Student Physiotherapists Research Articles

An Exploratory Pilot Study Into Undergraduate Physiotherapy Students' Perceptions Of Working With Patients With Mental Illness And Working Within The Mental Health Sector Of Health Care

Background/Aims Mental illness is widespread throughout the United Kingdom with increasing prevalence. As mental illness affects such a large proportion of the population, it is likely that healthcare professionals, including qualified and student physiotherapists, will work with patients in all areas of healthcare, who have mental illness alongside co-morbidities. Physiotherapy students are placed into a wide range of placements throughout an undergraduate degree to develop skills and autonomy in rehabilitation. Understanding students' perspective appears relatively unexplored and was stimulated by personal experience of the first author where patients' rehabilitation could be impacted by mental illness. The impact varied depending on the severity of their illness, as well as the understanding of that illness by the multidisciplinary team involved in their care. The aim of this phenomenological study was to: explore physiotherapy students' lived experiences and perceptions of working with patients with mental illness, despite no mental health specific placement and understand their views of working in the mental health sector of healthcare Methods Ethical approval was obtained from Coventry University Ethics and a qualitative methodology was applied. Purposeful sampling was used to recruit six participants, who were all Undergraduate physiotherapy students at Coventry University, and data were collected via a focus group. The focus group explored their lived experiences, opinions and perceptions. Results A number of themes were discovered from the data, with associated sub-themes: ‘Lack of clarity’ with sub-themes: ‘Definitions, Terminology and understanding’, ‘Mental illnesses’ and ‘Physiotherapist role’ ‘Emotional Roller-Coaster’ with sub-themes: ‘Negative reactions’ and ‘Positive sentiments’ ‘Transferable skills’ with sub-themes: ‘Core competencies’ and ‘Core skills to elevate’ ‘Everyone has a story to tell’ with sub-themes: ‘Job’, ‘Placement’ and ‘Personal experience’ The themes influenced their ‘curious intrigue’, which related to their views of working in the mental health sector of health care. Conclusions All participants in the study had experiences to discuss and found it challenging to provide effective rehabilitation, appropriate to the patients' needs. Discussing these experiences evoked a complex range of perceptions and emotions.

Student physiotherapists’ perceptions of using smartphone applications versus paper exercise sheets in clinical practice

Purpose: The aim of this study was to explore student physiotherpists’ perceptions of web based applications (Apps) as oppose paper based exercise sheets to support patient rehabilitation.

Investigating feasibility of use of an Android Smart Phone Application (MoveIt) as a clinical outcome measure

Purpose: Mobile accelerometry has been validated against gold-standard motion analysis and current low-cost, low-tech clinical (Physiological Profile Assessment) measures of stance stability (Patterson et al., 2014). This could offer a fast, portable, specific and feasible clinical Method to the PPA. This study assesses feasibility of use of ‘MoveIt’ for student physiotherapists (MoveIt: An android Smart Phone application with a standardised procedure to measure stance stability).

Perceived acquisition, development and delivery of empathy in musculoskeletal physiotherapy encounters

ABSTRACTEmpathy is considered essential to creating a positive clinician-patient relationship, along with improving patient experience and adherence to treatment. It is not clear how physiotherapists acquire their empathic skills.This study explored physiotherapists’ perceptions of empathy during musculoskeletal clinical encounters. Seventeen participants attended three focus groups separated by clinical employment grade. The definition of empathy, its acquisition and impact on a clinical encounter were discussed, audio-recorded, transcribed verbatim and analysed thematically.Six key themes and 48 sub-themes were identified. Empathy was defined similarly in all three focus groups. There was divergence on its acquisition and the extent to which it can be taught, however participants agreed that empathy is an innate characteristic. Senior physiotherapists placed greater emphasis on the importance of empathic communication than student physiotherapists, whilst student and junior physiotherapists considered limited clinical experience to be a barrier in delivering empathic communication, anticipating this to improve over time.This study identified a mismatch between the perceived importance of empathic communication in the literature and by clinicians, compared with the time spent acquiring and developing these skills. Clinicians need to place a greater emphasis on enhancing their empathic communication skills throughout their career to help create a positive patient experience and enhance clinician-patient relationships.

