Rehabilitation Physiotherapists Research Articles

Exploring what influences physiotherapists’ capability, opportunity and motivation to integrate new evidence into routine clinical care using the Balance Intensity Scale

Purpose To explore influences on the capability, opportunity and motivation of physiotherapists integrating new evidence into routine care. Materials and Methods Mixed-methods study utilising the Theoretical Domains Framework and Capability-Opportunity-Motivation-Behaviour model. Metropolitan inpatient rehabilitation physiotherapists participated by integrating the Balance Intensity Scale into routine care for 6 weeks. Evidence integration was supported by a tailored theory-informed approach. Participants completed pre- and post-evidence integration surveys and a post-evidence integration focus group. Results Pre- and post-surveys were completed by 24 and 12 participants, respectively. One focus group (n = 7) was conducted. Framework analysis identified themes in Capability (n = 4), Opportunity (n = 4) and Motivation (n = 5) domains influencing behaviour when implementing new evidence. The evidence integration process enhanced participants’ Knowledge (p = 0.04), Skills (p = 0.003) and Belief in capabilities (p = 0.03) when prescribing and measuring balance exercises. Conclusions This study identified perceived barriers and enablers to evidence integration of a new outcome measure into routine care. It highlights strategies that may support physiotherapy teams in incorporating new evidence into routine care. These strategies include education on the evidence being implemented, physical resources, change champions to facilitate social support, management endorsement, and recognition of the time and effort required for evidence integration in the short term.

Early prehabilitation reduces admissions and time in hospital in patients with newly diagnosed lung cancer.

Lung cancer is the leading cause of cancer death in the UK. Prehabilitation aims to maximise patient fitness and minimise the negative impact of anticancer treatment. What constitutes prehabilitation before non-surgical anticancer treatment is not well established. We present data from a pilot project of Early prehabilitation In lung Cancer. All new patients with likely advanced lung cancer were offered prehabilitation at respiratory clinic, if fit for further investigation. Prehabilitation included assessment and appropriate intervention from a consultant in palliative medicine, registered dietitian and rehabilitation physiotherapist. Four objective endpoints were identified, namely admissions to hospital, time spent in the hospital, treatment rates and overall survival. Outcomes were to be compared with 178 prehab eligible historical controls diagnosed from 2019 to 2021. From July 2021 to June 2023, 65 patients underwent prehabilitation and 72% of patients underwent all 3 interventions. 54 patients had a stage 3 or 4 lung cancer. In the prehab group, fewer patients attended Accident and Emergency (31.5 vs 37.4 attendances per 100 patients) and fewer were admitted (51.9 vs 67.9) when compared with historical controls. Those receiving prehab spent a lot less time in the hospital (129.7 vs 543.5 days per 100 patients) with shorter admissions (2.5 vs 8 days). Systemic anticancer treatment rates increased in the short term but were broadly similar overall. Median survival was higher in the prehabilitation group (0.73 vs 0.41 years, p=0.046). Early prehabilitation appears to reduce time spent in the hospital. It may improve survival. Further work is required to understand its full effect on treatment rates.

Barriers and facilitators of family doctor contract services in caring for disabled older adults in Beijing, China: a mixed methods study

ObjectiveTo evaluate the current state of family doctor contract services (FDCS) in Beijing, identify the roles of family doctors who have worked with disabled older adults and investigate the barriers...

Physiotherapists’ perceptions and barriers to use of telerehabilitation for exercise management of people with knee osteoarthritis in Sri Lanka

