Physiotherapy Profession Research Articles

Understanding underperformance in a high-stakes clinical-based simulation assessment in physiotherapy: a descriptive analysis

BackgroundHigh-stakes assessments are often used as a ‘gate-keeper’ activity for entry into the health professions by ensuring that the minimum core competency thresholds of the profession are met. The aim of the study was to explore if common areas of underperformance existed in international candidates assessed with a high-stakes clinical-based simulation assessment for entry into the physiotherapy profession in Australia.MethodsA retrospective mixed methods analysis of the clinical assessments completed by international candidates over a one-month period in 2021 that were deemed as not meeting competency. The clinical assessments were completed in one of the three practice areas: cardiorespiratory, musculoskeletal, or neurological rehabilitation. Each assessment was scored by two independent assessors, who discussed the performance and then completed a moderated assessment form. The assessment form used to score competency included seven domains such as initial assessment, effective treatment, communication skills, and risk management.ResultsFifty-one clinical assessments graded as not competent were analysed. Across the practice areas, a high failure rate was found in domains related to interpreting assessment findings and developing a treatment plan. This trend was also observed in the qualitative data, suggesting candidates struggled to meet competency in areas of planning and prioritisation, interpretation and implementation of the information gathered, and selection and evaluation of effective treatment.ConclusionThese findings align with published data on the underperformance of Australian physiotherapy students in clinical placement settings, suggesting these issues are not specific to high stakes assessment of overseas physiotherapists, and that education needs to focus on improving these skills within the profession at all levels. With the identified areas of underperformance aligning with the ability to use higher order thinking and skills integral to clinical reasoning, improvements in the education and implementation of clinical reasoning may be a place to start.

Exploring Injury Profiles in Non-elite Cricketers: Harnessing Online Surveys for Effective Assessment.

An increase in the on-field intensity in modern cricket, results in an increased number of player injuries. Integration and easy access to professional physiotherapy, technology, rehab protocols, and mental/physical conditioning aid in early return to sports in the injured; however, at the grassroots, these facilities may not be available with untrained support staff and limited funds. Injuries can go unnoticed and, therefore, there is a need for an easy process of identification and documentation of such injuries. We devised a questionnaire-based survey to evaluate its effectiveness at the junior level of professional cricket. An Online self-administered questionnaire was prepared and the link was given to active Union Territory Cricket Academy (UTCA), Chandigarh, cricketers of any gender between 15 and 35years of age, through different online platforms like WhatsApp, Telegram and emails, for the submission of their responses. The questionnaire was administered to 98 participants out of which 77 participants' responses were evaluated (41 males and 36 females). 74/77 participants were below 30years of age. There were 18 wicketkeepers, 33 bowlers and 26 batsmen as per their major role in the team. 37/77 cricketers (20 males, 17 females) had injuries during the previous 2years; this included 17 bowlers, 11 batsmen and 9 wicketkeepers. The most common body part injured in the survey were fingers (12) followed by the back (7). The amount of training time lost, reported in the survey ranged from a week up to 1year. Online surveys could be the first step to accumulating data and making initial player profiles, starting even at junior levels of cricket. Further detailed evaluations may be performed after this, and coaches and administrators could potentially profile cricket injuries and identify chronic issues. The online version contains supplementary material available at 10.1007/s43465-023-00995-3.

Research Agenda for Physical Therapy From the American Physical Therapy Association.

The Research Agenda for Physical Therapy From APTA identifies research priorities within the profession vital to advancing the practice and profession of physical therapy. The research agenda has 6 key areas of focus: population health research, mechanistic research, clinical research, education and professional development research, health services research, and workforce research. Researchers, funding agencies, and public policy makers can use the research agenda to concentrate research efforts around these areas.

Inclusion of Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Other Related Identities Content in Australian Physical Therapy Curricula: Perceived Barriers and Priorities for Inclusive Education.

