Private Physiotherapy Practices Research Articles

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.

Exploring the experiences of UK-based private physiotherapists when running and progressing a physiotherapy business: a hermeneutic phenomenological study

AimTo explore the experiences of UK-based private physiotherapists when running and progressing a physiotherapy business. DesignA hermeneutic phenomenological approach. ParticipantsSix UK-based private physiotherapy practice owners were recruited via purposive and snowball sampling. MethodsIn-depth, semi-structured video interviews (2 per participant), audio-recorded and transcribed. Field notes, respondent validation and a reflexive diary were used. Data underwent line-by-line analysis, identifying codes and themes. Constant comparison of data, codes and themes occurred throughout. Peer review was utilised, small sections of data and all emerging codes were independently reviewed. ResultsThree interconnecting themes. Working for myself: participants highlighted the freedom, flexibility and independence of business ownership, whilst acknowledging the additional pressures/challenges associated with this. Evolution of a practice: business growth was slow, requiring income supplementation initially. Successful growth often utilised luck and unexpected opportunities. Working with others: participants faced decisions regarding solo or joint ownership, when/what additional staff were required, whether staff should be employed or self-employed, and how to appropriately manage/support staff. ConclusionsPrivate practice ownership brings an array of benefits and challenges. Areas for future research include exploring the stresses of private roles and business ownership, the evolution of private physiotherapy practices, small-scale business partnerships, and employment vs self-employment. Contribution of the Paper•This research suggests that although private practice ownership brings increased freedom, flexibility, and job satisfaction, this is tempered by an array of increased pressures and responsibilities.•Practice growth was gradual, often involving luck and unexpected opportunities.•Clinic owners face challenging decisions regarding the selection, management and support of additional staff.

Metabolic syndrome is prevalent and undiagnosed in clients attending private practice physiotherapy: a cross-sectional study

ObjectivesTo determine the prevalence of metabolic syndrome in clients presenting for primary care physiotherapy within private practice settings, and the factors that may be associated with metabolic syndrome. The secondary aim was to determine client’s attitudes towards lifestyle change. DesignA cross-sectional study in which self-report and biometric data were collected. The study was conducted in physiotherapy private practices across metropolitan and regional areas, Australia. Participants230 clients (mean age 54 (SD18) years, 64% women) presenting for physiotherapy participated. Main outcome measuresParticipant socio-demographic and lifestyle characteristics were collected. Metabolic syndrome presence was determined by the existence of three or more risk factors on physical examination and capillary blood sample: abdominal obesity, hypertension, elevated random blood glucose, elevated triglycerides and/or reduced HDL cholesterol. ResultsThirty-seven percent of participants had metabolic syndrome, but none knew they had it. Metabolic syndrome was associated with older age and poorer socio-economic status and may have been associated with lower levels of physical activity but not diet. Of those identified as having hypertension and elevated triglycerides, many were undiagnosed (56% and 29% respectively). ConclusionMetabolic syndrome is prevalent and undiagnosed in clients attending private practice physiotherapy. Clients felt lifestyle change was important and they were willing to make changes. This study highlights the need for greater screening of metabolic risk factors in primary care and presents an opportunity for physiotherapists in private practice to identify risk and intervene to improve the overall health of their clients and contribute to chronic disease prevention. Contribution of the Paper•Metabolic syndrome is more prevalent in clients attending private practice physiotherapy (37%) compared to the general population (25%).•Older clients from areas of relative socio-economic disadvantage who are no longer employed and are inactive are most at risk.•Physiotherapists can make an impact by detecting metabolic syndrome and then providing advice and prescribing exercise and physical activity, along with referral for appropriate medical or dietary management.

