Physiotherapy Practice Research Articles

Measuring guideline adherence in physiotherapy: A scoping review of methodological approaches.

Clinical practice guidelines summarise the existing evidence on specific health conditions and aim to optimise quality of care by providing evidence-based recommendations. Studies have reported a gap between research findings and clinical practice in physiotherapy. Guideline adherence is often used as a measure of agreement between therapeutic care and guideline recommendations. However, there is currently no standardised methodological approach for measuring guideline adherence. The objective of this scoping review was to summarise the methods and results of studies that assessed guideline adherence in physiotherapy. MEDLINE, EMBASE, PEDro and CENTRAL databases were searched for relevant literature up to December 2022. Published reports of observational studies and controlled clinical trials that provided information on the assessment of guideline adherence in physiotherapists were included. The selection process was performed independently by two reviewers. The methodological quality of the identified reports was not assessed. Results were summarised narratively. From a total of 2560 potentially relevant records, 53 reports were included in the analysis. Physiotherapists' adherence to guidelines was primarily assessed in the context of musculoskeletal conditions, such as low back pain (n = 25, 47.2%) and osteoarthritis (n = 8, 15.1%). A wide range of measurement approaches were used with the majority of reports using web-based surveys (n = 21, 39.6%), followed by chart reviews (n = 17, 32.1%). Most reports (n = 21, 39.6%) provided information on the level of adherence in terms of frequency dichotomising (self-reported) clinical practice as adherent or non-adherent. Adherence rates varied widely between included reports. Although the large number of included reports indicates a high level of interest in the topic of guideline adherence, there is considerable heterogeneity between studies regarding the methodological approaches used to assess guideline adherence in physiotherapists. This reduces the comparability of the study results. INPLASY (registration no. 202250081). Registered on 12th May 2022.

Psychometric and edumetric properties of the Turkish version of the assessment of physiotherapy practice

BackgroundClinical education is a crucial process in which students learn how to use theoretical knowledge in clinical settings. However, there is no standardized assessment tool routinely used to evaluate the clinical performance of physiotherapy students in Turkey. This study aimed to examine the psychometric (validity and reliability) and edumetric (acceptability, feasibility, and educational impact) properties of the Turkish version of the Assessment of Physiotherapy Practices (APP-T).MethodsThis methodological study included 7 clinical educators and 174 4th-grade physiotherapy students at three universities in Turkey. Students were assessed with the APP-T on completion of 4-week clinical placements. The construct validity was examined using the exploratory factor analysis. The internal consistency was determined using Cronbach’s α-coefficient. The test-retest and inter-rater reliability were evaluated with the intra-class correlation coefficient (ICC). For the measurement error of the APP-T, standard error of measurement (SEM) and minimum detectable change (MDC) values were calculated. After the administration of the APP-T was completed, clinical educators were requested to provide feedback on the acceptability, applicability, and educational impact of the APP-T.ResultsExploratory factor analysis demonstrated the 20 items of the APP-T represent a single dominant dimension explaining 76.28% of the variance. Excellent test-retest and inter-rater reliability was detected by ICC = 0.94 and ICC = 0.77, respectively, and good internal consistency was detected by Cronbach’s α = 0.935. The MDC90 values for test-retest and inter-rater reliability were 3.11 and 6.86, respectively. Clinical educators provided generally positive feedback on the acceptability, feasibility, and educational impact of the APP-T.ConclusionsThe current findings provided evidence for universities and clinical educators that the APP-T has sufficient psychometric and educational properties for evaluating the clinical performance of physiotherapy students in Turkey.