Providing culturally responsive, patient-centered care is crucial for ensuring safe and positive health care experiences for individuals with diverse gender identities and sexual orientations. Doing so requires adequate training and knowledge of the health professionals involved in those health care experiences. Individuals identifying as lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other related identities (LGBTQIA+) experience significant barriers to health and positive health care experiences. In physical therapy, research has identified that individuals who identify as LGBTQIA+ experience discrimination, discomfort, and lack of practitioner knowledge about health needs. The aim of this study was to determine how, and to what extent, content related to LGBTQIA+ individuals is included in Australian physical therapy curricula as well as perceived barriers to inclusion. Physical therapy program directors (PDs) as of January 2022 for all Australian universities that deliver physical therapy programs (n = 24). A Qualtrics survey was emailed to PDs to collect quantitative and qualitative data regarding the inclusion and mode of delivery of LGBTQIA+ content, as well as the perceived importance, and barriers to inclusion, of LGBTQIA+ curricula. Twenty-four (100%) universities (PD or proxy) responded to the survey. More than 62% (15/24) of PDs reported that their programs included LGBTQIA+ content with 88% (21/24), indicating that LGBTQIA+ content is relevant to the physical therapy curriculum. Time devoted to LGBTQIA+ content ranged from 0 to 6 (median 2-4) hours across any year, delivered primarily in general or foundational courses (37%). Perceived lack of trained faculty (14/22; 64%) and time (13/22; 59%) were barriers to the integration of LGBTQIA+ specific content into the curriculum. Our results indicate that the physical therapy curriculum may be contributing to ongoing negative experiences of individuals identifying as LGBTQIA+ with physical therapy encounters. Although most (87%) physical therapy program leaders in Australia believe that LGBTQIA+ specific content is relevant to the training of new graduates, content is included in only 62% of curricula. Perceived barriers to inclusion of LGBTQIA+ specific curriculum were a lack of time and appropriately trained faculty. Externally developed content is available to address limited expertise within programs, but faculty may require guidance on how to overcome perceived lack of time (ie, space in the curriculum). Most Australian physical therapy programs include LGBTQIA+ content to a limited extent in their curricula, indicating a lack of perceived importance relative to other topics. In this way, Australian universities are maintaining the pervasive heteronormativity of the physical therapy profession and are complicit in the ongoing health disparities between the LGBTQIA+ and heteronormative communities.

Ten Steps for NPH Management: Advancements in Diagnosis and Treatment of Adult Hydrocephalus

Abstract Objectives The authors of the present study intend to describe a straightforward protocol for normal pressure hydrocephalus diagnosis and management, with the employment of a multidisciplinary team approach effort. Methods Using a strict methodological approach for initial diagnosis, taking into consideration occupational therapy and physical therapy assessment, the authors have set out to elaborate a simple protocol for suspicion and, once diagnosed, treatment of normal pressure hydrocephalus. We have used the MoCA (Montreal Cognitive Assessment) and walking assessment that included speed, independence, and distance (SID), 10 m walk test, TUG (timed up and go) evaluation, 6-minute Walk Test, MiniBESTest, as the main factors for pre and post lumbar drainage assessment, after which, the alternatives were deliberated and followed, or not, by ventriculoperitoneal shunt insertion. Results The authors have described a protocol, consisting of ten easy steps, which involves a multidisciplinary team, including occupational therapy and physical therapy professionals, as well as neurologists and neurosurgeons for improved and objective assessment prior to insertion of lumbar drain and, thereafter, detecting the population at most benefit for ventriculoperitoneal shunt insertion. We have described the Ten Step Approach for Normal Pressure Hydrocephalus management, including from initial clinical presentation and imaging, to pre and post lumbar drainage, for lastly deciding upon necessity for ventriculoperitoneal shunt insertion. Conclusions A straightforward protocol for normal pressure hydrocephalus seems not only feasible, but simple to implement in most neurosurgical departments, with good accuracy of prediction of lumbar drainage assessment to shunting outcomes.