Private practice model of physiotherapy: professional challenges identified through an exploratory qualitative study

Introduction Community-based primary care physiotherapy has developed through private practice, fee-for-service model in Aotearoa New Zealand where independent businesses operate in competition. Aim We aimed to explore how the private practice model of physiotherapy impacts patient care, physiotherapists, and professional behaviour. Methods Six physiotherapists managing musculoskeletal conditions in a primary care private practice in Aotearoa New Zealand were recruited using maximum variation purposive sampling. In-depth individual face-to-face semi-structured interviews were audio-recorded, transcribed verbatim, and analysed using Interpretive Description. Inductive data analysis synthesised and contextualised data, creating a thematic framework that developed across interviews. Results All physiotherapy participants discussed concerns about culture and professionalism in private practice physiotherapy despite not being asked about these. Three themes were identified. ‘Competitive business model and lack of collaboration’ – participants thought that competition between practices resulted in a lack of trust, collegiality, and collaboration, and pressure on clinicians to maintain income. ‘(Un)professional behaviour’ – participants thought that physiotherapists were defensive and averse to scrutiny, resulting in reluctance to admit when they needed help, or to undertake peer review or seek second opinions. ‘Lack of support and mentoring’ – the professional culture in private practice was perceived to reduce support and mentoring, with negative impacts that affected physiotherapists at all stages of career. Conclusion This exploratory qualitative study suggests that competition dominates communication and collaboration in private practice physiotherapy and may have wider implications for professionalism and the quality of patient care. Competitive business models and an aversion to scrutiny may reduce collegial interaction and professional behaviour.

Promoting effective interprofessional collaborative practice in the primary care setting: recommendations from Queensland physiotherapy private practitioners.

Physiotherapy private practitioners represent a growing proportion of Australia's primary care workforce; however, they face significant barriers in integrating seamlessly within interprofessional teams. Historically, the landscape of primary care in Australia has been one where many physiotherapists work in monoprofessional private practice facilities at dispersed locations, potentially limiting collaborative and coordinated care. The aim of this study was to investigate strategies recommended by physiotherapists to promote effective interprofessional collaborative practice (IPCP) within the Australian private practice setting. Using interpretive description as the guiding methodological framework, semi-structured interviews were conducted with 28 physiotherapists in 10 private practice sites in Queensland, Australia. Data analysis produced three themes that characterised physiotherapy private practitioners' recommendations to improve IPCP: (a) the need for improved funding and compensation, particularly addressing the limitations of the Medicare Chronic Disease Management program; (b) the development of integrated and secure digital communication systems to facilitate better information exchange; and (c) prioritising professional development and training to enhance collaboration. This research lays the groundwork for informed policy making to advance person-centred care and support the integration of services in the Australian healthcare system. The findings from this study indicate that promoting effective IPCP in physiotherapy private practice requires a comprehensive strategy that addresses systemic funding and compensation issues, enhances digital communication systems and optimises interprofessional education and training.

The Barriers to Interprofessional Collaborative Practice: Perspectives from Australian Physiotherapy Private Practitioners

Background: Despite the growing presence of physiotherapy private practitioners within Australia’s healthcare workforce, little is known about their perspectives of interprofessional collaborative practice (IPCP). This study aims to explore the barriers to IPCP from the perspective of Australian physiotherapy private practitioners. Methods: Semi-structured interviews were conducted with 28 physiotherapists and 64 hours of observation was completed in 10 private practice sites in Queensland, Australia. Interview and observation data were pooled and analyzed using reflexive thematic analysis. Findings: Data analysis produced five themes that characterized physiotherapists’ perspectives of IPCP: a) competition for clientele, b) personal attitudes and beliefs, c) time constraints and work schedules, d) geographic location, and e) rules of funding schemes. Conclusion: The findings from this study suggest that implementing IPCP in the Australian physiotherapy private practice setting presents several challenges. Financial concerns, such as physiotherapy private practitioners’ perceived need to compete for clientele, were significant barriers to IPCP. The introduction of financial incentives and adoption of alternative payment models may be necessary to provide physiotherapy private practitioners with a clear motivation to engage in IPCP. The need for more formal opportunities to bring health practitioners from diverse professional backgrounds together to gain new insights and knowledge of other professions’ expertise and challenge their own assumptions was also highlighted.