Spotlight on equality of employment opportunities: A qualitative study of job seeking experiences of graduating nurses and physiotherapists from black and minority ethnic backgrounds

BackgroundThere is growing attention in the UK and internationally to the representation of black and minority ethnic groups in healthcare education and the workplace. Although the NHS workforce is very diverse, ethnic minorities are unevenly spread across occupations, and considerably underrepresented in senior positions. Previous research has highlighted that this inequality also exists at junior levels with newly qualified nurses from non-White/British ethnic groups being less likely to get a job at graduation than their White/British colleagues. Although there is better national data on the scale of inequalities in the healthcare workforce, there is a gap in our understanding about the experience of job seeking, and the factors that influence disadvantage in nursing and other professions such as physiotherapy. AimThis qualitative study seeks to fill that gap and explores the experience of student nurses (n=12) and physiotherapists (n=6) throughout their education and during the first 6-months post qualification to identify key experiences and milestones relating to successful employment particularly focusing on the perspectives from different ethnic groups. ParticipantsParticipants were purposively sampled from one university to ensure diversity in ethnic group, age and gender. MethodsUsing a phenomenological approach, in-depth semi-structured interviews were conducted at course completion and 6 months later. ResultsTwo main themes were identified. The ‘proactive self’ (‘It’s up to me’) theme included perceptions of employment success being due to student proactivity and resilience; qualities valued by employers. The second theme described the need to ‘fit in’ with organisational culture. Graduates described accommodating strategies where they modified aspects of their identity (clothing, cultural markers) to fit in. At one extreme, rather than fitting in, participants from minority ethnic backgrounds avoided applying to certain hospitals due to perceptions of discriminatory cultures, ‘I wouldn’t apply there ‘cos you know, it’s not really an ethnic hospital’. In contrast, some participants recognised that other graduates (usually white) did not need to change and aspects of their identity brought unsolicited rewards ‘if your face fits then the barriers are reduced'. ConclusionsThe findings indicate that success in getting work is perceived as determined by individual factors, and fitting in is enabled by strategies adopted by the individual rather than the workplace. Demands for change are more acute for graduates from black and minority ethnic backgrounds. This is an issue for healthcare organisations seeking to be inclusive and challenges employers and educators to acknowledge inequalities and take action to address them.

Effect of pain neurophysiology education on physiotherapy students’ understanding of chronic pain, clinical recommendations and attitudes towards people with chronic pain: a randomised controlled trial

ObjectiveTo investigate the effect of pain neurophysiology education (PNE) on student physiotherapists’: (1) knowledge of chronic pain; (2) attitudes towards patients with chronic pain; and (3) clinical recommendations for patients with chronic pain. DesignMulticentre single-blind randomised controlled trial. SettingOne UK and one Irish university. ParticipantsSeventy-two student physiotherapists. InterventionParticipants received either PNE (intervention) or a control education. Both were delivered in a 70-minute group lecture. Main outcome measures(1) The Revised Pain Neurophysiology Quiz to assess knowledge; (2) the Health Care Pain Attitudes and Impairment Relationship Scale (HC-PAIRS) to assess attitudes; and (3) a case vignette to assess the appropriateness of clinical recommendations. ResultsPost education, the PNE group had a greater increase in pain neurophysiology knowledge [mean difference 4.0 (95% confidence interval 3.2 to 4.7), P<0.01] and more improved attitudes [−17.5 (95% confidence interval −22.1 to −12.9), P<0.01] compared with the control group. Post education, students in the PNE group were more likely to make appropriate recommendations regarding work (94% vs 56%), exercise (92% vs 56%), activity (94% vs 67%) and bed rest (69% vs 33%) compared with those in the control group (P<0.05). ConclusionThe improvements in knowledge, attitudes and recommendations for pain management show that PNE is a potentially valuable part of the education of physiotherapy students, and could be used on a more widespread basis. There is a need to investigate whether these findings can be replicated in other healthcare professions, and how well these reported changes lead to changes in actual clinical behaviour and the clinical outcomes of patients.