Research From Low-Income and Middle-Income Countries Will Benefit Global Health and the Physiotherapy Profession, but It Requires Support.

Research From Low-Income and Middle-Income Countries Will Benefit Global Health and the Physiotherapy Profession, but It Requires Support.

KNOWLEDGE AND PERCEPTIONS OF GREEK PHYSIOTHERAPISTS REGARDING THE FUNCTIONAL TESTS USED IN PATIENTS WITH POST-COVID-19 SYMPTOMATOLOGY

Aim: To investigate the knowledge and attitudes of Greek physiotherapists regarding functional assessment tests used in the rehabilitation of post-COVID-19 patients. Methods: Based on the literature, a specific 27-question questionnaire was designed and divided into 3 sections: a) sources of information about the management of patients with post-COVID-19 symptomatology, b) functional assessment tests most commonly used in clinical practice, c) willingness for further knowledge on performing functional tests. Inclusion criteria for completing the questionnaire were: a) physiotherapy profession, b) involvement with post-COVID-19 patients’ treatment in the last year. The completion of the questionnaire was anonymous. It was shared in Google Forms format, via personal email invitations and public sharing on social media by all researchers, with republishing ability by each user. Sharing was conducted over two periods, lasting 16 and 13 days, respectively. Results: The study included 82 physiotherapists (28 men and 54 women), 56.1% of whom were less than 39 years old and 50% had more than 10 years of professional experience. The main sources of information on rehabilitation in post-COVID-19 patients were journal publications (69.6%). Among the most well-known and frequently used tests were the six-minute walk test (85.4%), the one-minute sit-to-stand test (86.6%), and the timed up-and-go test (76.9%). A large percentage of physiotherapists used functional assessment tests before initiation (80.5%) and at the end (70.8%) of the treatment program. The 91.5% expressed the willingness for further education on practicing functional tests. Conclusions: Greek physiotherapists get information from the recent literature and use well-known functional tests for assessing functional capacity in post-COVID-19 patients.

Critical physiotherapy: a ten-year retrospective

ABSTRACT Critical physiotherapy has been a rapidly expanding field over the last decade and could now justifiably be called a professional sub-discipline. In this paper we define three different but somewhat interconnected critical positions that have emerged over the last decade that share a critique of physiotherapy’s historical approach to health and illness, while also diverging in the possibilities for new forms of practice and thinking. These three positions broadly align with three distinctive philosophies: approaches that emphasize lived experience, social theory, and a range of philosophies increasingly referred to as the “posts”. In this paper we discuss the origins of these approaches, exploring the ways they critique contemporary physiotherapy thinking and practice. We offer an overview of the key principles of each approach and, for each in turn, suggest readings from key authors. We conclude each section by discussing the limits of these various approaches, but also indicate ways in which they might inform future thinking and practice. We end the paper by arguing that the various approaches that now fall under the rubric of critical physiotherapy represent some of the most exciting and opportune ways we might (re)think the future for the physiotherapy profession and the physical therapies more generally.

A Continuous Quality Improvement Framework for Sustainable Action and Advancement of Diversity, Equity, Inclusion, and Belonging in Physical Therapy.

To address racial and ethnic disparities, physical therapy organizations, educational institutions, and clinical practices seek to advance diversity, equity, inclusion (DEI), and social justice in health care. Although our professional organizations have crafted proclamations, resource lists, developed new accreditation standards, and strategic plans, we lack a unifying framework and action tools for substantial and sustained progress. In addition, the DEI acronym is missing the essential element of belonging (B), that is, sharing a sense of purpose and feeling safe to contribute opinions as a valued member of an organization. Therefore, the purpose of this position paper is to propose the utilization of a continuous quality-improvement (CQI) framework using Plan-Do-Study-Act (PDSA) cycles to advance DEI-B in physical therapy education and practice. The CQI framework and PDSA cycles are data-driven, iterative approaches for identifying areas for improvement, implementing interventions, collecting data, analyzing outcomes, and taking evidence-based next action steps. Application of this framework can enhance sustainability of DEI-B goals and foster progress toward the proposed accreditation criteria of the Commission on Accreditation in Physical Therapy Education in this critical area. Tenants for PDSA team success are presented, and PDSA cycles are described. Addressing racism and advancing DEI-B efforts in the physical therapy profession requires bold, sustained, and intentional action that incorporates standards, strategies, and methods for measuring change. Examples of PDSA DEI-B initiatives, interventions, and outcomes are provided to illustrate how this approach can be implemented within a physical therapy education program. Using this CQI framework provides our profession with a DEI-B roadmap for advancing incremental and sustained progress.