Purpose To assess physiotherapists’ perceptions and barriers to using telerehabilitation via video and telephone for exercise management for people with knee osteoarthritis (OA) in Sri Lanka. Materials and methods Currently registered and practising Sri Lankan physiotherapists who care for knee OA patients were invited to participate in a cross-sectional online survey framed according to a previous study. A logistic regression analysis was used to assess the effect of physiotherapists’ characteristics on their interest in telerehabilitation. Results A total of 268 physiotherapists completed the survey, which was broadly representative of locations and work settings across Sri Lanka. Only three out of 16 statements received majority agreement; these were that telephone-delivered care would save patients’ time (72%), save money (68%) and improve patients’ privacy (67%). There was a consensus that video-based care would save money (79%), and many favoured this medium over telephone-delivered care. Lack of experience with telerehabilitation was associated with reduced interest in telephone-delivered care. Increased interest in video-based care was associated with frequent care of knee OA patients. Most physiotherapists perceived technical issues with telerehabilitation as a significant barrier to implementing it. Conclusions Physiotherapists perceived video-based telerehabilitation more positively than care over the telephone. Reduced interest in telerehabilitation was associated with having no prior experience with it. Moreover, technical issues with telerehabilitation were perceived as the main barrier to its use. A training programme for physiotherapists, appropriate guidelines and a framework for better implementing telereahabilitation may yield substantial benefits for knee OA patients. IMPLICATIONS FOR REHABILITATION Physiotherapists in Sri Lanka perceive telerehabilitation for exercise management for knee OA patients positively. Telerehabilitation via video or telephone is a viable option for delivering exercise management for knee OA patients in Sri Lanka. The widespread practice of telerehabilitation by physiotherapists in Sri Lanka requires appropriate strategies to mitigate barriers to its implementation.

Physiotherapists’ experiences and views of older peoples’ exercise adherence with respect to falls prevention in Singapore: a qualitative study

Purpose To seek physiotherapists’ perspectives on patient adherence to exercise prescription for falls prevention/risk reduction in the Singapore setting. Method Three focus groups with physiotherapists (n = 16) were conducted. An inductive thematic analysis was performed to identify main themes by four independent researchers. Results Three main themes emerged: “it’s about the patient,” “delivery of the programme,” and “carer/family support and facilitation.” Physiotherapists believed that adherence was all about the patients’ mindset and motivation, and they had to tailor interventions to optimise adherence to cater for patients as distinct characters, with different health/cultural beliefs and ability to prioritise time. Furthermore, physiotherapists reported better patient adherence when therapy goals referred to maintaining function rather than reducing falls. Families/carers can act as facilitators while providing practical and/emotional support further enhanced exercise adherence. Conclusions Awareness of the perspectives of physiotherapists in identifying and addressing patients' adherence to exercise may better equip researchers and healthcare providers in developing culturally relevant interventions that promote exercise adherence in Singapore. Certainly, adherence varies widely among patients receiving the same treatment. Analysis of predictive factors of non-adherence will assist to tailor intervention. Implications for rehabilitation Physiotherapists believe the use of individualised approaches that adapt to patients and their health beliefs are critical for exercise adherence in older people in Singapore to prevent falls and falls risk. Adherence to exercise is multi-factorial: physiotherapists need to include attention to education, building rapport and facilitating practical and emotional family/carer support. Non-adherence is not merely a patient problem but is influenced by both clinicians and the healthcare system in Singapore/Southeast Asia.

Healthcare needs, expectations, utilization, and experienced treatment effects in patients with hereditary spastic paraplegia: a web-based survey in the Netherlands

BackgroundWe aimed to identify healthcare needs, expectations, utilization, and the experienced treatment effects in a population of Dutch patients with hereditary spastic paraplegia (HSP).MethodsWe distributed an online questionnaire among 194 adult persons with HSP in the Netherlands, of which 166 returned a fully completed version. After applying predefined exclusion criteria, 109 questionnaires from persons with pure HSP were analysed.ResultsHealthcare needs and expectations were primarily focused on the relief of muscle stiffness and reduction of balance and gait impairments (65–80%), but many participants also expressed needs regarding relief of non-motor symptoms (e.g. pain, fatigue), emotional problems, impaired sleep and self-care capacity, and participation problems (> 60%). Remarkably, despite these frequent needs, relatively few participants (< 33%) expected to be able to improve in these additional domains. Rehabilitation physicians and physiotherapists were more frequently consulted than neurologists and occupational therapists, respectively. Physiotherapy was the most often proposed non-pharmacological intervention (85%), followed by orthopedic footwear (55%) and splints (28%). Approximately one third of the participants was never offered any pharmacological (spasmolytic) treatment. Spasmolytic oral drugs, injections, and intrathecal baclofen were given to 41%, 26%, and 5% of the participants, respectively. Independent of the type of pharmacological intervention, 35–46% of these participants experienced decreased spastiticy and improved general fitness. Other experienced effects differed per type of intervention.ConclusionsBased on this web-based survey in the Netherlands, there seems to be ample room for improvement to meet and attune the healthcare needs and expectations of people with HSP concerning both their motor and non-motor symptoms and functional limitations. In addition, the provision of adequate information about non-pharmacological and pharmacological interventions seems to be insufficient for many patients to allow shared decision making. These conclusions warrant a more pro-active attitude of healthcare providers as well as an interdisciplinary approach for a substantial proportion of the HSP population, also involving professionals with a primary occupational and/or psychosocial orientation.

