Senior Physiotherapists Research Articles

Combined exercise Intervention protocol validation in sedentary workers health risk with Nonspecific Chronic low back pain People

Background: Most chronic low back pain is nonspecific as the cause of the pain is unknown. Hence exercise protocol focussing on one area of fitness is not appropriate. A general exercise programme that combines muscular strength, flexibility and aerobic fitness would benefit the rehabilitation of Nonspecific Chronic Low Back Pain and its health risk. The present study aimed to validate the content of the combined exercise intervention protocol. Methods: The development and expert judgement stages are part of the content validation process. The development of the exercise protocol was based on a comprehensive literature review. The protocol was created in a step-by-step progressive manner. Exercises for flexibility (20 minutes), stabilisation and strengthening (20 minutes), and aerobic (20 minutes) make up the three main parts of the exercise protocol. 12 independent professionals with a minimum of 10 years of experience were invited. Ten of the twelve specialists consented to take part in the study. In India, all of the professionals were engaged in orthopaedic and musculoskeletal physical therapy. There are two professors, three associate professors, and five senior physiotherapists among the experts. Responses were gathered by mail. During the validation phase, The Exercise protocol was graded by the experts on relevance and ease of performance using a 5-point scale. After collecting the responses content validity index and kappa values were calculated. Results: 37 out of 39 items in the combined exercise intervention protocol showed good agreement. Treadmill walking with 60-75% and 80% and above target heart rate showed a kappa value of 0.66 for relevance and 0.50 for ease of performance. Conclusions: The designed exercise protocol exhibited good content validity.

Explorations of strategies for inclusion for newly qualified physiotherapists from racially minoritised groups in a large, urban NHS Trust, UK

ObjectivesThe study aimed to i) understand the experiences of newly qualified physiotherapists from racially minoritised backgrounds in a large hospital physiotherapy department and ii) co-create and implement inclusive strategies to affect work culture. DesignThe project used an action research design with co-creation principles and was in 3 phases. Phase 1 explored the experiences of inclusion for newly qualified racially minoritised staff, using focus groups and transcripts analysed thematically. The themes identified were used to co-create strategies for inclusion that were implemented in Phase 2 and evaluated Phase 3. SettingA large urban teaching hospital physiotherapy department in the UK. ParticipantsParticipants were invited to join focus groups for newly qualified racially minoritised staff, newly qualified white staff, or senior staff. ResultsPhase 1 findings are reported here, while phases 2 and 3 are reported elsewhere. Seventeen newly qualified physiotherapists (eight racially minoritised, nine white colleagues) and ten senior physiotherapists participated in seven focus groups. Thematic analysis identified four themes; 1) Fear spectrum: all colleagues struggled to find a common ground for discussing race, 2) Race as an additional burden for racially minoritised staff in belonging in the department, 3) Contradiction between the organisation culture and impact on racially minoritised staff, and 4) Consistent work practices give an illusion of inclusion. ConclusionsThe findings reflect previous studies that racially minoritised physiotherapists experience additional burdens not fully understood by their white peers. There are implications for the department which are currently being enacted and evaluated and will be reported elsewhere. Contribution of the Paper•Racism in the workplace continues to limit a sense of belonging for racially minoritised physiotherapists.•All physiotherapy colleagues experience a fear of discussing race in the workplace that has implications for inclusion.•Existing policies and structures in the physiotherapy workplace give an illusion of inclusion, but lack racial equity.

Minimum standards of clinical practice for physiotherapists working in critical care units in Ireland: a modified Delphi technique

INTRODUCTION: Physiotherapists in Irish hospitals with critical care units deliver physiotherapy services 24 hours a day, seven days a week. There is a perceived lack of consistency in the level of clinical competence, required skills and content of training between hospitals, compounded by the absence of a national policy, procedure or clinical framework for physiotherapists working in critical care. The study aimed to identify the minimum standards of clinical practice expected of physiotherapists working in critical care settings in Ireland. METHODS: A modified Delphi technique was used to survey a panel of senior and clinical specialist physiotherapists working in critical care units in Ireland to obtain consensus of items. The questionnaire of 214 items was completed over three rounds. Items were determined ‘Essential/Not Essential/Unsure’ by participants. Items that did not reach consensus were included in the subsequent round with additional items suggested by participants. RESULTS: 25/46(54%) physiotherapists completed the first round, with 17 and 13 completing round 2 and round 3 respectively. A total of 220 items were included, 120 of which were deemed essential for a minimum standards of independent clinical practice in Irish critical care units. Fifty-six items were considered not essential while consensus was not reached on 44 items. CONCLUSIONS: This study identified 120 items of knowledge and clinical skills considered essential as a minimum standard by physiotherapists working in Irish critical care units. Further discussion is required to determine how these results can be applied to guide clinical practice for physiotherapists working in critical care in Ireland.