Physiotherapy in the digital age: A narrative review of the paradigm shift driven by the integration of artificial intelligence and machine learning

Abstract: A variety of physical impairments and functional restrictions are assessed and treated in the practice of physiotherapy. Subjective measures, rater variability, and restricted access to high-quality care are some of the unavoidable problems that contemporary physical therapy practice approaches must overcome. In light of these challenges, cutting-edge technologies such as artificial intelligence (AI) and machine learning (ML) are demonstrating remarkable efficacy in tackling these issues head-on. The focus of this review is to explore how the integration of AI and ML might change physical therapy practice and education in the age of digital communication. It delves into the challenges accompanying this integration and considers future prospects in this domain. A literature search was conducted using data base PubMed, Google Scholar, Web of Science, and Scopus with keywords such as ‘physiotherapy’, ‘artificial intelligence’, and ‘machine learning’, limited to English articles from 2014 to 2024. Results were imported into reference management software, duplicates removed, and relevant articles were screened and assessed for inclusion, with reasons for exclusion documented. Emerging technologies like AI and ML use algorithms to examine patient data and make automatic decisions, enhancing areas such as virtual reality therapy (VR), tele-rehabilitation, clinical decision support, individualized rehabilitation and physical function evaluation. These advance technologies optimize physical therapy and improve outcomes, but further research is needed to address obstacles like bias and data privacy to ensure responsible implementation. AI and ML can revolutionize physical therapy by improving therapy precision, patient monitoring, optimization and individualized therapy plan. However, it’s crucial for physiotherapists to balance technological advancements with compassionate, patient-centred approach.

Personalised decision support in the management of patients with musculoskeletal pain in primary physiotherapy care: a cluster randomised controlled trial (the SupportPrim project).

We developed the SupportPrim PT clinical decision support system (CDSS) using the artificial intelligence method case-based reasoning to support personalised musculoskeletal pain management. The aim of this study was to evaluate the effectiveness of the CDSS for patients in physiotherapy practice. A cluster randomised controlled trial was conducted in primary care in Norway. We randomised 44 physiotherapists to (1) use the CDSS alongside usual care or (2) usual care alone. The CDSS provided personalised treatment recommendations based on a case base of 105 patients with positive outcomes. During the trial, the case-based reasoning system did not have an active learning capability; therefore, the case base size remained the same throughout the study. We included 724 patients presenting with neck, shoulder, back, hip, knee, or complex pain (CDSS; n = 358, usual care; n = 366). Primary outcomes were assessed with multilevel logistic regression using self-reported Global Perceived Effect (GPE) and Patient-Specific Functional Scale (PSFS). At 12 weeks, 165/298 (55.4%) patients in the intervention group and 176/321 (54.8%) in the control group reported improvement in GPE (odds ratio, 1.18; confidence interval, 0.50-2.78). For PSFS, 173/290 (59.7%) patients in the intervention group and 218/310 (70.3%) in the control group reported clinically important improvement in function (odds ratio, 0.41; confidence interval, 0.20-0.85). No significant between-group differences were found for GPE. For PSFS, there was a significant difference favouring the control group, but this was less than the prespecified difference of 15%. We identified several study limitations and recommend further investigation into artificial intelligence applications for managing musculoskeletal pain.

Chronic Pain in Spanish Physiotherapy Practice: Treatment Challenges and Opportunities in Diverse Healthcare Settings-A Qualitative Study.

Background/Objectives: Physiotherapists face significant challenges in managing chronic pain; a complex condition best addressed through a biopsychosocial (BPS) approach. Although substantial evidence exists globally, research specific to Spain remains limited. This study explores the experiences and challenges Spanish physiotherapists encounter in integrating BPS elements across public and private healthcare settings. Methods: Semi-structured interviews with 12 experienced physiotherapists were conducted, using a qualitative approach with purposive sampling and reflexive thematic analysis. The analysis, grounded in a constructivist/interpretivist framework, allowed themes to emerge naturally from the data, supported by relevant quotes. Results: Three primary themes were identified: (1) challenges in implementing the BPS approach, including patient resistance and limited training; (2) facilitators for adopting the BPS model, such as multidisciplinary support and positive patient outcomes; and (3) emotional and psychological aspects of the physiotherapists. The findings highlight the complexities of chronic pain management in physiotherapy, emphasizing the need for enhanced psychological training, integrated multidisciplinary care, early diagnosis, and effective family involvement. These insights are critical for improving both patient care and physiotherapist well-being. Conclusions: This study provides valuable guidance for future strategies, focusing on educational enhancements, multidisciplinary collaboration, healthcare policy reform, and emotional support for physiotherapists within the Spanish healthcare context.