Control Strategy and Experimental Research of Cable-Driven Lower Limb Rehabilitation Robot

The passive training with fixed trajectory is more suitable for the initial rehabilitation training of patients with no muscle strength in the affected limb. In order to meet the needs of patients' rehabilitation training in different rehabilitation stages and improve the active participation and rehabilitation training effect of patients, a fuzzy sliding mode variable admittance (FSMVA) controller based on safety evaluation and supervision is proposed for the cable-driven lower limb rehabilitation robot (CDLR) in this paper. The FSMVA controller consists of an inner loop fuzzy sliding mode controller, an outer loop variable admittance controller, and a safety evaluation and supervision module. Through the safety evaluation index of the CDLR system and the comprehensive evaluation of patients' rehabilitation effect given by rehabilitation physiotherapists, a real-time adjustment algorithm of variable admittance controller parameters is designed, which can realize the real-time switching of training modes and adjustment of variable admittance controller parameters in active training mode and passive training mode. The trajectory tracking experiments with no admittance, fixed admittance, and variable admittance based on safety evaluation and supervision were carried out on the experimental platform. The experimental results show that the proposed FSMVA control strategy has high position control accuracy in the active training mode. In addition, the training intensity and the active participation of patients can be increased according to the patient's exercise ability. In the passive training mode, according to the training needs of patients, the amount of the trajectory adjustment can be increased to improve the comfort of the training process and the safety of patients. It lays a foundation for the further study of the evaluation system of the rehabilitation training process and the experiment of human-machine interaction compliance.

Management of whiplash-associated disorder in the Italian emergency department: the feasibility of an evidence-based continuous professional development course provided by physiotherapists

Purpose The management of whiplash and associated disorders (WAD) in the Italian Health System is still empirical and influenced by a single professional’s expertise. Therefore, the purpose of our study is to describe a structured management changes in an Italian emergency department (ED) after an evidence based continuous professional development (CPD) course. Methods A CPD course was organized by Orthopedic Manipulative Physical Therapists (OMPT) for personnel of ED in the hospital Girolamo Fracastoro (San Bonifacio, Verona, Italy), based on latest scientific evidence. Data regarding the number of X-Rays, computed tomography (CT) scan, orthopaedic referrals, neck collars and WAD IV (i.e., severe diagnosis) before and after the course were compared. Results 3066 cases of WAD have been analyzed in 2016 and 2185 in 2017/2018. The number of X-Rays dropped down from 15.1% to 13.5%; the CT scans increased from 1.3% to 1.9%; the WAD IV diagnosis increased from 0.7% to 1.6%; the orthopaedic referrals dropped from 1.5% to 1.1%; the collars prescription dropped from 8.8% to 2.5%. Conclusion An updated framework increased the efficiency of ED’s maintaining the same level of safety (i.e., WAD IV diagnosis). Given that, it can also be argued that, in line with other countries, the implementation of an OMPT role within the ED multidisciplinary team is advised also in Italy. Implications for rehabilitation Physiotherapists were commissioned to organize a management change of patients in an Italian Emergency Department clinical setting for the management of whiplash; Guidelines and other appropriate clinical rules facilitate the delivery of an evidence-based and more appropriate management and care plan; An inter-disciplinary continuous professional development course has the potential to positively influence patients’ journey and to optimize the use of departmental resources; The involvement of other health professionals (e.g., Physiotherapists) within the Italian Emergency Department organizational chart might lead to further improvement of service provided.