Physiotherapy practices when treating patients with COVID-19 during a pandemic: A survey study

Background Specific details pertaining to the clinical and other challenges faced by physiotherapists managing patients with COVID-19 during the pandemic are still largely unknown.Objectives To determine how physiotherapists clinically managed patients with COVID-19 in a hospital-based setting during the pandemic and to identify the personal and professional effects of working as a physiotherapist at this time.Methods Self-administered electronic cross-sectional survey. Participants included physiotherapists from around the world involved in the clinical management of patients with COVID-19.Results Of the 204 participants who returned the questionnaire, 39% worked as senior physiotherapists, 29% as consultant or specialist physiotherapists, 23% as general physiotherapists and 4% as graduate physiotherapists. Seventy-two percent of participants worked in the intensive care unit. The largest barrier to treating patients with COVID-19 was a lack of intensive care trained physiotherapists (70%). Eighty-three percent of participants reported performing activities outside of their typical work duties, including proning patients (55%), tutoring and advising other staff in the intensive care unit (55%) and adjusting or changing ventilator settings (52%). Almost all participants (90%) reported being aware of physiotherapy specific guidelines for treating patients with COVID-19, yet most participants performed techniques that were not recommended.Conclusions The experience of the pandemic highlighted the need for specialist training and availability of experienced cardiorespiratory physiotherapists to manage patients with COVID-19, specifically in intensive care. Furthermore, clear guidelines on the management of patients with COVID-19 should be established to ensure optimal management of patients and ensure the safety of physiotherapy staff.

The type and scope of physiotherapy is under-utilised in Australian residential aged care facilities: a national, cross-sectional survey of physiotherapists

BackgroundWith an increasingly ageing population in Australia, more older adults who are frail are living in residential aged care facilities (RACFs). The aim of this study was to detail the type, scope, and funding of physiotherapy utilised in Australian RACFs.MethodsRegistered physiotherapists (n = 219, 72% female, mean age (SD) = 38.6 (12.9) years) working in Australian RACFs participated in a nationwide, cross-sectional online survey. The survey was developed iteratively through a review of the literature and clinical guidelines, consensus of final survey items by an expert panel of five senior physiotherapists and aged care managers. Survey questions related to the characteristics of the physiotherapists (e.g., age, gender, employment status), characteristics of the RACFs (e.g., state, remoteness, sector), the type and scope of physiotherapy provided by respondents, and the availability of equipment and certain spaces (e.g., gyms) in the RACFs that respondents worked in. Survey responses were analysed and presented descriptively. Correlation using Spearman’s rho (ρ) and the associated 95% confidence intervals (CI) were used to determine whether the availability of equipment or space at the RACF was associated with the time dedicated to performing non-Aged Care Funding Instrument (ACFI) tasks.ResultsCommon reasons for physiotherapy referral were chronic pain management as per the ACFI framework (89.7%), falls (69.2%), and reduced mobility (35.9%). Rehabilitation or short-term restorative care was provided in only 22.2% of the facilities. The ACFI funded 91.4% of all participants, which limited physiotherapists to low-value chronic pain management including massage and electrical stimulation. Respondents spent 64.5% of their time on ACFI tasks, which equated to 19 h per week. More time was spent on non-ACFI tasks particularly when resistance bands (ρ = 0.28, 95%CI 0.14–0.41) and a dedicated therapy space or gym (ρ = 0.19, 95%CI 0.04–0.33) were available.ConclusionsThe expertise of physiotherapists is currently being under-utilised in Australian RACFs, which may be related to the availability of public funding, equipment, and space for therapy. Therefore, public health policy should address the urgent need for high-value, evidence-based physiotherapy that supports the reablement and independence of older adults living in RACFs.