Demographics and scope of Australian emergency department physiotherapists

QuestionsTo provide workforce data on the status of Australian Emergency Department (ED) physiotherapy practice, including physiotherapist demographic data, staffing levels and funding sources. Evaluate the scope of practice currently undertaken by ED physiotherapists and alignment of ED physiotherapy service provision with demand levels.DesignCross sectional survey.ParticipantsAustralian physiotherapists working within an Australian ED.Outcome measuresWorkforce data, scope of practice and alignment of physiotherapy service provision to ED presentations and demand.Results94 Australian ED physiotherapists completed the survey, 76.9% were working as primary contact clinicians. They had a diverse scope of practice, 100% perform mobility assessments, 89.9% provide care for paediatric patients and 10.1% were involved in administration of medications. 86.2% of participants (75/87) reported working within a service model that provided seven-day per week physiotherapy coverage to ED.ConclusionThe sample of ED physiotherapists were found to be experienced and highly trained clinicians with a diverse scope of practice, who are well placed to meet the unpredictable and highly variable patient caseload of Australian EDs.

Physiotherapy practices in the clinical assessment of lateral elbow tendinopathy: An international survey.

Understanding physiotherapy practices is important to identify variations from empirical evidence and highlight requirements for training. This survey explored international physiotherapy practices for assessment of lateral elbow tendinopathy (LET). Two hundred ninety-nine surveyed physiotherapists from eight member countries of the International Federation of Manual and Orthopaedic Physical Therapists completed the survey. Respondents rated their frequency of use (never, rarely, sometimes, often, and always) for items related to: patient history; diagnostic tests; grip and upper limb strength; cervical and neurological assessment; and medical imaging. To establish practices, the five response categories were dichotomised into routine practice (often, always) and not-routine practice (sometimes, rarely, never). A response rate of ≥70% for each dichotomy was used to determine whether an assessment item was deemed routine practice or not, with items not meeting either criterion considered neither routine nor not-routine practice. Most respondents were from United States (63%). The 'chair pick up test', 'cervical special tests', and 'plain radiograph' met our criteria for not routine practice (i.e., 70%, 72%, and 71%, respectively). All other assessment items did not meet the criteria to be considered routine or not-routine practice. The chair pick-up test, cervical spine special tests (e.g., Spurling's test), and plain radiography appear to not be routinely used in the assessment of LET. The finding that no assessment technique met the criteria for routine use may imply that physiotherapists adopt a nuanced approach to selecting clinical assessment items as opposed to routinely applying tests.

Barriers and facilitators to the use of clinical practice guidelines in osteoarthritis care: a qualitative study among German physiotherapists

ObjectivesThe objective of this study was to explore barriers and facilitators to the use of clinical practice guidelines (CPGs) in osteoarthritis (OA) care among German physiotherapists.DesignQualitative semistructured interviews were conducted...

Enhancing physiotherapists' knowledge and perceptions of telerehabilitation: A before-after educational intervention study.

In the evolving landscape of healthcare, telerehabilitation is emerging as a pivotal modality, especially in delivering services to vulnerable populations. With the increasing reliance on digital health solutions, there is a pressing need for physiotherapists to be adequately trained in telerehabilitation. This training is essential for them to adapt to new technologies and methodologies, ensuring effective and efficient patient care. The aim of this study was to evaluate the effect of a telerehabilitation educational intervention on physiotherapists' knowledge and perceptions in Bucaramanga and its metropolitan area. A group of 27 physiotherapists underwent an educational intervention focused on telerehabilitation. Before- and after-intervention assessments were conducted to gauge their perceptions and knowledge. Participants generally held a positive perception of telerehabilitation both before and after the intervention [Before Median (Md) and interquartile range (IQR): Md=2.5 (IQR=2.1-3); after: Md=2.7 (IQR=2.4-3.1), p=0.256]. A significant increase in their knowledge after-intervention was observed [Before: Md=55.5 (IQR=33.3-66.6)]; after: Md=77.7 (IQR=66.6-88.8), p=<0.001, emphasizing the potential benefits of targeted educational interventions. The educational intervention significantly improved physiotherapists' knowledge of telerehabilitation, underscoring the importance of professional training in this domain. While perceptions remained consistently positive, the notable increase in knowledge suggests that such educational programs are crucial for enhancing the adoption and effective use of telerehabilitation in physiotherapy practice.

