Physiotherapy Clinicians Research Articles

Attitudes of Japanese Physiotherapists towards Death and Terminal Illness

A preliminary study was carried out by means of a three-part questionnaire to determine attitudes of 146 physiotherapy clinicians in Yamaguchi Prefecture, Japan, towards death and terminal illness. This self-administered postal survey was cross-sectional. Results indicated that there was little discernible difference in the response to the questions among the subgroups vis-á-vis gender and years of professional practice. Topics of death and terminal illness were found to have been subjects that were relatively openly discussed in the respondents' families. The majority of the respondents desired "dignified death" for themselves and to be informed of their condition if they became terminally ill. Although they were willing to treat persons with terminal illness, the respondents were psychologically uncomfortable in the situation, and the majority of them seemed to lack sufficient knowledge and, therefore, necessary execution skills to provide the necessary psychological support when subjected to such a situation. Therefore, education and training of physiotherapists enabling them to professionally confront persons with terminal illness would be of significant value if introduced into the physiotherapy curricula.

Physiotherapy assessment of unilateral neglect: insight into procedures and clinical reasoning

Abstract Objectives Although unilateral neglect (ULN) can affect a person's ability to engage in and benefit from rehabilitation, little attention has been given to the assessment and diagnosis of this disorder by physiotherapy clinicians. The purpose of this study was to identify the procedures used by physiotherapists to assess and diagnose ULN after stroke. Design Qualitative research design employing focus groups and one-to-one interviews. Setting Healthcare and university departments, Melbourne, Australia. Participants Thirty-three physiotherapists, comprising both experienced neurological physiotherapists and novice clinicians. Methods Participants were asked to describe in detail how they determine whether a person has ULN, and how they differentially diagnose the different types of neglect as well as differentiating neglect from other impairments. Measurement and documentation were also discussed. Results The findings revealed that observation is a key component of the assessment and that physiotherapists rely heavily on real task performance to evaluate the patient. Although physiotherapists are primarily concerned with the functional implications of ULN, the functional impact of the disorder is rarely measured. Physiotherapists appear to use both hypothesis testing and pattern recognition approaches to clinical reasoning in the assessment of ULN. Conclusions The physiotherapy clinicians in this sample do not routinely differentiate the different types of neglect during patient assessment. Education on the different types of neglect and the range of valid tools available to measure functional implications may be warranted.

An investigation of occupational therapy and physiotherapy roles in a community setting

This qualitative study investigated current occupational therapy and physiotherapy practice in a community rehabilitation setting to elicit areas of role difference, skill sharing and commonality within the two professions. The study was carried out with service users (n=4), occupational therapy and physiotherapy clinicians (n=11) and therapy service managers (n=9) to try and explore as many different opinions and experiences as possible. Focus groups were used to gather the data. The findings from this study were broad ranging. Service users were frequently unable to identify the difference between occupational therapists and physiotherapists. Skill sharing and the blurring of professional boundaries between occupational therapists and physiotherapists occured on a daily basis. Interdisciplinary team working was regarded as essential for an effective needs-led service by all the participants of the study. However, despite this, it appeared that professional tribalism existed between the two professional groups, which hampered effective team working at times. There was a general feeling that increasing interprofessional education at as early a stage in undergraduate training as possible was vital and would help increase awareness of other professional roles and prepare therapists for the reality of working life.

Placebo Analgesia: Clinical considerations

Summary Pain is the predominant symptom that prompts patients to seek medical advice and treatment from physiotherapists. Various treatment modalities such as heat and cold, electrical stimulation ( Cheing and Hui-Chan, 1999) , ultrasound, manipulative techniques, massage and laser treatment have been demonstrated in varying degrees to be clinically effective for managing pain of different pathologies. However, all these treatments could be assumed to have some placebo elements ( French, 1994) . From a research design perspective, the presence of placebo response is undesirable and must be controlled as it complicates the demonstration of ‘real' treatment effect. From a clinical perspective, it is intriguing to note that the condition of patients in the placebo control groups did improve considerably in many of these validation studies, although in the majority the improvement was not so marked as in the treatment groups. Conspicuously, some neuro-physiological and psychological aspects of the placebo effects may have clinical use in enhancing the effect of pain treatments and their outcomes. Unfortunately, although placebo response has been a subject of continuing interest among some physiotherapy researchers and clinicians, information about placebo analgesia and its clinical utility is seldom discussed. The purpose of this paper is to provide clinicians with an overview of the construct and research related to placebo analgesia as well as a discussion of the potential clinical use of certain components of placebo analgesia to enhance pain rehabilitation outcomes in physiotherapy practice.

Evidence-based practice and physiotherapy in the 1990s

Physiotherapy emerged as a profession only a century ago and has a fragile, but evolving research evidence base. Physiotherapy has been subject to decades of criticism for its lack of research utilisation, and is often perceived as a profession whose treatment techniques lack scientific support. Numerous editorials and scholarly addresses have urged physiotherapists to become research consumers. The 1990s saw evidence-based practice emerge as a new paradigm within health care and health education, and also the emergence of initiatives like the Cochrane Collaboration, and the UK Department of Health Research and Development initiative, which aim to promote evidence use within the health professions. To determine the extent to which physiotherapy has responded to these criticisms and initiatives this paper presents studies that have explored the fundamental questions of whether physiotherapists read journal literature, implement research findings into practice, and employ scientific documentation and measures. The results of the various studies consistently indicate that despite the numerous initiatives to promote evidence use, many physiotherapy clinicians remain unaware of the extent and nature of published research evidence. The assimilation and utilisation of research literature among physiotherapy clinicians is limited, with the exception of those with higher-degree experience. Journal provision and access to journal clubs within physiotherapy hospital departments is poor. The major factors infl uencing practice were education, prior experience, and peer opinion, rather than research and evidence. Deficiencies in quality and type of documentation also emerged in addition to an apparent unwillingness to employ evidence-based outcome measures. Methods for maximising the positive findings and addressing the deficiencies that emerged are proposed.

Physiotherapy clinical educator’s needs

Physiotherapy clinicians have been involved in student clinical education since the early days of physiotherapy training. As the physiotherapy practice and student learning has changed over the last three decades, so have the role of the clinical educators. Little has been done though, to prepare or support the clinical educators in this new role which is more complex. The needs of the clinical educators in terms of their involvement in clinical education and their training for this role are established and recommendations are made to meet these needs.

A multivariate analysis of physiotherapy clinicians’ journal readership

This paper describes a survey of journal readership by physiotherapists in hospital practice in England. With few exceptions, the results reveal extremely limited journal readership, though those who either had or were registered for a degree read more extensively. Using smallest space analysis, clear readership structures emerged that enabled differentiation between degree and non-degree respondents, and between what have been termed primary and secondary journal sources.