Assessment and monitoring of Achilles tendinopathy in clinical practice: a qualitative descriptive exploration of the barriers clinicians face

Our primary objective was to explore the barriers preventing clinicians from implementing what they think is ideal practice as it relates to using tools to aid diagnosis and monitor progress...

Evaluating the accuracy of predicting discharge date post hip surgery using pre-morbid function

Purpose: Prior to this service evaluation, senior physiotherapists completed a service development which identified the New Mobility Score (NMS) as an efficient outcome measure to predict realistic and evidence-based discharge dates on the day of hip surgery, based upon pre-morbid function. This project aims to evaluate the reliability of setting estimated discharge dates (EDD) using the NMS, by objectively measuring patients’ function on their EDD using the Barthel Index (BI).

Risk factors for burnout and depression in healthcare workers: The national AMADEUS study protocol

ContextBurnout is an international phenomenon defined as a state of professional exhaustion. It can lead to depression and have major economic and organizational impacts. Previous studies of healthcare professionals in France have focused on physicians, but none to date have explored other healthcare professions. ObjectivesThe main objective of our study is to determine the prevalence of burnout among healthcare workers. The secondary objectives are to explore the associations of burnout with professional and psycho-social factors and the risk of depression, professional harassment, sexual harassment, sexual-orientation based discrimination, consumption of antidepressants, anxiolytics and also the lifestyle of the individual: smoking, alcohol consumption, coffee consumption, physical activity and sleep quality. Materials and methodsThe survey will take the form of a voluntary and anonymous online questionnaire carried out on the FramaForm1® platform and will be disseminated via social networks, professional networks and mailings. Study PopulationSenior doctors, interns, directors of care, nurses, head nurses and senior head nurses, physiotherapists and occupational therapists, dieticians, radiology technicians, laboratory technicians, psychologists, nurses’ aides, auxiliary nurses and midwives will be included. Collected dataBurnout will be measured with the Maslach Inventory burnout (MBI) questionnaire, work environment with the Karasek questionnaire and anxiety, depression risk with the Center for Epidemiologic Studies- Depression (CES-D), physical activity with the Global Physical Activity Questionnaire (GPAQ) and sleep quality with the Pittsburgh Sleep Quality Index (PSQI). EthicsThis protocol has been accepted by the ethical committee (IRB n°C08/21.01.06.93911, CNIL). Expected resultsBased on international studies, we expect a high rate of burnout with disparities according to profession, socio-demographic data, seniority and type of service. We also expect a significant rate of untreated depression. This study will provide evidence for policy makers to implement collective strategies to reduce burnout and depression in the different populations studied.

Psychological, social and lifestyle screening of people with low back pain treated by physiotherapists in a National Health Service musculoskeletal service: an audit

Purpose Psychological, social and lifestyle (multidimensional) factors predict low back pain (LBP). The Short Form Örebro Musculoskeletal Questionnaire (SFÖQ) helps clinicians identify these factors in people with LBP and was mandated in a physiotherapy department at one NHS Hospital Trust in the UK. This study examined (i) use of the SFÖQ by physiotherapists with varying levels of clinical experience; (ii) whether psychological, social, and lifestyle factors were documented in patient records; and (iii) physiotherapists views on using the SFÖQ, and screening for these factors. Methods A retrospective audit of the physiotherapy records of 100 people referred with LBP. Results Eighty-one patient records were eligible for analysis. The SFÖQ was completed in 52 records. Fourteen of the completed SFÖQ’s were used by physiotherapists. Screening for, and documentation of, multidimensional factors varied between factors ((i) psychological: cognitive (20%), emotional (26%); (ii) social (41%) and (iii) lifestyle (62%)). 67% of the most senior physiotherapists screened and documented emotional factors. Physiotherapists identified a lack of training, confidence and time as barriers to screening for multidimensional factors and using the SFÖQ. Conclusion Physiotherapists rarely used the SFÖQ and did not consistently screen or document multidimensional factors. However, more senior physiotherapists more consistently screened and documented emotional factors.

Challenges and opportunities in point-of-care ultrasound: A qualitative exploration of respiratory physiotherapists' experiences of lung ultrasound training and its adoption in critical care.