The effectiveness of combining ultrasound therapy with splinting and exercise therapy for patients with carpal tunnel syndrome

Background: Carpal tunnel syndrome (CTS) can cause patients to experience negative symptoms that can significantly affect their ability to use their hands to perform daily activities. This study aimed to compare the effectiveness of a combination of splinting and exercise therapy with or without ultrasound therapy in improving CTS symptoms and the functional status of patients.
 Methods: This randomized pre and post-test control group design study was conducted in private physiotherapy practices in the Denpasar area from August to September 2022. Twenty-four subjects with unilateral CTS were randomly divided into an Intervention Group (n=12; splinting, exercise therapy, and ultrasound therapy) and a Control Group (n=12; splinting and exercise therapy only). Splinting was used all day and night for four weeks. Exercise therapy was given three times per week for four weeks. Ultrasound therapy was given once a day, three times per week, for four weeks. The subject's symptoms and functional status before and after treatment were evaluated using the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ), which consists of the Symptom Severity Scale (SSS) and the Functional Status Scale (FSS).
 Results: Significant improvements were found in SSS and FSS in Group 1 (SSS: p=0.000; FSS: p=0.000) and Group 2 (SSS: p=0.000; FSS: p=0.000), and a significant between-group difference was found in SSS (p=0.000) and FSS (p=0.001).
 Conclusion: The addition of ultrasound therapy to splinting and exercise therapy is more effective than that in improving the symptoms and functional status of patients with CTS.

Facilitators of effective interprofessional collaborative practice for physiotherapy private practitioners: An interpretive descriptive study

IntroductionDespite the growing presence of physiotherapy private practitioners within Australia's health care workforce, little is known about their perspectives of interprofessional collaborative practice (IPCP). The aim of this study was to explore the facilitators of IPCP from the perspective of Australian physiotherapy private practitioners. MethodsSemi-structured interviews were conducted with 28 physiotherapists and 64 h of observation was completed in 10 private practice sites in Queensland, Australia. Interview and observation data were pooled and analysed using reflexive thematic analysis. ResultsData analysis produced four main themes and three sub-themes that characterised physiotherapists’ perspectives on the facilitators of IPCP: (a) close physical proximity (integrated team membership; co-location; interior architecture); (b) technological advancements; (c) complex client presentations; and (d) positive professional reputation. ConclusionThis study provides valuable insights into the facilitators of IPCP from the perspective of physiotherapy private practitioners. Emphasising close physical proximity of multiple health practitioners, leveraging technological innovations, recognising the value of IPCP for clients with chronic and complex care needs, and cultivating positive professional reputations can promote effective IPCP for physiotherapy private practitioners. The findings from this research may be used to guide the development of innovative strategies that will support robust and sustainable models of IPCP in the physiotherapy private practice setting.

Physiotherapists perceive hosting clinical placements in private practice as an investment in future physiotherapists: a mixed-methods study.

What do private practitioners perceive to be the benefits, barriers, costs and risks of hosting physiotherapy students on clinical placement? What models of placement are used and what support would private practitioners like to enable them to continue hosting students? A national mixed-methods study comprising a survey and four focus groups. Forty-five private practitioners from six states and territories who host on average 208 students per year (approximately one-third of all physiotherapy private practice placements in Australia) completed the survey. Fourteen practitioners participated in focus groups. Participants reported that hosting placements helped to recruit graduates and assisted private practitioners in developing clinical and educator knowledge and skills. Cost (both time and financial) and difficulties securing a sufficient caseload for students were perceived barriers to hosting placements. Hosting placements was perceived to be low risk for clients due to supervised care, but there was potential for risk to business reputation and income when hosting a poorly performing student. Participants mostly described a graded exposure placement model whereby final-year students progressed from observation to shared care to providing care under supervision. Participants perceived that they could be assisted in hosting placements if they were to receive additional financial and personalised support from universities. Private practitioners perceived hosting students to be beneficial for the practice, the profession, staff and clients; however, they did report them to be costly and time-consuming. Universities are perceived to play a vital role in providing training, support and communication with educators and students for ongoing placement provision.