SPORTS STARS: a practitioner-led, peer-group sports intervention for ambulant, school-aged children with cerebral palsy. Parent and physiotherapist perspectives

Background Sports participation is an important goal for children with cerebral palsy classified at GMFCS Level I or II, however there are no studies of parent or physiotherapist perspectives on effectiveness or overall acceptability of transition-to-sports interventions. Methods Parent and physiotherapist perspectives of Sports Stars: a novel, practitioner-led, peer-group sports intervention (Trial registration: ACTRN12617000313336) were collected from Sports Stars Session Reports (39 children, 6–12 years, GMFCS I = 11, II = 28, Female = 12), Fidelity Evaluations (28 children), and Perspectives Surveys (Parents = 29, female = 26; Physiotherapists = 8, female = 5). Outcomes were perceived impact on: (1) sports Participation (Attendance, Involvement), (2) sports Activity Competence across Physical, Social, Cognitive and Psychological Physical Literacy domains and (3) overall acceptability. Results Over 84% of children Attended most sessions. Physiotherapists rated session Involvement as high (median = 3/4). In Session Reports, physiotherapists recorded quantitative improvements in Physical and Cognitive performance and described improvements across all domains. Parents reported improvements across all domains, with comments focusing on Social and Psychological performance. All physiotherapists (8/8) and most parents (26/29) reported a community-based peer-group was the intervention design of choice for sports-focused goals. Conclusions Parents and physiotherapists perceived Sports Stars, a practitioner-led, peer-group sports intervention, as effective and acceptable for children with cerebral palsy with sports-focussed goals. IMPLICATIONS FOR REHABILITATION Parents and physiotherapists agree that Sports Stars improved sports Participation and Physical, Social, Psychological and Cognitive Activity Competence for children with cerebral palsy. Children with sports-focused goals should be offered practitioner-led, peer-group sports interventions in community environments. Therapists should design sports interventions with Physical, Cognitive, Social and Psychological content and outcomes.

Physical activity referral to cardiac rehabilitation, leisure centre or telephone-delivered consultations in post-surgical people with breast cancer: a mixed methods process evaluation

BackgroundPhysical activity (PA) programmes effective under ‘research’ conditions may not be effective under ‘real-world’ conditions. A potential solution is to refer patients to existing PA community-based PA services.MethodsA process evaluation of referral of post-surgical patients with early-stage breast cancer to cardiac rehabilitation exercise classes, leisure centre with 3-month free leisure centre membership or telephone-delivered PA consultations for 12 weeks. Quantitative data were collected about PA programme uptake and reach, patient engagement with the PA programme, delivery and fidelity and PA dose. Qualitative data were collected about patient experiences of taking part in the PA programmes. Audio-recorded qualitative interviews of participants about the programmes were analysed thematically. Quantitative data were reported descriptively using means and SD.ResultsIn Phase I, 30% (n = 20) of eligible patients (n = 20) consented, 85% (n = 17) chose referral to leisure centre, and 15% (n = 3) chose cardiac rehabilitation. In Phase II, 32% (n = 12) consented, 25% (n = 3) chose leisure centre and 75% (n = 9) chose telephone-delivered PA consultations. Walking at light intensity for about an hour was the most common PA. All Phase I participants received an induction by a cardiac rehabilitation physiotherapist or PA specialist from the leisure centre but only 50% of Phase II participants received an induction by a PA specialist from the leisure centre. Four themes were identified from qualitative interviews about programme choice: concerns about physical appearance, travel distance, willingness to socialise and flexibility in relation to doing PA. Four themes were identified about facilitators and barriers for engaging in PA: feeling better, feeling ill, weight management, family and friends.ConclusionsThe current community-based PA intervention is not yet suitable for a definitive effectiveness randomised controlled trial. Further work is needed to optimise PR programme reach, PA dose and intervention fidelity.Trial registrationISRCTN11183372.

ВИКЛАДАННЯ ДИСЦИПЛІН НА КАФЕДРІ ФІЗИЧНОЇ РЕАБІЛІТАЦІЇ, ЗДОРОВ`Я ЛЮДИНИ ТА ФІЗИЧНОГО ВИХОВАННЯ ЗА НАПРЯМОМ ПІДГОТОВКИ “ЗДОРОВ’Я ЛЮДИНИ”

&lt;p&gt;Реабілітація є одним із основних напрямків у системі охорони суспільного здоров’я і включає державні, соціально-економічні, психологічні, медичні, професійні, педагогічні та інші заходи, що спрямовані на лікування та попередження захворювань. На даний час в державі відсутня система підготовки спеціалістів з фізичної реабілітації з вищою медичною освітою, які могли б надати кваліфіковану медичну допомогу хворим для досягнення ними максимальної фізичної повноцінності. Сьогодні окремі функції з фізичної реабілітації виконують лікарі-фізіотерапевти та лікарі з лікувальної фізкультури. Але це не відповідає сучасним вимогам до фахівця з фізичної реабілітації. &lt;/p&gt;