Diagnostic lung ultrasound (LUS) is gaining popularity among respiratory physiotherapists as an imaging modality to aid pulmonary assessments, guide intervention selection, and monitor the efficacy of chosen interventions. The ability of respiratory physiotherapists to incorporate LUS into their clinical practice is influenced by multiple factors to adoption and implementation. The aim of this study was to explore the experiences of senior respiratory physiotherapists who have attempted to adopt and implement LUS into their clinical practice in critical care. It is hoped these experiences will inform the development of educational and adoption strategies for the future implementation of LUS. Following a national call out, eight senior critical care respiratory physiotherapists were purposively selected to be interviewed using semi-structured questions exploring their varied experiences of LUS adoption into clinical practice in critical care. The transcribed data were thematically analysed. Five main themes emerged from the participants' responses: (i) support for physiotherapists using LUS, (ii) knowledge and understanding of LUS evidence, (iii) governance, (iv) physiotherapists' motivation to use LUS, and (v) resources. Quotes for each of the five themes are given as exemplars. Participants reported a range of factors that influenced their ability to adopt and implement LUS into practice several were enabling, and others were barriers to progress. Online Appendix 1 contains recommendations from the authors to help guide managers and clinicians wishing to adopt LUS into respiratory physiotherapy services and patient pathways.

Clinicians’ experiences of discontinuing routine hip precautions following total hip replacement surgery: a qualitative analysis

Purpose Hip precautions are routinely provided in the UK, despite evidence suggesting that they are no longer needed. A change in practice was introduced into an orthopaedic service whereby the provision of routine hip precautions was discontinued for selected individuals receiving a primary total hip replacement. The change involved implementing a new regime of “no precautions” which was facilitated using a number of key strategies. The aim of this study was to explore the experiences of clinicians associated with the change in practice. Material and methods Individual semi-structured interviews were conducted with clinicians who had experience of delivering both hip precautions and no hip precaution regimes. Data were analysed thematically. Results Ten orthopaedic staff (two senior occupational therapists, one occupational therapy support worker, three senior physiotherapists, two surgeons, and two senior nurses) were interviewed. Three main themes were identified: changes experienced, perceptions of the new regime, and challenges experienced. Conclusion Several barriers and facilitators to the successful changeover were identified. Successful strategies in changing practice included assigning “Hip Champions”, staff education and targeted training. It is proposed that holding multidisciplinary education and training would be the ideal model. Implications for rehabilitation Key strategies for changing practice were educating staff and providing targeted training. Multidisciplinary training might prevent discrepancies in the advice given to patients. Appointing “Hip Champions” provided clear role models and enabled new clinical behaviours to be enforced.

Physiotherapists' perceptions of collaborations with inter-professional team members in an ICU setting.

Background In the intensive care unit (ICU) environment, inter-professional team collaborations have direct impact on patient care outcomes. Current evidence shows that providing physiotherapy to ICU patients shortens their length of stay and reduces their incidence of ventilator associated pneumonia and severity of critical illness neuropathy. Physiotherapists’ perceptions of their interactions with nurses and doctors as inter-professional team members in the ICU is important. Objectives To identify barriers and enablers of physiotherapists’ interactions with inter-professional team members in adult ICU settings, identify solutions to the barriers and determine if perceptions of interactions with ICU team members differ between junior and senior physiotherapists. Methods A qualitative study was done using semi-structured group discussions. Participants were recruited using convenience sampling. Participants were junior and senior physiotherapists from four private and four public sector hospitals in urban Johannesburg, South Africa. Interviews were audio recorded. Recordings were transcribed and direct content analysis of data was done to create categories, subcategories and themes. Results Twenty-two junior and 17 senior ICU physiotherapists participated in the study. Barriers raised by physiotherapists regarding communication with inter-professional team members in the ICU were non-ICU trained staff working in ICU, personality types, lack of professional etiquette, and frequent rotation of ICU staff. Enablers of communication with inter-professional team members were presence of team members in ICU during the day, good time management, teamwork approach to care and sharing of knowledge. Differing paradigms of teamwork among health professionals was highlighted as a cause of tension in the ICU inter-professional collaborations. Conclusion Physiotherapists are important members of the inter-professional ICU team. Exploring their interactions with other team members identified solutions that may improve collaboration between inter-professional team members to facilitate improved patient outcomes. Inter-professional education should inform ICU policies to create an environment that fosters teamwork. Finding creative ways to adequately staff the ICU without losing quality or driving up costs of care are matters that should take priority among policy makers. Contributions of the study Physiotherapists are essential and strategically placed in the ICU to reduce length of stay, and prevent patient physical function decline post ICU admission. This work explored physiotherapists’ perceptions of collaboration within inter-professional teams in the ICU and identified barriers that impede communication in inter-professional teams and suggested solutions. This research will contribute in improving collaboration between inter-professional teams in the ICU setting.