Prevalence of signs and symptoms of temporomandibular disorders in victims of scalping

Conclusion(s): Despite benefits for the patient being identified in both the study and by the DOH, student physiotherapists that took part in this study recognised that patients would receive enhanced holistic care which could lead to better prognosis. Participants have also acknowledged concerns for the profession and amongst the MDT. The reputation of the physiotherapist and the profession could be at risk and participants felt that patients and professionals may lose trust in physiotherapy due to the risk of errors and physiotherapists relying on medication as a form of intervention. Further exploration raised concerns regarding the potential for developing occupational stress due to the increased workload for independent prescribers. Implications:This research highlighted areas for concern that need consideration from appropriate governing bodies. Advice regarding medication continues to be a grey area for non-prescriber’s which is further highlighted by the potential to become an independent prescriber. Patient safety is an area that will need addressing throughout training. Further consideration into reducing the potential for occupational stress is recommended.

A framework for caring in physiotherapy education and practice

Background: Caring is central to the practice of physiotherapy. However, explicit components of caring required for South African physiotherapy practice within a model of primary healthcare are not detailed.Method: Employing a narrative enquiry as the selected methodology, data were produced through multiple methods to obtain multiple perspectives and orientation on how caring was facilitated in the physiotherapy curriculum and in practice. Data production, involving student physiotherapists, physiotherapy academics and practising physiotherapists, included in-depth focus group interviews, individual interviews, journal entries and open-ended questionnaires. Initially, the data were analysed separately for each group of research participants, followed by a cross-sectional analysis.Results: Components of caring were identified from the interactions of student physiotherapists with patients, academics, practising physiotherapists and among the students themselves. Emerging expressions of caring were grouped as collegiality and valuing; listening, and showing empathy and nurturing; being an expert practitioner; having interdisciplinary knowledge and utilising biopsychosocial intervention; having cultural and language competence; and community and human-interconnectedness.Conclusion: This paper identifies the components of caring that are important for physiotherapy across multiple sectors. The findings are significant for physiotherapy development and may be considered within other health science professions.

Identifying the influence of gender on motivation and engagement levels in student physiotherapists

Background: There is an increasing focus in higher education on the role of learner characteristics and their influence on academic performance. Educators are interested in how students engage with learning activities as they progress through the curriculum. A previous study highlighted gender effects in academic performance in student physiotherapists, despite comparable entry scores.Aims: The aim of this study was to determine variation in student motivation and engagement, across the four year levels of the physiotherapy program at The University of Notre Dame Australia while considering gender and age.Methods: A cross-sectional design was adopted surveying 233 students utilising the Motivation and Engagement Scale – University/College (MES-UC), to review motivational thoughts and behaviours influencing learning.Results: Results identified gender effects with males having on average significantly lower scores for planning, task management and persistence; and higher scores for disengagement from their studies. Females displayed higher average scores for anxiety particularly in their first year and final clinical year. Results were consistent with gender effects noted in academic performance throughout the program for previous student cohorts.Conclusions: The application of the MES-UC early in course would highlight to educators the areas where intervention can be targeted. Early individualized intervention is recommended to address learner characteristics influencing performance.

Investigating the learning experiences of student physiotherapists with visual impairments: An exploratory study

This article discusses the exploratory phase of a study to understand the learning experiences of physiotherapy students with visual impairments (VI) in higher education (HE). The purpose of the study was (1) to explore semi-structured interview as a data collection method for this population, (2) to identify barriers and enablers to learning physiotherapy for students with VI, and (3) to identify individual strategies for tackling barriers in physiotherapy education. Three purposively sampled participants consented to be interviewed; two were recent physiotherapy graduates and one was a current physiotherapy student. The findings identified that physiotherapy students experienced similar barriers and enablers to learning that students with disabilities experience in HE, and that they had developed similar and specific strategies to enable learning in physiotherapy. Staff behaviours, resources, and the time and effort of being a visually impaired student were identified as the main barriers. Staff behaviours and resources were also identified as enablers to learning physiotherapy. Specific physiotherapy and VI-related barriers were identified that will be explored further in the main phase of data collection and will be disseminated through future publications.

