The intervention sessions in both groups were twice per week for 8 weeks. The outcome measures were evaluating pre and post treatment via assessing the inter recti distance and abdominal muscle thickness for the right and left rectus abdominal muscles and external oblique muscles by using ultrasonography. Results: The inter recti distance showed highly significant decrease (p < 0.0001) and highly significant increase (p < 0.0001) in rectus abdominis as well as external oblique muscles in both groups (A&B) post treatment. Comparison between both groups post treatment showed a highly significant difference (p < 0.0001) in favor of group(B) in muscle thickness and inter recti distance. Conclusion: Kinesio Taping (KT) helps in recovery of abdominal muscle after cesarean delivery.

Effectiveness of Educational Interventions to Increase Knowledge of Evidence-Based Practice Among Nurses and Physiotherapists in Primary Health Care: Protocol for a Systematic Review.

BackgroundThe implementation of evidence-based practice (EBP) in daily health care practice is strongly encouraged; it is widely recognized as a means to improve the quality and safety of health care for patients and reduce avoidable costs. Primary care nurses and physiotherapists face numerous challenges in trying to ensure that they deliver effective daily care. Broadly promoted educational interventions aim to increase the integration and implementation of EBP in their daily practice.ObjectiveThis systematic review will retrieve and evaluate publications examining the effectiveness of educational interventions to increase the integration and implementation of EBP among nurses, nurse practitioners, and physiotherapists active in primary care.MethodsWe will conduct a systematic review of published articles in relevant professional, scientific journals (from their start dates) and in the following electronic databases, from inception until October 31, 2020: Medline Ovid SP (from 1946), PubMed (NOT Medline[sb]; from 1996), Embase.com (from 1947), CINAHL Ebesco (from 1937), the Cochrane Central Register of Controlled Trials Wiley (from 1992), PsycINFO Ovid SP (from 1806), Web of Science Core collection (from 1900), PEDro (from 1999), the JBI Database of Systematic Reviews and Implementation Reports (from 1998), and the Trip Database (from 1997). We will use the predefined search terms of “evidence-based practice,” “nurses,” or “physiotherapists” and combinations with other terms, such as “educational interventions.” We will also conduct a hand search of the bibliographies of all the relevant articles and a search for unpublished studies using Google Scholar, the ProQuest Dissertations and Theses dissemination, Mednar, WorldCat, OpenGrey, and Grey Literature Report. We will consider publications in English, French, German, and Portuguese.ResultsThe electronic database searches were completed in October 2020. Retrieved articles are currently being screened, and the entire study is expected to be completed by March 2021.ConclusionsThis systematic review will provide specific knowledge about the effectiveness of educational interventions to increase the implementation and integration of EBP in the daily practice of nurses and physiotherapists providing primary care services. Its findings will inform us about the types and frequencies of the most successful educational interventions.Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42017077309; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=77309International Registered Report Identifier (IRRID)DERR1-10.2196/17621

Short and long-term clinical effectiveness and cost-effectiveness of a late-phase community-based balance and gait exercise program following hip fracture. The EVA-Hip Randomised Controlled Trial.

The aim of this trial was to evaluate the clinical effectiveness and cost-effectiveness of a home-based exercise program delivered four months following hip-fracture surgery. In the two-armed randomized, single blinded clinical trial we included persons who lived in the catchment area, were 70 years or older, and community-dwelling at time of the fracture. We excluded persons who were unable to walk ten meters prior to the fracture, and those who were bedridden or had medical contraindications for exercise at baseline (ie. four months after the fracture). All participants underwent routine treatment and rehabilitation. The intervention group received additional 20 sessions (10 weeks) structured, home exercise targeting gait and balance, delivered by physiotherapists in primary health care. Gait speed was the primary outcome. Secondary outcomes included physical activity, gait characteristics, cognitive function, activities of daily living, health-related quality of life, and health care costs extracted from hospital and municipality records. In total, 223 participants were included. Four months post surgery 143 were randomized for the exercise trial (70% women, mean age 83.4 (SD 6.1) years, mean gait speed 0.6 (SD 0.2) m/sec). Estimated between group difference in gait speed was 0.09 m/sec (95% CI: 0.04 to 0.14, p<0.001) at posttest and 0.07 m/sec (95% CI: 0.02 to 0.12, p = 0.009) 12 months post surgery. The mean between-group QALY difference was -0.009 (95% CI: -0.061 to 0.038). The mean between-group total cost difference was +242.9 EUR (95% CI: -8397 to 8584). Our findings suggest that gait recovery after hip fracture can be improved by introducing a home-based balance and gait exercise program four months post surgery, without increasing total health care costs. Future research should focus on how to implement gait and balance exercise in comprehensive interventions that increase adherence among the most vulnerable persons and have an effect on daily life activities and patient-centred outcomes.Trial registration: ClinicalTrials.gov NCT01379456.