Executive dysfunction post-stroke: an insight into the perspectives of physiotherapists

Purpose: To gain an understanding of physiotherapy practice in relation to executive dysfunction (ED) post-stroke. Method: Three focus groups were conducted using semi-structured interview schedules to highlight how ED post-stroke was understood by 12 physiotherapists with greater than 1 year of experience working in the area of stroke care. The focus group data were analysed using qualitative data analysis. Results: The themes extracted from the data on physiotherapists’ self-reported knowledge of ED post-stroke were: physiotherapists’ lack of knowledge of ED post-stroke; current physiotherapy practice regarding ED post-stroke; the negative impact of ED on physiotherapy rehabilitation post-stroke and the future learning needs of physiotherapists regarding ED post-stroke. Conclusions: Current results demonstrate that ED has negative implications for physiotherapy rehabilitation post-stroke. Although further interdisciplinary research is warranted, the present results suggest that physiotherapists should be aware of the presence of ED in people post-stroke and develop strategies to minimise the impact of ED on physiotherapy rehabilitation.Implications for RehabilitationPhysiotherapists report a lack of knowledge of ED post-stroke and a requirement for future learning and training regarding the optimal management of people with ED undergoing physiotherapy rehabilitation post-stroke.ED has negative implications for physiotherapy rehabilitation post-stroke and physiotherapists should be aware of the presence of ED in people post-stroke and develop strategies to minimise the impact of ED on physiotherapy rehabilitation.

Role of rehabilitation physician and physiotherapist in the classification in disabled sports, an example: Paracycling

Role of rehabilitation physician and physiotherapist in the classification in disabled sports, an example: Paracycling

From physical and functional to continuity with pre-stroke self and participation in valued activities: A qualitative exploration of stroke survivors’, carers’ and physiotherapists’ perceptions of physical activity after stroke

Purpose: Physical activity (PA) improves fitness, functioning, health and wellbeing after stroke. However, many survivors are inactive. This study explored survivors’, carers’ and physiotherapists’ beliefs about PA to identify how these support or hinder PA participation. Methods: Semi-structured in-depth interviews with community dwelling stroke survivors (n = 38); two focus groups involving six carers each; two focus groups, respectively, involving seven and eight stroke rehabilitation physiotherapists from clinical and community settings. Data were audio-recorded and transcribed. Analysis was structured using the Framework Approach to identify themes and a dynamic, conceptual model. Findings: Desired outcomes and control over outcome achievement were key concepts. For survivors and carers, PA supported participation in valued activities, providing continuity with pre-stroke sense of self. Carers adopted motivating strategies for PA to support recovery and participation in shared activities. In contrast, physiotherapists prioritised physical and functional outcomes and viewed survivors’ control of outcomes as limited which was reflected by the support they provided. Conclusions: Individualised interventions that account for social and environmental influences on behaviour appear vital to enabling survivors to participate in meaningful physical activities. Such interventions should facilitate development of shared perspectives among physiotherapists, carers and survivors of PA and related outcomes and provide tailored strategies to facilitate PA participation.Implications for RehabilitationPhysical activity after stroke rehabilitation is important for fitness, health, functioning and well-being.Reasons for survivors participating or not in physical activity after stroke are complex and varied.Physiotherapists and carers influence survivors’ participation in physical activity but their views about how to do this do not always match, or do they always complement the views of survivors.Integrated approaches to supporting physical activity that account for survivors’ preferences and recognise the carers’ role should be developed and applied by physiotherapists and other health professionals.