Clinical validation of expert consensus statements for respiratory physiotherapy management of invasively ventilated adults with community-acquired pneumonia: A qualitative study

ObjectivesTo conduct multidisciplinary peer-review of expert consensus statements for respiratory physiotherapy for invasively ventilated adults with community-acquired pneumonia, to determine clinical acceptability for development into a clinical practice guideline. Research methodologyA qualitative study was undertaken using focus groups (n = 3) conducted with clinician representatives from five Australian states. Participants were senior intensive care physiotherapists, nurses and consultants. Thematic analysis was used, with a deductive approach to confirm clinical validity, and inductive analysis to identify new themes relevant to the application of the 38 statements into practice. SettingAdult intensive care. FindingsSenior intensive care clinicians from physiotherapy (n = 16), medicine (n = 6) and nursing (n = 4) participated. All concurred that the consensus statements added valuable guidance to practice; twenty-nine (76%) were deemed relevant and applicable for the intensive care setting without amendment, with modifications suggested for remaining nine statements to enhance utility. Overarching themes of patient safety, teamwork and communication and culture were identified as factors influencing clinical application. Cultural differences in practice, particularly related to patient positioning, was evident between jurisdictions. Participants raised practicality and safety concerns for two statements related to the use of head-down patient positioning. ConclusionMultidisciplinary peer-review established clinical validity of expert consensus statements for implementation with invasively ventilated adults with community-acquired pneumonia.

P194 Use of a protocolised estimated discharge date following hip fracture surgery improves discharge planning and reduces length of stay

Purpose: Prior to this service development, senior Physiotherapists observed that estimated discharge date setting for hip fracture patients at daily MDT board round was arbitrary and differed significantly based upon which staff members were in attendance that day. A service development was therefore completed to identify an effective and efficient means to use a validated outcome measure to set a protoclised, realistic and evidence-based discharge date on the day of surgery, based upon pre-morbid function. Methods: A literature review was completed to identify possible methods for reliably predicting post-operative function and length of stay following hip fracture. The New Mobility Score (NMS) was identified as the most appropriate measure to use as it was a quick, validated predictor of post-operative function, reliable with good inter-rater reliability, and readily available to complete pre-operatively, thereby enabling a reliable estimated discharge date (EDD) to be set on the day of surgery. 323 patients over 2 years (2016/17) were then retrospectively scored and grouped using the NMS and these scores were analysed against length of stay. The groupings were analysed for the best fit by Kinǵs College Statistician Clare Flach who identified ideal groupings as high level (NMS 9), medium (8 to 2) and low level (1 and 0). The 1st quartile for length of post-operative stay for each group was then used as the EDD i.e. 4 days for high level, 9 days for medium level and 15 days for low level. The service development was shared with the entire MDT and received excellent buy-in from all MDT members and in August 2018 the pre-operative NMS score was implemented as a means of setting reliable EDD's in hip fracture patients. Results: In the 4 months since implementation the median length of post-operative stay following hip fracture reduced to 9 days (IQR 16.6 days, n = 64) compared with a median of 12 days (IQR 9.6 days, n = 58) in the 6 months immediately leading up to the change. Further anlaysis of the 323 patient notes during the 2016/2017 period found that 80% of patients were functioning at an appropriate level to be discharged on their protocolised EDD (i.e. 4/9/15 days). Conclusion(s): The NMS provides an effective means to set protocolised EDD following hip fracture based upon pre-morbid function has been associated with reduced length of stay. This service development has been incredibly well received by the MDT and provides an effective means to manage patient complexity and can give rise to targeted interventions, rehabilitation and prioritisation to manage this complexity and facilitate a safe discharge in an efficient and predictable time frame. Implications: This method for stratifying and protocolising patient care following hip fracture could be easily adopted at other centres as a means to improve patient care. It provides a quick and easy framework to set reliable and evidence-based discharge dates on the day of surgery which can assist with prioritisation, resource allocation, pathway flow and expectation management for patients whilst reducing length of stay. Funding acknowledgements: No funding was recieved for this local project

Association of Workplace stress with age among physiotherapists working in public and private sectors of Faisalabad.