Physiotherapy private practitioners’ opinions regarding interprofessional collaborative practice: A qualitative study

ABSTRACT Physiotherapy private practitioners comprise a growing proportion of Australia’s primary care workforce, yet their views and experiences of interprofessional collaborative practice (IPCP) are poorly documented. The aim of this study was to explore Australian physiotherapy private practitioners’ opinions regarding IPCP. Twenty-eight semi-structured interviews were conducted with physiotherapists in 10 private practice sites in Queensland, Australia. Interviews were analyzed using reflexive thematic analysis. Data analysis produced five themes that characterized physiotherapists’ perceptions of IPCP: (a) quality of care considerations; (b) not a one-size-fits-all approach; (c) the need for effective interprofessional communication; (d) fostering a positive work culture; and (e) fear of losing clientele. The findings from this study suggest that physiotherapy private practitioners value IPCP because it can deliver superior client outcomes, can strengthen interprofessional relationships, and has the potential to enhance the professional reputation of the organizations within which they work. Physiotherapists also claimed that IPCP can contribute to poor client outcomes when performed inappropriately, while some reported approaching interprofessional referrals with caution following instances of lost clientele. The mixed views toward IPCP in this study highlight the need to explore the facilitators and barriers to IPCP in the Australian physiotherapy private practice setting.

Study protocol for a multicenter randomized controlled trial of personalized exercise therapy and self-management support for people with multimorbidity: The MOBILIZE study.

Despite the great individual and societal burden associated with multimorbidity, little is known about how to effectively manage it. The aim of this multicenter randomized controlled trial (RCT) is to investigate the 12-month effects of a personalized exercise therapy and self-management support program in addition to usual care in people with multimorbidity. This is a protocol for a pragmatic, parallel-group (1:1 ratio), superiority RCT conducted at five intervention sites (two hospitals, a private practice physiotherapy clinic and two municipal rehabilitation centers) in Region Zealand, Denmark. A total of 228 persons with multimorbidity aged 18 years or older, will be randomly allocated to one of two groups. Both groups will receive usual care, defined as routine care for multimorbidity at the discretion of the treating doctor, while the intervention group will also participate in a 12-week exercise therapy and self-management support program tailored to people with multimorbidity at one of the intervention sites. The primary outcome will be the between-group difference in change in EQ-5D-5L from baseline to the follow-up at 12 months. Secondary outcomes include objectively-measured physical function and physical activity, inflammatory markers, disease and treatment burden, anxiety, depression, stress, sleep, pain and other self-reported parameters. In parallel with the RCT, an observational cohort will follow persons aged ≥18 years with multimorbidity not adhering to all eligibility criteria, as well as people fulfilling all eligibility criteria, but unwilling to participate in the RCT. This study was approved by the Regional Committee on Health Research Ethics for Region Zealand (SJ-857) and results will be communicated in scientific papers, at relevant conferences and to a broader audience. Exercise therapy and self-management support is safe and effective in people with single conditions. However, it is still unclear whether this holds true for individuals with multimorbidity. This pragmatic, multicenter RCT will provide high-quality evidence on the benefits and harms of exercise therapy and self-management support and, if the results support it, lead to the development of a plan for implementation in clinical practice.

Towards an ethical multiplicity in low back pain care: Practising beyond the biopsychosocial model.