The injured worker's role in the recovery process

The injured worker himself is provides the most powerful of all healing and recovery forces, and yet is the most ignored in contemporary disability management practice. The well-meaning attempts to assist the worker return to work by health professionals may actually be prolonging his disability. It's very difficult for most health professionals to step outside the heath professional paradigm and remember that the injured worker is the entity most capable of recovery, and most responsible for it. If the health professional is “ working harder than the injured worker”, the chances of a successful outcome are minimised. Associating with other professionals by way of referrals, team management practices make it even harder to step outside the health professional paradigm of “we know what's best for you.” The advantage of “encouraging”, “allowing”, “permitting” the injured worker to take the lead role in his own recovery is that the worker can resume the central place in his own life and not become beholden to others. Self-determination in recovery is the principal method whereby an injured worker offsets the psycho-social elements of the cause of, and the recovery from, any workplace injury. Psycho-social reasons are the principal reasons why a person becomes injured in the first place and takes longer to recover than he might otherwise do. Without placing the psycho-social element in a place of prominence, much input by Rehabilitation Providers, Physiotherapists, Physicians and other health professionals is not only ineffective, but contributing to the very psycho-social elements which caused the problem in the first place. Allowing the injured worker to take responsibility for his own recovery is vital to this recovery and preventing injury in the future. Health professionals need to be constantly vigilant that their input is contributing to the injured worker helping himself, and not usurping that role.

A pilot randomized controlled trial of an early multidisciplinary model to prevent disability following traumatic injury

Purpose: Chronic pain, posttraumatic stress disorder (PTSD), and depression are common outcomes following traumatic injury. Yet, screening and early intervention to prevent the onset of these disorders do not occur routinely in acute trauma settings. This pilot study examined the clinical utility of screening and early multidisciplinary intervention for reducing disability following traumatic injury. Method: 142 non-severe head injured trauma inpatients (26% female, Injury Severity Score M = 9.65, M age = 36 years) were assessed for injury-related factors, pain, and psychological function within 4 weeks post injury. Patients were randomly allocated to a Multidisciplinary Intervention (MI) or Usual Care (UC) group. MI patients received assessment and treatment at one and 3 months post injury from pain and rehabilitation medicine doctors, physiotherapists, occupational therapists, and clinical psychologists. Outcomes at 6 months were then compared. Results: Acute pain intensity, posttraumatic adjustment, depression and acute trauma symptoms, and alcohol use predicted a significant 26%, 49%, 56%, and 30% of the variance in pain, depressive, and PTSD severity, and physical mobility respectively at 6 months. Despite MI group patients reporting no improvement in the severity of pain and psychological symptoms, these patients reported significantly improved relief from pain symptoms as a result of treatment at 6 months. Twenty four per cent of the UC group initially below the cut-off for being at risk of developing PTSD/Depression received new clinical diagnoses at 6 months compared with none of the ‘not at risk’ MI group attendees who remained asymptomatic. Conclusions: Early findings point to the value of early screening to identify patients at risk of treatable pain, physical, and psychological impairments. Moreover, early multidisciplinary intervention models following traumatic injury show promise for protecting against the onset of posttraumatic psychological disorders.Implications for RehabilitationThe prevalence of chronic pain, posttraumatic stress and depressive disorders, and functional disability is high following traumatic injury.Standardized screening within acute trauma settings can identify patients are highest risk of long-term physical and psychological disability.Coordinated early interventions conducted by acute trauma, pain and rehabilitation teams working in collaboration show promise for reducing long-term disability among recently injured trauma patients.

Community ambulation: Perceptions of rehabilitation physiotherapists in rural and regional communities

Research has highlighted the impact of the external environment on the ability to walk in the community but little research exists about the abilities, skills, or contextual factors that physiotherapists identify as important to enable a client to return to walking in their rural or regional community. This article investigates the abilities, skills, and contextual factors that rehabilitation physiotherapists practicing in rural and regional communities in Australia perceive significant in enabling clients post stroke to return to walking in their rural or regional community. Physiotherapists involved in treating clients with stroke were interviewed about their perceptions of the skills and abilities required by clients post stroke with a mobility problem that are significant in enabling a return to walking in the community. Data were interpreted by using a grounded theory methodology that involved coding and analysing observational notes and interview transcripts to develop an understanding of the emergent themes. Six key themes were identified: 1) ability to walk at speed and physical fitness, 2) the ability to negotiate different terrains, 3) ambient conditions, 4) the ability to reason and monitor the environment, 5) to have support of a person or aid, and 6) to have the drive (internal and external) to walk in the community. Some of these abilities are described in the current literature, but others are not. The findings of this research will add to the existing body of knowledge on physiotherapist's decision making around the emerging topic of community ambulation.