A survey of physiotherapy students’ experiences and attitudes towards treating individuals with mental illness

Introduction: Very few research articles have considered the views and attitudes of student physiotherapists towards treating individuals with a mental illness (MI). Therefore, this study's objective was to consider the experiences and attitudes of student physiotherapists towards treating individuals with MI. Methods: A cross-sectional cohort design was used. One hundred and eighty one physiotherapy undergraduate degree students at UK institutions participated in the survey. The survey had been specifically designed for this study, and contained a mixture of open and closed questions. Results: Seventy one per cent (123/173) of the students were exposed to less than 4 hours teaching time about MI, and 76% (131/173) wanted further education on MI. Students were concerned about limited knowledge of MI conditions and how to approach patients who have a MI. A summary of the specific concerns of students is identified within the text. Conclusions: Further education about MI is required to give students greater confidence in treating patients who have an MI. Education would also likely benefit some students who identify negative characteristics of patients with MI.

The Beliefs of Third-Level Healthcare Students towards Low-Back Pain.

Objectives. Beliefs held by healthcare providers are part of the complex recovery of a patient with low-back pain (LBP). The aim of this study was to investigate the attitudes and beliefs of Irish university healthcare students towards LBP. Methods. Physiotherapy (n = 107), medicine (n = 63), nursing, and midwifery (n = 101) students completed the survey. Demographic data, LBP related beliefs [Back Beliefs Questionnaire (BBQ) and the Fear Avoidance Beliefs Questionnaire physical subsection (FABQ-PA)] were collected. Results. Two hundred and seventy-one students responded (response rate 29%). Student physiotherapists had significantly lower FABQ (P < 0.001) scores than medical (95% CI [−5.492, −1.406]) and nursing students (95% CI [−7.718, −22.307]). Physiotherapy students had significantly higher BBQ scores (P < 0.0001) than medical (95% CI [1.490, 5.406]) and nursing students (95% CI [6.098, 11.283]). Beliefs of physiotherapy and medical students were significantly better among fourth-year year than first-year students (P < 0.0001) but were not significantly different for nursing students (P = 0.820 for FABQ and P = 0.810 for BBQ). Conclusions. Physiotherapy students had more positive beliefs towards LBP than medical and nursing students. Physiotherapy and medical students' beliefs towards LBP significantly improved over the course of their studies.

Targeted education on the topic of professional boundaries does not change student physiotherapists’ opinions or their responses to a series of ethical scenarios

...Given the importance of professional behaviours and attitudes for clinical practice, there is growing interest in examining the impact and efficacy of ethics education on physiotherapy students’ ethics knowledge, values, and behaviours. These studies have focused on whether the education increases students’ capacities to reflect and develop skills in moral wisdom and ethical reasoning within their professional formation. They have established that a carefully designed curriculum can influence a student’s understanding and motivation to act ethically.In this paper, we build on this literature by examining whether a targeted education strategy which focuses on professional boundaries influences students’ beliefs about and responses to a series of vignettes in which the boundaries in the professional interactions were unclear.

The Clinical Education Experience of Student-Physiotherapists within a Transformed Model of Healthcare