271 - Characteristics of premenopausal women in pelvic physical therapy practice

271 - Characteristics of premenopausal women in pelvic physical therapy practice

Student physical therapists’ confidence in appraising and applying research after participating in a weekly journal club

Introduction: The objective of this study was to assess changes in student physical therapists’ confidence in their ability to critically appraise research and use research findings to inform their practice after completing a weekly journal club. Methods: Thirty-four students in a doctoral-level physical therapist education program completed a questionnaire before and after participating in a weekly journal club. The questionnaire asked students to rate their confidence in critically appraising research and using research to inform their practice. Results: Over the semester, there was significant improvement in students’ confidence in their ability to critically appraise research related to physical therapy practice and their confidence in using research to inform their practice. Conclusions: In general, it appears that a course-based weekly journal club can be effective for improving student physical therapists’ confidence in their ability to perform some of the key functions required for evidence-based practice.

Enhancing Physiotherapy Services within a Community Specialist Team for Older Adults: An Evaluation Study

Abstract Background An aim of Community Specialist Teams (CSTs) is to provide integrated multidisciplinary services to older people closer to home. Physiotherapy is a key component of this service. This evaluation aims to describe current physiotherapy practices within a specific CST and identify potential areas for improvement. The CST under examination maintains a physiotherapy staffing level of 1.2 Full-Time Equivalents. Methods An evaluation was completed of the physiotherapy input provided to 71 older adults who underwent a Comprehensive Geriatric Assessment (CGA) with the CST between July and December 2023. Data encompassing service user demographics and physiotherapy specific information were anonymised and analysed using Microsoft Excel. Results The median age of clients was 84 years (range 66-95), with 84.5% aged over 75 years. 70% were female. The median Clinical Frailty Scale (CFS) was 5 (range 3-7), with 75% being classified as frail. The reasons for referral were community rehabilitation (43%), admission avoidance (20%), early supported discharge (17%) and other (20%). Median time to CGA was 18 days (range 1-64 days). 64 (94%) patients were referred to physiotherapy and received an average of 4.4 sessions. Time to physiotherapy assessment following CGA ranged from 0-41 days with a median of 6 days. 83% of clients had physiotherapy intervention in their homes, 14% attended community hubs and 3% both. Analysis of delayed discharge revealed a range of 0-99 excess days beyond the estimated discharge date, with a median delay of 6 days. Conclusion This evaluation underscores the prevalent need for physiotherapy input among the service users engaged with this CST. Concerns arise regarding the breach of the of the National Integrated Care Programme for Older Persons (NICPOP) guideline for CGA timing (2 weeks) and target discharge date (6 weeks). The findings of this review will inform future service planning and the development of integrated physiotherapy pathways for older people.

Physiotherapists' Treatment Strategies and Delineation of Areas of Responsibility for People With Musculoskeletal Conditions and Comorbidities in Private Physiotherapy Practice: A Qualitative Study.