The biopsychosocial model is currently considered by most researchers and clinicians to be the best approach to low back pain (LBP) care. The model was popularised in LBP care in response to some clear deficiencies in earlier biomedical approaches and is now widely recommended in clinical guidelines and policy statements. Yet the biopsychosocial approach has also been critiqued for its narrow conceptualisation and application. In this article, we explore how attending to the multidimensionality of LBP in practice goes beyond a biopsychosocial approach. We engaged with 90 ethnographic observations of clinical practices, 22 collaborative dialogues with clinicians, and eight consultatory meetings with people with experience of LBP to consider the sociomaterialities of clinical practices in two settings: a private physiotherapy practice and a public multidisciplinary pain clinic. Drawing on the work of Annemarie Mol and Rosi Braidotti, our analyses suggest that sociomaterial practices, involving human and non-human actors, produced multiple objects of clinical attention and ethical concerns about how to attend to this multiplicity well. We argue that the multiplicity of LBP is attended well by reimagining: (1) clinical settings as 'becoming more-than-sterile environments' where objects, furniture and elements such as tears and laughter help to provide a relational, welcoming and comfortable space to all bodies with LBP; (2) differences through 'becoming minoritarian' where considering power relations allows actions towards connectiveness and belonging; and (3) disciplinary boundaries through 'becoming interdisciplinary within' where actions expand traditional scopes of practice. The flux of these multiple becomings moves clinical practice and conceptualisations beyond the biopsychosocial approach to consider a new ethico-onto-epistemological approach to LBP care. They invite clinical practices that engage with an ethical multiplicity of LBP care, providing a better understanding of how places, objects, emotions, power, bodies and professions are interconnected and come together in everyday practice.

Exploring the business skills, experiences and preparedness of UK-based private physiotherapists when establishing and developing a physiotherapy business: A hermeneutic phenomenological study

AimTo explore the business skills, experiences and preparedness of UK-based private physiotherapists when establishing and developing a physiotherapy business. DesignA hermeneutic phenomenological approach. ParticipantsSix UK-based private physiotherapy practice owners were recruited via purposive and snowball sampling. MethodsIn-depth, semi-structured video interviews (n = 12) were audio-recorded and transcribed. Field notes, respondent validation and a reflexive diary were used. Data underwent line-by-line analysis, identifying codes and themes. Constant comparison of data, codes and themes occurred throughout. Peer review was utilised, and small sections of data and all emerging codes were independently reviewed. ResultsKnowledge acquisition: participants acquired business knowledge from training, external help, and trial-and-error approaches. Improved physiotherapy-related business training was requested. Business skills: Business plans were generally organic or lapsed with time. Success and timing of marketing strategies varied widely. The altruistic nature of many physiotherapists creates difficulties in requesting payments for services. Clinical policies: Lone working risks appeared more weighted towards protecting staff from physical abuse rather than allegations. ConclusionsImproved physiotherapy-related business support and guidance may be beneficial. Focusing on word-of-mouth, website marketing, and establishing support networks may benefit practice owners. Greater consideration of the potentially negative implications of lone working, particularly accusations of inappropriate sexual behaviour, is recommended.

Adaptation of a clinical reasoning model for use in inflammatory conditions of the lactating breast: a retrospective mixed-methods study.