Purpose: The democratisation of the health system was a cornerstone of post-apartheid South Africa. Primary healthcare (PHC) was adopted for increased access, broader participation, and equity in health. Hereafter, physiotherapy and other health sciences curricula, research function, and teaching staff would have to be re-oriented towards enabling implementation and sustainability of the new model. This is an important consideration for the design of clinical education programmes, a learning trajectory within professional curricula that is fundamental to the education, training, and professional socialisation of emerging healthcare personnel. This study explored how student-physiotherapists experienced clinical education practice within the model of PHC. Methods: The perspectives of students of a physiotherapy clinical education programme at a South African university were examined within a qualitative research framing. Forty-two final year student physiotherapists participated in the study. Employing narrative inquiry, data were produced through reflective journals and focus group interviews. Interviews were audio-taped and verbatim transcripts of the interviews were produced. Interview data and journal entries were analysed inductively using thematic coding and categorisation. Results: Broad themes that emerged included programme design, content, pedagogy, and assessments. Strong adherence to the medical model and under-emphasis of PHC as a guiding philosophy for curriculum development resulted in participants reporting they were under-prepared for autonomous practice within multidisciplinary teams and in contexts that were under-resourced and outside of hospital-based settings. Conclusion: To develop skilled and competent physiotherapists for a transformed model of healthcare practice in South Africa, the physiotherapy education programme needs to be grounded in principles of PHC.

Kinematic predictors of single-leg squat performance: a comparison of experienced physiotherapists and student physiotherapists

BackgroundThe single-leg squat (SLS) is a common test used by clinicians for the musculoskeletal assessment of the lower limb. The aim of the current study was to reveal the kinematic parameters used by experienced and inexperienced clinicians to determine SLS performance and establish reliability of such assessment.MethodsTwenty-two healthy, young adults (23.8 ± 3.1 years) performed three SLSs on each leg whilst being videoed. Three-dimensional data for the hip and knee was recorded using a 10-camera optical motion analysis system (Vicon, Oxford, UK). SLS performance was rated from video data using a 10-point ordinal scale by experienced musculoskeletal physiotherapists and student physiotherapists. All ratings were undertaken a second time at least two weeks after the first by the same raters. Stepwise multiple regression analysis was performed to determine kinematic predictors of SLS performance scores and inter- and intra-rater reliability were determined using a two-way mixed model to generate intra-class correlation coefficients (ICC3,1) of consistency.ResultsOne SLS per leg for each participant was used for analysis, providing 44 SLSs in total. Eight experienced physiotherapists and eight physiotherapy students agreed to rate each SLS. Variance in physiotherapist scores was predicted by peak knee flexion, knee medio-lateral displacement, and peak hip adduction (R2 = 0.64, p = 0.01), while variance in student scores was predicted only by peak knee flexion, and knee medio-lateral displacement (R2 = 0.57, p = 0.01). Inter-rater reliability was good for physiotherapists (ICC3,1 = 0.71) and students (ICC3,1 = 0.60), whilst intra-rater reliability was excellent for physiotherapists (ICC3,1 = 0.81) and good for students (ICC3,1 = 0.71).ConclusionPhysiotherapists and students are both capable of reliable assessment of SLS performance. Physiotherapist assessments, however, bear stronger relationships to lower limb kinematics and are more sensitive to hip joint motion than student assessments.

An exploration of undergraduate nursing and physiotherapy students’ views regarding education for patient handling

To ascertain the views of undergraduate student nurses and physiotherapists regarding their education in patient handling. Musculo-skeletal injuries are an important cause of staff sickness absence and attrition from the nursing profession and are a recognised problem within the physiotherapy profession. Nurses and physiotherapists are at risk of musculo-skeletal injuries as a result of their role in assisting patients with movement. A questionnaire survey was undertaken of undergraduate nursing and physiotherapy students (n = 371) at one university. Most students agreed that university teaching about moving and handling prepared them for clinical practice (64%). Over a third reported that they had never undertaken a written moving and handling risk assessment in clinical practice (38%). Almost half of the sample (40%) admitted undertaking unsafe moving and handling activities. Half (50%) also stated that they would rather 'fit' into the team than challenge unsafe practice. Almost a third (29%) stated that they had begun to experience pain since becoming a student. There were significant differences between nursing and physiotherapy students. Physiotherapy students were more likely to report being supervised when moving and handling and reported being more assertive about adhering to safe practice. The well-being of both nursing and physiotherapy undergraduate students is threatened when students undertake work placements in clinical settings. University-based education in safe patient handling, though important, can be undermined by workplace settings where unsafe practices occur. Collaboration is needed between university educators, managers and practice-based mentors to support students to maintain safe approaches to moving and handling patients. A third of students reported developing pain since becoming a healthcare student. Students entering their professions already injured may leave the workforce owing to poor physical well-being. It is vital that the clinical workplace supports safe systems of working.