Workplace stressors experienced by physiotherapists working in regional public hospitals

To identify and measure the effects of workplace stressors experienced by Victorian regional physiotherapists. Survey questionnaire. A questionnaire was distributed to three Victorian regional public physiotherapy departments and data were collected from 80 physiotherapists. The type and frequency of workplace stressors, the nature and frequency of common signs and symptoms of stress and the amount of leave taken as a result of stress were measured. Caseload quantity, complexity of patients, constant excessive workload, covering staff on leave and staff shortages, were reported as key workplace stressors. Physiotherapists aged between 20 and 29 years were significantly more likely to report a higher number of workplace stressors (F = 4.173, n = 80, P = 0.009). Inpatient rehabilitation physiotherapists were significantly more likely to report stress at a higher frequency than physiotherapists working in other areas (chi(2) = 14.359, n = 73, P = 0.002). Eleven per cent of all respondents reported taking leave from work as a result of stress with no significant difference identified between those who took leave and those who did not. There was, however, a trend identified with senior staff (Z = 1.792, n = 80, P = 0.073) and those who work in inpatient rehabilitation (chi(2) = 6.926, n = 80, P = 0.074) being more likely to take leave as a result of stress. Many of these physiotherapists did not make their employers aware of the reasons for the leave (77%, n = 9). High caseloads, periods of increased activity and staff shortages are some of the factors that contribute to stress in regional physiotherapists. Younger therapists were more likely to identify stressors with greater frequency. Strategies to monitor, prevent and manage stress should be implemented to minimise burnout in regional physiotherapists.

A perspective on disability and rehabilitation

This paper is written in honor of the memory of the late Jules Rothstein, editor in chief “emeritus” of the Physical Therapy (the journal of the American Physical Therapy Association - APTA) who passed away on the 27-08-2005. It is fitting to dedicate a paper on disability to Dr. Rothstein, as he himself likened disability with the identity of physiotherapy. A paper focusing on disability at this time might be the wake up call needed to make physiotherapists heed the African decade of the disabled person, which is more than halfway through. The paper highlights the problem of sparse evidence in rehabilitation and emphasizes the need for an evidence-based approach to rehabilitation. Practical suggestions for the implementation of EBP in rehabilitation using the International Classification of Functioning, Disability (ICF) as a framework are proposed. This paper is envisaged to enthuse rehabilitation physiotherapists to embrace EBP, so that their focus is redirected to the ‘eradication of disability’.

Study protocol: Home-based physical rehabilitation for survivors of a critical illness [ACTRN12605000166673

IntroductionNumerous primary studies and several review papers have highlighted delayed physical and psychological recovery for survivors of critical illness, often beyond 6 months after discharge. This randomized controlled trial with blinded assessment aims to test the effects of an 8-week, home-based, individually tailored physical rehabilitation programme on physical and psychological recovery for survivors of a critical illness after discharge from hospital.MethodParticipants are survivors of a critical illness discharged from nine intensive care units (ICUs) in Australia, who are aged 18 years or older, in an ICU longer than 48 hours, discharged home to self-care or carer (non-institutional care), able to participate in physical rehabilitation, and within the hospitals' local geographical areas for home visits. The study is based in participants' home environments. Blinded assessments at weeks 1, 8 and 26 after hospital discharge examine physical functioning, exercise capacity, health-related quality of life and psychological well being. The intervention is graded, individualized endurance and strength training prescribed by a pulmonary rehabilitation physiotherapist over an 8-week period, with three home visits, five follow-up phone calls, and a printed exercise manual supporting the training. Initial focus is on lower limb exercises and walking, with warm-up stretches, and progresses to the addition of core stabilization and upper limb exercises.ResultsThe burden of a critical illness is well documented. This novel study will determine whether a home-based physical rehabilitation programme improves the recovery trajectory for survivors of critical illness. The projected sample size of 200 patients aims to detect a clinically important 10% improvement in physical functioning. The study will also examine whether other important physical and psychological measures are improved.ConclusionThis multicentre, randomized controlled trial will examine outcomes that are meaningful to patients, their family and society, namely functional ability and well being. The study will also target a health problem that is likely to increase as the population ages. If the programme is effective, it will provide a model that can be easily adapted and adopted by existing primary care or community services to improve the recovery of individuals following critical illness.