Background:Many potential factors associated with Inflammatory Conditions of the Lactating Breast (ICLB) have been reported in the literature, by lactating mothers and clinicians. Clinicians, including general practitioners, lactation consultants and physiotherapists, require a clinical reasoning model that summarises associated or linked factors, to aid in the assessment, treatment, and prevention of ICLB. Thus, we aimed to adapt the existing Breastfeeding Pain Reasoning Model (BPRM), for use in the management of ICLB, using prior research and clinical audit data to guide adaptation. The existing BPRM categorises contributing factors for breastfeeding nipple pain, rather than ICLB.Methods:Factors linked with ICLB were identified from prior research and considered for inclusion into the existing model. Clinical data from a retrospective audit of ICLB patient notes at a private physiotherapy practice were also examined. Any factors identified from prior research that could not be identified in the clinical notes were not considered for inclusion into the existing model. Additional factors from the clinical notes that appeared repeatedly were considered for inclusion into the adaptation of the BPRM. A draft adapted model was created comprising all eligible factors, considering their counts and percentages as calculated from the clinical data. The research team iteratively examined all factors for appropriate categorisation and modification within the adapted model.Results:Prior research and data from 160 clinical notes were used to identify factors for inclusion in the adapted model. A total of 57 factors, 13 pre-existing in the BPRM and 44 extra identified from the prior research or clinical audit, comprised the draft adapted model. Factor consolidation and terminology modification resulted in a total of 34 factors in the final proposed adapted ICLB model. The three main categories, CNS modulation, External influences and Local stimulation, from the existing model were maintained, with one minor terminology change to the former Local stimulation category, resulting in ‘Local influences’ category. Terminology for five subcategories were modified to better reflect the types of factors for ICLB. The most common factors in the adapted model, calculated from the clinical audit population of mothers with ICLB, were employment (85%), high socioeconomic status (81%), antibiotic use during breastfeeding (61%), history of an ICLB (56%), any breast pump use (45%), multiparity (43%), birth interventions (35%), decreased milk transfer (33%), breastfeeding behaviour and practices (33%), nipple pain (30%) and fit and hold (attachment and positioning) difficulty (28%).Conclusion:An ICLB-specific linked factors model is proposed in this paper. Clinicians treating mothers with ICLB can use this model to identify influencing and determining factors of ICLB clinical presentations and provide targeted education and effective treatment plans.

The physiotherapy workforce in Nepal: A national survey.

Physiotherapy is a relatively young profession in Nepal. Education standards, and workforce organization and representation have improved in recent years, but there is no detailed workforce data to support decision-making and long-term planning. Therefore, this study aimed to describe the demographic characteristics, physiotherapy practice areas, settingsand employment characteristics of physiotherapists in Nepal; and to document job satisfaction and the factors that influence it. In a cross-sectional survey, we asked Nepali physiotherapists about their sociodemographic characteristics, employment or physiotherapy practice area and settings, and job satisfaction. We assessed the associations between sociodemographic factors and job satisfaction among physiotherapists using univariable and multivariable logistic regressions. We invited all Nepali physiotherapists to participate via email, social media and visits to hospitals. Of the 1120 physiotherapists who were contacted, 52% (female: 287; male: 293) completed the survey. The majority of the participants (75%) were less than 30 years old. The majority (73%) held a Bachelor of Physiotherapy degree. Eighty percent were employed at the time of data collection; 58% had 1-4 years of experience. The majority (77%) practiced in or near the capital Kathmandu. Most physiotherapist worked either in private hospitals (46%) or in private physiotherapy practices (26%), rehabilitation centres (19%)and 11% practiced in public hospitals. The most common areas of practice were musculoskeletal physiotherapy (90%) and adult neurology (67%). More than half of the physiotherapist (53%) felt that they were underpaid and 41% were not satisfied with their current job status. The majority of the physiotherapists (67%) reported that they participated in continuing professional development activities. Multivariable logistic regression showed that physiotherapists who had a higher remuneration were more likely to be satisfied with their job. The majority of the physiotherapy workforce in Nepal is well-educated, young and at an early career stage. Most physiotherapists work in musculoskeletal and adult neurological physiotherapy, in private practices or private hospitals near Kathmandu. Job dissatisfaction was common and was related to low annual income. This first nationwide survey described the current physiotherapy workforce and provides comparison data for future physiotherapy workforce surveys.