Patients with multiple chronic conditions, for example, musculoskeletal conditions and comorbidities, often receive inadequate and sometimes even contradictory care. Physiotherapists are well qualified to manage patients with musculoskeletal conditions and comorbidities due to their education and experience with rehabilitation; however, it is unknown which challenges they face when treating these patients. To identify challenges, treatment strategies, and delineations of areas of responsibility among physiotherapists working in private physiotherapy practice when treating people with musculoskeletal conditions and comorbidities. Qualitative study using focus group discussions and participant observations of 13 physiotherapists working in Danish private physiotherapy clinics. Grounded theory was applied to guide the analysis. Two major themes emerged from the focus groups and the observations (1) The necessity of adapting management to the patients and their treatment trajectory; (2) The dilemma of overall responsibility for coordinating care. The physiotherapists described different elements of adapting their management, including being challenged on time, taking extra care of the patient, and having to adjust to a fluctuating course of treatment. The dilemma in coordinating care concerned whether the responsibility should lie with the physiotherapist, other healthcare professionals, or the patients, and whether to treat only the condition on the referral or to treat all the conditions the patient had. Physiotherapists use adapted strategies for diagnosing and treating patients with musculoskeletal conditions and comorbidities and are uncertain about the overall responsibility for coordinating care and whether they should focus on the index condition alone or also the other comorbidities the patient has.

Implementation of a Virtual Reality Intervention in Outpatient Physiotherapy for Chronic Pain: Protocol for a Pilot Implementation Study.

Chronic pain is a global health issue that causes physical, psychological, and social disabilities for patients, as well as high costs for societies. Virtual reality (VR) is a new treatment that provides an opportunity to narrow the gap between clinical practice and recommended care in the use of patient education and behavioral interventions in the outpatient physiotherapy setting. However, there is currently no implementation strategy to integrate VR treatments into this setting. This protocol outlines a pilot implementation study that aims to (1) identify barriers and facilitators for implementing a VR intervention in outpatient physiotherapy care for people with chronic pain and (2) develop and pilot test an implementation strategy in 5 practices in Germany. The study consists of 4 phases. The first phase involves adapting the treatment protocol of the VR intervention to the local context of outpatient physiotherapy practices in Germany. The second phase includes the collection of barriers and facilitators through semistructured interviews from physiotherapists and the development of a theory-driven implementation strategy based on the Theoretical Domains framework and the Behavior Change Wheel. This strategy will be applied in the third phase, which will also include a 6-month span of using VR interventions in practices, along with a process evaluation. The fourth phase consists of semistructured interviews to evaluate the developed implementation strategy. The recruitment process and phase 1, including the adaptation of the treatment protocol, have already been completed. We recruited 5 physiotherapy practices in Lower Saxony, Germany, where the VR intervention will be implemented. The collection of barriers and facilitators through semistructured interviews is scheduled to begin in February 2024. This pilot implementation study aims to develop a theory-driven implementation strategy for integrating a VR intervention into outpatient physiotherapy care for people with chronic pain. The identified barriers and facilitators, along with the implementation strategy, will serve as a starting point for future randomized controlled implementation studies in different settings to refine the implementation process and integrate VR interventions into the outpatient care of people with chronic pain. German Clinical Trials Register DRKS00030862; https://tinyurl.com/3zf7uujx. DERR1-10.2196/58089.

Exploring the Opportunities and Barriers of Implementing the Health Focused Physical Therapy Model

The Health-Focused Physical Therapy Model integrates lifestyle behavior management into physical therapy practice using a standardized care model and motivational patient interviewing. The purpose of this study was to identify the perceived opportunities and barriers physical therapists, physical therapist assistants, and rehab administrators may face when implementing the model. This study included a survey of 19 physical therapy clinicians, and interviews with four rehabilitation administrators from one healthcare system. All participants attended a continuing education course covering the model and then completed a survey detailing their perceptions. Participants included female (100%), physical therapists (78.9%) and physical therapy assistants (21.1%), with variable educational degrees, and at least 16 years of clinic experience (73.7%). Four rehabilitation administrators, 100% female with at least 11 years of PT practice, participated in a semi-structured interview. Survey analysis revealed participants were confident in their understanding of the model and believed the model would positively impact the health of patients. However, over half perceived time limitations as a barrier. Meanwhile, three themes from the interview emerged including holistic care, implementation barriers, and needed resources. This study demonstrated time limitations and productivity standards could limit the implementation of health-focused physical therapy care. Future research should analyze opportunities and barriers of the model with broadened participant sampling methods and triangulation across healthcare practitioner roles to guide implementation and realistic practice standards.