Background: Stress in the working environment occur when there is imbalance between demand and ability of physiotherapists to fulfill those demands. Objective: This study aims to find out the stressors causing stress at the workplace and to determine the association of stress experienced by physiotherapists with their age. Methodology: A total of 100 physiotherapists from Faisalabad was included in this study to see the effect of workplace stressors in relation to their age, by giving them questionnaires. Simple Random sampling technique was used in this study and written informed consent was taken from all the participants. Criteria included age between 24-60, working hours 4 to 7 and experience of 1 year or more prominent. Results: Caseload Quantity, complexity of patients, staff shortage and increased work demand were identified as main workplace stressors. Physiotherapists aged below 25 years (junior physiotherapists) have experienced higher symptoms of the stress in their working environment as compared to senior and senior most physiotherapist (X2 = 9.752, p<0.01). Seventy-seven percent of junior physiotherapists taken leave from the duty (X2 = 11.54, p<0.01) because of above-mentioned workplace stressors. Conclusion: Junior physiotherapists (age below 25) tend to be more affected at the workplace due to emotional and physical stress. Due to shortage of staff the have experienced more stress and have taken more leaves from duty and as a result their job performance becomes poor when contrasted with senior physiotherapists (age between 25-40) and most senior physiotherapists (age above 40). Keywords: Anxiety, Hypertension, Occupational health, Physiotherapists, Workplace stress

Can a physiotherapy student assume the role of an advanced practice physiotherapist in Orthopaedic surgery triage? A prospective observational study

BackgroundAdvanced practice physiotherapists (APP) have helped improve accessibility to orthopaedic outpatient care. Several studies have validated the APP practice model in orthopaedic care, demonstrating high agreement between APPs and orthopaedic surgeons (OS) regarding diagnosis and management. However, as APPs tend to be experienced senior physiotherapists, such a study involving physiotherapy students (PS) has not yet been explored. The objective of this study was to evaluate the agreement for orthopaedic diagnoses and surgical triage between a PS and OSs.MethodsA prospective study involving a final year PS and seven OSs was conducted in a university hospital, after the PS had undergone a three-week intensive training. Eighty-six adult patients referred to OSs for knee osteoarthritis, hip osteoarthritis or shoulder problem were independently evaluated by the PS, and then re-evaluated by an OS. The diagnoses and surgical triage recommendations of both clinicians were analyzed for agreement using raw percent agreement and Cohen’s kappa. Patient satisfaction with the outpatient clinic experience was noted using a modified version of the Visit-Specific Satisfaction Instrument.ResultsOur sample consisted of 86 patients (mean age = 63.4 years). Reasons for consultation included shoulder problems (36%), knee osteoarthritis (52%) and hip osteoarthritis (12%). The raw percent agreement for diagnosis was 95.3%. The agreement for surgical triage was high (κ = 0.86, 95% CI: 0.74–0.98) with a raw agreement of 94.2%. Patient satisfaction was high.ConclusionsThe PS and OSs made similar diagnoses and triage recommendations suggesting that clinical experience alone is not a prerequisite for physiotherapists to help increase accessibility to orthopaedic care.

Physiotherapists lack knowledge of the WHO physical activity guidelines. A local or a global problem?