Cardiovascular and Pulmonary Entry-Level Physical Therapist Competencies: Update by Academy of Cardiovascular & Pulmonary Physical Therapy Task Force

Purpose: Competency-based education and creation of profession-based entrustable professional activities are current trends in physical therapist (PT) education. The purpose of this project is to determine the current entry-level PT competencies for cardiovascular & pulmonary (CVP) physical therapy. Methods: The Academy of Cardiovascular & Pulmonary Physical Therapy Competency Task Force was established to update and expand previous competencies. A mixed method approach of Subject Matter Expert (SME) consensus (modified Delphi process) and a broader survey process was used to develop these entry-level competencies. With SME guidance, a modified version of the levels of competence, None-to-Proficient, was adopted based on previous competency work by the American Council of Academic Physical Therapy. Results: Twenty-nine SME members engaged in the consensus process, and 268, 194, 305, and 222 respondents completed the 4 surveys, respectively. Six hundred fifty-one competency items were rated across most Commission on the Accreditation of Physical Therapy Education Standard 7 Curriculum areas, following the patient–client management model. Conclusions: These competencies establish specific expected levels of knowledge, skills, and behaviors essential for entry-level CVP PT practice. Adopting these competencies will help lay the groundwork for future competency-based PT education and aid in the development of the physical therapy profession's core entrustable professional activities.

Cultural And Social Barrier in Community Physiotherapy Practice: Ethics in the Indian context

Background: Ethics becomes inevitable in the physiotherapy profession as it is concerned with professionalism and patient outcomes by avoiding patient-therapist conflicts and helps avoiding medical negligence. Objctive: This study aims to explore the impedance faced by the community physiotherapist in implementing the code of ethics. Methodology: A structured interview-based questionnaire was framed to assess the perception of ethics, role of ethics and the barriers faced in implementing ethical guidelines by community physiotherapist during their practice. Results: Ethics is important as it dignifies the profession and gains the confidences of the patient and helps in developing a good rapport with the patient. The most important barriers faced by the physiotherapist in abiding by the code of ethics were the unawareness among the patient and their cultural belief alongside with lack of inter-sectorial harmony. Conclusion: This study concludes that educating the patients and creating an inter-sectoral harmony will be most effective in breaking the barriers in ethical implementation in practice.

Gender disadvantage in physiotherapy

Gender inequality exists in healthcare, resulting in a gendered division of labour where women generally receive lower pay and status in the industry than male health professionals. This critical review will examine the state of gender disadvantage in health work and physiotherapy using feminist theories and exposing social norms and beliefs that allow these practices to be perpetuated. Gender disadvantage within the physiotherapy profession is explored, demonstrating gender disparity permeating through career lifespans from training to retirement, including, among others, differences in career specialisation, workplace violence, and unequal treatment of patients. Using historical references, the evolution of gender discrimination and disruption is reviewed. In understanding these factors, a pathway can be exposed to move towards gender equality within our profession.

Transforming Society Through Critical Service-Learning: A Position for a Justice-Based Approach to Experiential Learning in Physical Therapy Education.