Pharmacy—Physiotherapy Interprofessional Education and Practice

Interprofessional education (IPE) is an educational technique in which tutors and students from several healthcare disciplines, such as pharmacy and physiotherapy, collaborate to achieve a common goal. IPE has been shown to increase patient outcomes and professional growth among healthcare teams. Pharmacists and physiotherapists have different knowledge bases and skills, both of which are integral to the effectiveness of a collaborative healthcare team. By bringing their respective expertise together in an interprofessional context these healthcare professionals can work to develop increased understanding, respect for each other’s roles, and the ability to collaborate more effectively.

Applying Clinical Practice Guidelines on Chronic Headaches, Neck Pain, and Chest Symptoms: A Single Case Report

BACKGROUND: Neck pain and headaches are common conditions in physical therapy practice. Clinical practice guidelines (CPG’s) are forms of evidence designed to decrease practice variability and guide care. CPG recommendations are general, with few specific tactics recommended, which could be a factor in their limited adoption and poor application. This case report demonstrates an example of implementing the Academy of Orthopedic Physical Therapy (AOPT) Neck Pain Revision CPG while also highlighting limitations and areas lacking specificity. CASE PRESENTATION: The patient was a 37-year-old female with neck pain, chest pain, and headaches. She was treated following the recommendations within the AOPT CPG along with psychologically informed practice. The Neck Disability Index (NDI), Patient Specific Functional Scale (PSFS), Fear Avoidance Beliefs Questionnaire (FABQ), symptoms, and impairments were measured at evaluation, discharge, and 2 months post discharge. OUTCOMES: Clinically meaningful improvements in NDI and PSFS scores, improved cervical endurance, scapular strength, and cervical motor control were observed at discharge. Additional improvements in NDI scores were seen at 2-months post discharge. DISCUSSION: While the CPG promotes the use of manual therapy, exercise and general screening, the authors demonstrate specific techniques for identifying and managing fear avoidance behavior with cognitive and graded exposure techniques.

Blooming Through the Evolution of DEI+

ABSTRACT The lexicon and language surrounding diversity, equity, and inclusion (DEI) are evolving with new and nuanced meanings arising, depending on historical and current contexts. Notably, the DEI initialism has evolved to incorporate justice, equity, diversity, and inclusion to create the acronym JEDI, excluding key terms such as accessibility, belonging, or antiracism. Adding a plus sign (+) to the DEI initialism embraces a more comprehensive and intersectional approach, creating space for transformative and evolving language. DEI+ aims to include and invite everyone into ongoing conversations where all are respected, supported, and feel a sense of belonging. Using Bloom's Taxonomy for cognitive learning as a framework, the authors advocate incorporating the DEI+ initialism within physical therapy education, research, and practice.

Empathy and emotional intelligence in physiotherapy: Enhancing patient care and outcomes

This paper explores the critical role of empathy and emotional intelligence in physiotherapy, focusing on their impact on patient care and treatment outcomes. The study identifies key empathy skills, including reflective listening, emotional labeling, perspective-taking, empathic acknowledgment, and compassionate curiosity, as essential for building strong therapeutic relationships and enhancing patient satisfaction and adherence. Data from surveyed physiotherapists reveal that approximately 85% observed improved patient engagement when these skills were applied, with 70% noting increased patient satisfaction and 60% reporting a positive effect on the therapeutic alliance. However, the study also highlights challenges such as compassion fatigue, which affects about 40% of physiotherapists and can diminish their capacity for empathy. Strategies like regular self-care and professional development were shown to improve management of these challenges by 50%, underscoring the need for continuous training in emotional intelligence. The paper concludes that integrating empathy and emotional intelligence into physiotherapy practice not only fosters a culture of patient-centered care but also significantly improves patient outcomes and satisfaction. It recommends incorporating comprehensive training on these skills into physiotherapy education and providing ongoing professional development opportunities to sustain high-quality, empathetic care.

Contribution of university curriculum, work and life experience to work readiness: perspectives of individuals transitioning from university to physiotherapy practice

Contribution of university curriculum, work and life experience to work readiness: perspectives of individuals transitioning from university to physiotherapy practice