BackgroundPhysical inactivity is a significant cause of premature deaths globally, yet many physiotherapists)PT's) have little knowledge of the World Health Organization's physical activity guidelines (PA). ObjectivesTo assess the knowledge of Israeli PT's regarding the World Health Organization's (WHO) recommendations for PA for adults and adolescents. Secondary aims were to determine how many Israeli PT's, are recommending PA for their patients and to evaluate the knowledge level of Israeli PT's in relation to PT's in other countries. DesignCross-sectional online survey. ParticipantsOf the 1413 Israeli PT's offered the survey, 1062 (75%) completed it, which represents 16.4% of the 6450 licensed PT's in Israel. ResultsA mere 6.8% physiotherapists were aware of the WHO-recommended level of adult PA, and only 4% were knowledgeable of the recommendations for adolescents. Novice PT's (5 > years of experience) knew significantly more about adult PA recommendations (P < 0.05) than did the more senior physiotherapists. Nine out of every ten (90%) PT's routinely initiate conversations about PA, 83.5% signpost to PA support elsewhere, and 70.5% deliver brief intervention themselves for PA. The main barriers to promoting PA were (1) the belief that promotion would not change patient behavior, (2) lack of time, and (3) perceived lack of skills at counseling for behavior change. ConclusionsIsraeli PT's have poor knowledge of the WHO's adults and adolescent guidelines for PA. Lack of knowledge among PT's regarding the WHO's PA guidelines is a recurrent global problem that requires immediate attention.

Development, implementation and evaluation of an advanced practice in continence and women's health physiotherapy model of care.

With public health facing workforce shortages, increasing costs and increasing demands, innovative patient pathways are vital to meet patient needs. Advanced practice physiotherapy roles are well established in emergency departments and musculoskeletal/orthopaedic services and have begun to emerge in other clinical areas. In 2014, the Royal Women's Hospital, Monash Health and Barwon Health received a Victorian Department of Health and Human Services (DHHS) Workforce Innovation grant to develop and implement an advanced practice in continence and women's health physiotherapy assessment model of care. A new model of care was developed with an advanced practice physiotherapy-led assessment clinic integrated into the triage and assessment process of gynaecology, urogynaecology and urology clinics in major public health centres. A clinical competency and credentialing pathway and toolkit were developed to support training and development of advanced practice skills for senior physiotherapists in this clinical area. The initial assessment of the new model of care was undertaken by DHHS and Price-Waterhouse Coopers, including access to care, cost of assessment and safety. An advanced practice continence and women's health physiotherapy assessment clinic was implemented safely and contributed to improved access to care as assessed by reduced waiting lists and waiting times for assessment, with high levels of patient satisfaction and no adverse events. Advanced practice continence and women's health physiotherapy clinics can contribute to streamlined, cost-efficient triage and assessment processes for patients with urological or gynaecological issues attending tertiary medical clinics.

A musculoskeletal single point of referral in primary care. The effect on physiotherapy, occupational therapy and orthopaedic triage providers

Purpose: A single point of referral was implemented in partnership between Allied Health Professionals Suffolk (AHPS) and Norfolk Community Health and Care (NCHC) forming the Integrated Therapy Partnership (ITP). This aimed to standardise the care pathways for musculoskeletal conditions and ensure primary care referrals are processed to the correct provider first time around. This should avoid unnecessary secondary care referrals, where patients are seen in secondary care, receive no treatment and are referred back to community providers. Referrals are triaged by senior physiotherapists. Similar models have been suggested as effective methods of service delivery by the British Orthopaedic Association (Lennox & Karstad, 2013).

Engaged in learning neurorehabilitation: Development and validation of a serious game with user-centered design

The presence of Serious Games (SGs) in the medical educational field is spreading due to their beneficial results in terms of learning outcomes and user' engagement. The effectiveness of these tools for physical therapy students is, however, still to be proven and prototypes for this user target are lacking. We adopted a user-centered design (UCD) approach to develop and validate a SG on dual task motor and cognitive rehabilitation for junior physical therapists training. The SG development and validation consisted in two phases: a design-evaluation-redesign phase with two groups of junior and senior physiotherapists (group 1, N = 10; group 2, N = 28), and the SG prototype testing phase comparing outcomes of junior physiotherapists in lab (N = 20) and physical therapy students in real context (N = 23). Usability, motivation, flow state, affective engagement and learning were tested. Results showed a high usability of the tool together with good levels of engagement in all groups. Interestingly, we observed a decrease in physiotherapists' negative affect and an increment of students' positive affect after experiencing the prototype. The adoption of the UCD for the validation of a SG on neurorehabilitation allowed the development of a usable and engaging prototype. Future research on SG topics should include a rehabilitation paradigm in their content.