Practitioner experiences from the structured implementation of evidence-based practice in primary care physiotherapy: A qualitative study.

To provide best available care, the practitioners in primary health care (PHC) must have adequate knowledge about effective interventions. The implementation of such interventions is challenging. A structured implementation strategy developed by researchers at Linköping University, Sweden, was used for the implementation of an evidence-based assessment and treatment programme for patients with subacromial pain among physiotherapists in PHC. To further develop strategies for implementation of evidence-based practices, it was deemed important to study the implementation from the practitioners' perspective. The aim of this study was to explore the practitioners' experiences from the implementation. A qualitative design with focus group discussions was applied. The implementation in terms of perceptions of process and outcome was evaluated by focus group discussions with, in total, 16 physiotherapists in the target group. Data were analysed using the method qualitative content analysis. The components of the strategy were viewed positively, and the applicability and evidence base behind the programme were appreciated. The programme was perceived to be adopted, and the practitioners described a changed behaviour and increased confidence in handling patients with subacromial pain. Both patient- and provider-related challenges to the implementation were mentioned. The practitioners' experiences from the implementation were mainly positive. A strategy with collaboration between academy and practice, and with education and implementation teams as facilitators, resulted in changes in practice. Critical voices concerned interprofessional collaboration and that the programme was focused explicitly on the shoulder, not including other components of physical function.

Clinical assessment and patient-reported outcome measures in low-back pain – a survey among primary health care physiotherapists

Purpose: We aimed to map the physiotherapy practice in Sweden of clinical tests and patient-reported outcome measures in low-back pain (LBP), and to study advantages and barriers in using patient-reported outcome measures.Methods: An online survey was mailed to 4934 physiotherapists in primary health care in Sweden. Multiple choice questions investigated the use of clinical tests and patient-reported outcome measures in assessing patients with LBP. Open questions investigating the advantages and barriers to the use of patient-reported outcome measures were analyzed with content analysis.Results: The response rate was 25% (n = 1217). Clinical tests were used “always/often” by >60% of the participants, while most patient-reported outcome measures were used by <15%. Advantages in using patient-reported outcome measures were: the clinical reasoning process, to increase the quality of assessment, to get the patient’s voice, education and motivation of patients, and communication with health professionals. Barriers were lack of time and knowledge, administrative aspects, the interaction between physiotherapist and patient and, the applicability and validity of the patient-reported outcome measures.Conclusion: Our findings show that physiotherapists working in primary health care use clinical testing in LBP to a great extent, while various patient-reported outcome measures are used to a low-to-very-low extent. Several barriers to the use of patient-reported outcome measures were reported such as time, knowledge, and administrative issues, while important findings on advantages were to enhance the clinical reasoning process and to educate and motivate the patient. Barriers might be changed through education or organizational change-work. To enhance the use of patient-reported outcome measures and thus person-centered care in low-back pain, recommendation, and education on various patient-reported outcome measures need to be advocated.Implications for rehabilitationTo increase the effects of rehabilitation in low-back pain, yellow flags, and other factors need to be taken into the consideration in the assessment which means the use of patient-reported outcome measures in addition to clinical testing.The use of patient-reported outcome measures is an advantage in the clinical reasoning process to enhance the quality of assessment and to educate and motivate the patient.Barriers to use patient-reported outcome measures are mainly lack of time and knowledge, and administrative aspects.Through education or organizational change-work, barriers to the use of patient-reported outcome measures might be changed.

Opportunities for Physiotherapists in Primary Health Care in Nigeria

Summary: This paper examines the concept, strength and weakness of Primary health care system (PHC) program in Nigeria, the opportunity and potential roles for physiotherapists in PHC delivery system as well as the perceived benefits of integrating physiotherapy profession into PHC delivery system in Nigeria.Currently, physiotherapy services are available at the big cities in the urban areas of the country, thus denying the myriads of people that might need the service that could not get to the big cities either due to their health conditions or due to financial incapacitation. Emphasis for the greater involvement of physiotherapists in PHC further arose from the fact PHC system in Nigeria is not yet adequately sensitized to promoting preventative measures needed to combats chronic non communicable diseases, the health care needs of the elderly and those of the people living with disability (PLWD).In conclusion, the paper recommendsa need for an urgent reform of the mode and delivery of PHC in Nigeria with emphasis on integrating physiotherapists and other relevant health care professionals and with enhancement of intersectoral/ interdisciplinary collaborations. This integration will undoubtedly increase health care providers’satisfaction and improve patients’ outcome in both acute and chronic care settingsKeywords: Primary Heath Care, Physiotherapy

Effectiveness of task specific gait and balance exercise 4 months after hip fracture: protocol of a randomized controlled trial--the Eva-hip study.