In response to the numerous calls for the physical therapy profession to position itself as an equity and social justice-centered profession, we are called to provide aspiring physical therapists with the skills to dismantle inequities and injustice in their communities. Exposure to health inequity and injustice through conceptual and experiential learning alone does not prepare students to create positive change and may serve to perpetuate stereotypes and offer simplistic solutions to complex problems. We argue that a traditional service-learning model lacks transformative potential for bringing about social change. Therefore, we introduce critical service-learning, compare it with the traditional model in the context of physical therapy experiential learning, and provide rationale and guidance on transitioning to this educational approach. We believe critical service-learning is an action-oriented approach that works to identify the root causes of social and structural determinants and accept personal and shared responsibility for acting to ameliorate their effects. Critical service-learning experiences require critical reflection and call for intentional design including teacher training, rich community engagement, student assignments that challenge current paradigms, and use of evaluative measures that assess community goals. These aspects add to the historically practiced traditional model. We invite educators to shift to critical service-learning, an approach that has great potential for benefiting all interested parties in meaningful and long-lasting ways. Critical service-learning holds the opportunity for our profession to be better positioned to transform society.

The Profession of Physiotherapy on the Internal Market of the European Union

The basic legal act governing professional qualification in the European Union (and the countries of the European Economic Area and Belgium) is Directive 2005/36/ EC of the European Parliament and of Council of 7 September 2005 on the recognition of professional qualifications. To practise a profession outside the country in which it was earned, a citizen must comply with certain legal requirements. The author discusses the Polish Act on the Profession of Physiotherapist. The EU has established a European Professional Card. Its holder is entitled to the same rights and privileges, as well as assuming obligations, across the EU as in the state in which the profession was learned. In Poland, pursuant to Article 5 of the Act on the Profession of Physiotherapist, the term “physiotherapist” may only be used by a person who has the right to practice the profession, and the professional title itself is protected by law.

Challenges and Opportunities for Physical Therapist Education Research: Results From an American Council of Academic Physical Therapy Needs Assessment Survey

Introduction. The physical therapy (PT) profession has cited a need for education research, yet the needs of researchers are not fully understood. Furthermore, there continues to be a limited understanding of where resources are most needed to support and advance education research. The purpose of this study was to identify barriers and opportunities for education research to support PT faculty. Review of Literature. Scholarly productivity may be related to the attainment of an academic doctoral degree, research culture within an institution, and faculty time devoted to research. There is a lack of knowledge about what factors relate to the production of education research and the types of support needed for education researchers. Subjects. Two hundred sixteen PT education researchers. Methods. An open survey invitation was sent through email through the American Council of Academic Physical Therapy newsletter. A multiple regression analysis was used to determine factors that were associated with scholarly productivity of education researchers in PT. Open responses to a question regarding needed resources for engagement in education research were qualitatively analyzed. Results. The multiple regression analysis yielded a large effect (R2 = 0.31), demonstrating that faculty years of experience, faculty rank, and having an academic doctoral degree were correlated with scholarly productivity. “Faculty time/workload” was considered “very important” or higher to the production of education research by 87% of respondents. This item was rated of highest importance on the survey. Mentorship was considered the most important external resource, with 69% of respondents rating it as “very important” or higher, whereas “other personal commitments (ie, family care, household management, other community-related volunteer commitments)” was the most important personal factor (rated by 70% of the respondents as “very important” or higher). Open-ended responses further suggest that institution logistics, appropriate dissemination venues, and funding are areas of need to foster success in engaging in education research. Discussion and Conclusion. Results highlight challenges and opportunities for resource investment in education research. Among these are time and funding. Existing professional networking and educational opportunities need to be continually evaluated for their effectiveness. Further development should focus on mitigating these barriers while considering the logistics of the researcher's institution.

Building the Science of Physical Therapy: Conundrums and a Wicked Problem.