Uncertainty in low back pain care – insights from an ethnographic study

Purpose To explore how uncertainty plays out in low back pain (LBP) care and investigate how clinicians manage accompanying emotions/tensions. Materials and methods We conducted ethnographic observations of clinical encounters in a private physiotherapy practice and a public multidisciplinary pain clinic. Our qualitative reflexive thematic analysis involved abductive thematic principles informed by Fox and Katz (medical uncertainty) and Ahmed (emotions). Results We identified three themes. (1) Sources of uncertainty: both patients and clinicians expressed uncertainty during clinical encounters (e.g., causes of LBP, mismatch between imaging findings and presentation). Such uncertainty was often accompanied by emotions – anger, tiredness, frustration. (2) Neglecting complexity: clinicians often attempted to decrease uncertainty and associated emotions by providing narrow answers to questions about LBP. At times, clinicians’ denial of uncertainty also appeared to deny patients the right to make informed decisions about treatments. (3) Attending to uncertainty?: clinicians attended to uncertainty through logical reasoning, reassurance, acknowledgement, personalising care, shifting power, adjusting language and disclosing risks. Conclusions Uncertainty pervades LBP care and is often accompanied by emotions, emphasising the need for a healthcare culture that recognises the emotional dimensions of patient-clinician interactions and prepares clinicians and patients to be more accepting of, and clearly communicate about, uncertainty. IMPLICATIONS FOR REHABILITATION Uncertainty pervades LBP care and is often accompanied by emotions. Neglecting complexity in LBP care may compromise person-centred care. Acknowledging uncertainty can enhance communication, balance patient-clinician relationships and address human aspects of care.

Supporting new graduate physiotherapists in their first year of private practice with a structured professional development program; a qualitative study

BackgroundThe transition from physiotherapy student to working in private practice has been identified as challenging. However, very little is known about whether structured professional development programs impact on this transition. ObjectivesTo describe new graduates’ perceptions of a structured professional development program, termed the Recent Graduate Program (RGP), designed to support their transition into physiotherapy private practice. DesignQualitative analysis of data from a one-year longitudinal mixed methods study. MethodA total of 72 interviews were conducted over a one-year period with 20 new graduates from 19 private practices within one publicly listed allied health organisation. Semi-structured interviews were conducted before commencing work and at three, nine and 12 months. Interviews were recorded and transcribed verbatim prior to a conventional content analysis that aimed to acquire direct information from new graduates without imposing preconceived categories or theoretical perspectives. FindingsNew graduates reported that the RGP supported their growth as a practitioner and facilitated their learning, particularly when complemented by the experiential learning from client interactions. The RGP met their expectations with the formal education program and regular mentoring sessions highly valued. Informal support from peers and senior clinicians, while not part of the RGP, was also perceived to facilitate their growth and confidence as a physiotherapist. ConclusionsThis study demonstrates that the provision of a structured transition program by a private practice employer was perceived by new graduates to facilitate their learning, confidence and self-efficacy. The RGP provides a useful model by which other practices may support new graduates.

Construct validity and internal consistency of the Breast Inflammatory Symptom Severity Index in lactating mothers with inflammatory breast conditions.

BackgroundInflammatory Conditions of the Lactating Breast (ICLB) affect more than one in five lactating mothers, yet no fully validated outcome measures exist to aid clinicians in their patient-centred care of women with ICLB. The Breast Inflammatory Symptom Severity Index (BISSI) is an ICLB-specific clinician administered patient-reported outcome measure, currently used by Australian clinicians, who treat mothers with ICLB. To date the BISSI has undergone partial psychometric development. This study, therefore, aimed to undertake the next stage of psychometric development by determining the construct validity and internal consistency of the BISSI.MethodsA retrospective audit was conducted on patient records of 160 mothers who were treated for ICLB, at a private physiotherapy practice in Melbourne, Australia. An electronic data capture tool was used to collate BISSI scores and associated ICLB assessment variables. Construct validity was determined through factor analysis and discriminant performance. Reliability was determined by assessing measures of internal consistency.ResultsFactor analysis established that BISSI items (n = 10) loaded on to four factors, Wellness, Pain, Physical Characteristics of Affected Area (PCAA), and Inflammation, which together, explained 71.2% of variance. The remaining item (‘Wellness/sickness unspecified’) did not load. Wellness, Pain, PCAA and Inflammation factors individually and collectively displayed the ability to discriminate symptom severity, as scores were significantly higher in mothers with high symptom severity (assessed via AUC close to or >0.7 and P value <0.005 for each factor). The BISSI demonstrated internal consistency with an overall Cronbach alpha of 0.742.ConclusionsThe BISSI has adequate construct validity, demonstrating behaviour consistent with theoretical constructs of inflammation severity, via its dimensionality and ability to discriminate symptom severity. The BISSI also has adequate internal consistency demonstrating reliability. Therefore, clinicians can have confidence that the BISSI is valid, the individual item scores are correlated, and the concepts are consistently measured.