Regular rehabilitation is not sufficient for regaining function after a hip fracture, and more targeted interventions for home-dwelling elderly hip-fracture patients are needed. This paper describes the protocol of a study assessing the effectiveness and cost effectiveness of a task specific progressive gait and balance exercise programme for hip-fracture patients, performed 4 months after the fracture. A single blind two-arm pragmatic randomised controlled trial was conducted with 142 hip-fracture patients randomized to a 10-week home-based exercise programme or to practice as usual 4 months following the surgery. Inclusion criteria were age >70 years and being home dwelling prior to the fracture. Exclusion criteria are life expectancy <3 months and inability to walk 10 m prior to the fracture. The content and organization of the programme was developed in collaboration between physiotherapy researchers and primary health-care physiotherapists. Participants were followed for 1 year post-surgery, evaluating short-term and long-term effects of the programme. The primary outcome is gait speed, and the secondary outcomes are spatial and temporal gait parameters, free living physical behaviour by activity monitoring, mobility performance, activities of daily living, fear of falling, cognitive function, depression and health-related quality of life. Cost-effectiveness analysis is planned. This paper describes a task specific exercise programme aimed to improve gait and balance after a hip fracture. Inclusion started in February 2011, and the last 1-year follow-up is performed in March 2014. Broad inclusion criteria and physiotherapy-guided home-based exercises may facilitate the participation from frail patients and thereby increase the generalizability of the findings. Development and completion of the intervention within routine clinical practice will enlighten the implementation of results into clinical practice. Results may add new insight into how physiotherapy can improve gait and thereby activity and functioning in everyday life and have implications on future content and organization of physiotherapy after a hip fracture.

General practitioners' perspectives of education and collaboration with physiotherapists in Primary Health Care: A discourse analysis

This paper explores the educational factors that underlie the poor collaboration between general practitioners (GPs) and physiotherapists (PTs) in Primary Health Care (PHC), from the GP's perspective. This study was conducted in Majorca, the Balearic Islands (Spain). Participants were nine GPs who graduated from different universities in mainland Spain. A discourse analysis study was developed employing the social–critical paradigm as theoretical framework and in-depth interviews for data collection. The perceived lack of knowledge about physiotherapy was considered by the interviewees as a major factor in the current poor communication between GPs and PTs. The individual learning during medical studies and poor interprofessional learning during clinical residency influenced their gatekeeper role, putting at risk the equity of the health system. Collaboration was considered beneficial for patients but challenging to improve in context due to multiple factors ranging from individual to systemic. The latter encompasses inadequate resources and organization for interprofessional learning. There is a need to further explore other factors influencing the poor collaboration, including PTs' views on this process.

Tailored skills training for practitioners to enhance assessment of prognostic factors for persistent and disabling back pain: Four quasi-experimental single-subject studies

The well-known gap between guidelines and behaviour in clinical practice calls for effective behaviour change interventions. One example showing this gap is physiotherapists' insufficient assessment of psychosocial prognostic factors in back pain (i.e., yellow flags). The present study aimed to evaluate an educational model by performing a tailored skills training intervention for caregivers and studying changes over time in physiotherapists' assessment of prognostic factors in telephone consultations. A quasi-experimental single-subject design over 36 weeks was used, with repeated measurements during baseline, intervention, and postintervention phases. Four physiotherapists in primary health care audiorecorded a total of 63 consultations with patients. The tailored intervention included individual goal setting, skills training, and feedback on performance. The primary outcome was the number of assessed prognostic factors (0–10). Changes were seen in all four participants. The amount of assessed prognostic factors increased from between 0 and 2 at baseline to between 6 and 10 at postintervention. Time spent on assessment of psychosocial factors increased, and time spent on discussions about biomedical pain symptoms decreased. Knowledge and biopsychosocial attitudes toward back pain were congruent with guidelines at inclusion and did not change markedly during the intervention. Self-efficacy for assessment of cognitive and emotional prognostic factors increased during the study phases. The results suggest that a tailored skills training intervention using behaviour change techniques, such as individual goal setting, skills training, and feedback on performance, is effective in producing change in specific clinical behaviours in physiotherapists.

Physiotherapy and management in early whiplash-associated disorders (WAD) – A review

The aim of the current review was to examine which management physiotherapists in primary healthcare should provide patients with early whiplash-associated disorders (WAD) grades I–III, to minimize chronic pain and disability. Pub Med, Medline, PEDro, CINAHL and EIRA, were searched from 1980 and forward, using combinations of keywords. In all, eight randomized controlled trials (RCTs) and clinical trials (CTs) were accepted. The results in the majority of the accepted studies showed that instruction and advice to act as usual and active treatment are preferred in the early WAD grades I–III. The pain decreased and the cervical range of movement increased. A deficiency in the studies is that there are no measurements used for disability due to neck pain. The studies suggest that active intervention, and advice to “act as usual” is preferred and the use of a soft collar should be avoided in WAD grades I–III. An appropriate and effective physiotherapy in the early WAD management should comprise pain relief, h...