Producing science that supports the physical therapist profession in all its endeavors is critical to ensure that the best evidence is used in practice and education. In this Perspective, numerous conundrums are discussed that can constrain efforts to be productive in research in the academic institutions that serve as the intellectual centers of the discipline. Taken together, these conundrums and the conditions that create them collectively contribute to the wicked problem of how to generate sufficient evidence to support the practice of physical therapy. In response, this Perspective recommends changes in the Standards and Elements of the Commission on Accreditation in Physical Therapy Education to support the importance of faculty research, reconfigure the rules for faculty composition, and introduce a new metric of productivity that reinforces the need of all programs to produce evidence for the profession, while still allowing flexibility and institutional prerogative to govern how this need is expressed.

Challenging power and unearned privilege in physiotherapy: lessons from Africa.

Power and unearned privilege in the profession of physiotherapy (PT) reside in the white, Western, English-speaking world. Globally, rehabilitation curricula and practices are derived primarily from European epistemologies. African philosophies, thinkers, writers and ways of healing are not practiced widely in healthcare throughout the globe. In this invited perspectives paper, we discuss the philosophies of Ubuntu and Seriti, and describe how these ways of thinking, knowing, and being challenge Western biomedical approaches to healthcare. We believe implementing these philosophies in the West will assist patients in attaining the health outcomes they seek. Further we call for Western professionals and researchers to stand in solidarity with their African counterparts in order to move towards a diversity of practitioners and practices that help to ensure better outcomes for all.

Intellectual Humility: How Recognizing the Fallibility of our Beliefs and Owning our Limits May Create a Better Relationship between the Physical Therapy Profession and Disability.

The development of enhanced intellectual humility in physical therapy may help to challenge long-held beliefs among physical therapists about disability-many of which are unnoticed, unquestioned, and difficult to counter.

A Study on Role of Health Care Management Streams

Health care is the maintenance or improvement of health care via the prevention, diagnosis, treatment, amelioration, or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health care professionals and allied health care fields. Medicine, dentistry, pharmacy, midwifery, nursing, optometry, audiology, psychology, occupational therapy, physical therapy, athletic training, and other health professions are all part of health care. It includes work done in providing primary care, secondary care, and tertiary care, as well as in public healthcare. Access to health care may vary across countries, communities, and individuals, influenced by social and economic conditions as well as health care policies. Providing health care services means “the timely use of personal health care services to achieve the best possible health care outcomes. A limitation to health care services affects negatively the use of medical services, the efficacy of treatments, and overall outcome (well-being, mortality rates). An efficient health care system can contribute to a significant part of a country’s economy, development, and industrialization. Health care is conventionally regarded as an important determinant in promoting the general physical and mental health care and well-being of people around the world, An example of this was the worldwide eradication of smallpox in 1980, declared by the WHO as the first disease in human history to be eliminated by deliberate health care interventions.

Applying the 2022 Cardiovascular and Pulmonary Entry-Level Physical Therapist Competencies to Physical Therapist Education and Practice.

Competency-based education (CBE) is an emerging topic within physical therapy (PT). It has emerged to assure all stakeholders that physical therapist education program graduates are proficient in the requisite knowledge, skills, and behaviors (KSBs) essential for entry-level practice. Competencies have existed within cardiovascular and pulmonary (CVP) PT since 1980, updated in 2008, and most recently updated in 2022. This article discusses how individuals should apply the 2022 CVP competencies to clinical practice and education. The 2022 CVP competencies were developed using a modified mixed-method Delphi approach. These competencies set a level of proficiency for KSBs used within entry-level CVP PT practice following the patient-client management model. The position put forward in this article describes how and why multiple stakeholder groups should apply these entry-level competencies specifically for graduates of physical therapist education programs who are entering practice (entry level). The competencies provide a more detailed description of expected proficiency for entry-level CVP PT practice than currently available documents. These competencies may form the basis for developing entrustable professional activities (EPAs). The establishment of entry-level competencies is essential for use by multiple stakeholders to inform physical therapist curriculum, provide clinical instructors with a reference for expected levels of proficiency during final student clinical experiences, guide content on the Federation of State Boards of PT national licensure examination, and prepare employers to provide needed continued professional development, based on the clinical environment. These competencies lend themselves to the future development of EPAs in the PT profession for CVP PT.