Physiotherapy student clinical placements in Australian private practice: Patient-reported outcomes with supervised student care.

The sustainability of physiotherapy clinical placements is an ongoing challenge, yet there is potential to increase placement capacity within the private practice sector. Barriers to hosting students, including perceived impacts on patient care, reportedly limit the uptake of hosting students within this setting. This study aimed to evaluate the effect of physiotherapy student involvement on patient-reported Global Rating of Change (GRoC) in Australian physiotherapy private practice care. A cross-sectional, patient survey study was conducted in three private physiotherapy practices over two 5-week periods. At their completion of care, participants completed the survey seeking demographic information, GRoC and aspects of care including number of consultations involving students, proportion of physiotherapy time involving students and frequency of student involvement in treatment delivery. After accounting for clinic-level differences, ordinal logistic regression analyses were performed to explore the impact of supervised student care on GRoC. 119 participants across three practices completed the survey. There were no significant associations between patient-reported GRoC and: (1) student involvement in patient care; (2) number of consultations involving students; (3) proportion of physiotherapy time involving students; or (4) frequency of student involvement in treatment delivery (p>0.05). Supervised student care in private physiotherapy practice does not appear to have a detrimental impact on patient-reported outcomes. These findings may address concerns relating to student involvement in patient care within this setting. Future research should address economic and service delivery impacts of supervised student care on private practices.

Wearables-based walking program in addition to usual physiotherapy care for the management of patients with low back pain at medium or high risk of chronicity: A pilot randomized controlled trial.

BackgroundAlthough chronic low back pain (LBP) is a leading cause of disability and accounts for large costs, none of the available conventional treatments are clearly more favourable in treating people at increased risk of chronicity.ObjectivesTo examine the feasibility and initial efficacy of a wearables-based walking intervention in addition to usual physiotherapy care in people with LBP at risk of chronicity.MethodsTwenty-six adult participants, diagnosed with non-specific LBP with medium or high risk of chronicity, were recruited from physiotherapy private practices. Participants were randomized into usual physiotherapy care (control, n = 14) and usual physiotherapy care plus a wearables-based walking intervention (experimental, n = 12). The intervention duration was 8 weeks. Feasibility outcomes included recruitment rate, adherence to the intervention, dropout rate, and serious adverse events reporting rate. Other outcomes included disability and pain (primary); and physical activity level, daily walking steps, depression, pain catastrophizing and fear of movement (secondary). The outcomes were assessed at baseline, post-intervention and 26 weeks post-randomization follow-up.ResultsAdherence of experimental participants with the prescribed walking program was moderate. Four participants dropped out during the intervention, and no serious adverse events were reported. Participants in the experimental group showed significant improvement in pain at 26 weeks (β = -0.38; 95% confidence interval (CI) -0.66, -0.10; P = .013), compared with the control group. No between-group differences were found for disability at any time point and pain immediately post-intervention. Experimental participants demonstrated post-intervention improvement in light-intensity (β = 156.71; 95% CI 86.79, 226.64; P < .001), moderate-intensity physical activity (β = 0.46; 95% CI 0.12, 0.80; P = .012), and daily walking steps (β = 7099.13; 95% CI 4522.93, 9675.32; P < .001). Experimental participants demonstrated post-intervention increase in pain catastrophizing (β = 0.52, 95% CI 0.18, 0.86; P = .006). No between-group differences were found for pain catastrophizing at 26 weeks and other secondary outcomes.ConclusionUsual physiotherapy care plus a wearables-based walking intervention program was safe and moderately feasible, and provided significant reduction in pain at 26 weeks as well as increasing the total volume of light- and moderate-intensity physical activity, and daily walking steps immediately post-intervention.