Investigating factors influencing 4th-year physiotherapy students' opinions of cardiorespiratory physiotherapy as a career path

Recruitment and retention issues in cardiorespiratory physiotherapy (CRP) have led to concerns for the future of this specialist area of physiotherapy. This study evaluated the career choices of student physiotherapists and elicited factors that influenced their perceptions of CRP. A postal questionnaire to two schools of physiotherapy in New Zealand and two in Australia was administered. Final year students were randomly selected and invited to complete the questionnaire. Details of respondents' clinical experience, future career intentions, and perceptions of CRP as a specialism were ascertained. A response rate of 61% (n = 149) was obtained. Although the majority of respondents had undertaken cardiorespiratory placements, only 3% of respondents reported being “extremely interested” in specializing in CRP. The variety and timing of clinical placements and educational and clinical supervision were key factors that had the potential to both positively and negatively influence students' opinions of CRP. An understanding of the role of CRP beyond that of inpatient care appeared limited. To promote uptake of CRP as a career option, clinicians, educators, and managers should strive to provide positive clinical placements and educational opportunities. The extensive scope of clinical practice of cardiorespiratory physiotherapists could be a greater focus within physiotherapy curricula.

Problem Based Learning in physiotherapy education: a practice perspective

BackgroundProblem Based Learning (PBL) has been integrated into a range of health education curricula; however there is limited research evaluating the application of skills developed through PBL in clinical practice. AimThis study aimed to provide evidence of how skills gained through PBL are applied in practice by student physiotherapists, from the perspective of their placement supervisors. MethodA qualitative one-to-one semi-structured interview methodology was used, purposively recruiting a sample of 10 qualified physiotherapists with experience of placement supervision of students studying on a PBL physiotherapy undergraduate degree. ResultsThe supervisors felt that PBL offered positive benefits for both student education and clinical practice. There was evidence of the application of skills and attributes associated with PBL, including positive learning behaviours and a high level of motivation and self-direction. Supervisors felt that proactive students were able to apply transferable skills inherent in the PBL approach to clinical practice, including a holistic, problem-solving approach and effective team-working but that there was considerable variation between students. ConclusionsThere is evidence of variable application of skills associated with PBL in clinical practice in this study group. Further research would be useful to explore the factors that enable students to successfully apply the attributes developed using a PBL approach into practice.

Effects of palliative care training program on knowledge, attitudes, beliefs and experiences among student physiotherapists: A preliminary quasi-experimental study

Background:Physiotherapists play an inherent role in the multidisciplinary palliative care team. Existing knowledge, attitudes, beliefs and experiences influence their team participation in palliative care.Aims:The objective of this study was to assess the changes in knowledge, attitudes, beliefs and experiences among student physiotherapists who attended a palliative care training program.Settings and Design:Preliminary quasi-experimental study design, conducted at an academic institution.Materials and Methods:Fifty-two student physiotherapists of either gender (12 male, 40 female) of age (20.51±1.78 years) who attended a palliative care training program which comprised lectures and case examples of six-hours duration participated in this study. The study was performed after getting institutional approval and obtaining participants’ written informed consent. The lecture content comprised WHO definition of palliative care, spiritual aspects of life, death and healing, principles, levels and models of palliative care, and role of physiotherapists in a palliative care team. The physical therapy in palliative care-knowledge, attitudes, beliefs and experiences scale (PTiPC-KABE Scale)- modified from palliative care attitudes scale were used for assessing the participants before and after the program.Statistical Analysis:Paired t-test and Wilcoxon signed rank test at 95% confidence interval using SPSS 11.5 for Windows.Results:Statistically significant differences (P<0.05) were noted for all four subscales- knowledge (7.84±4.61 points), attitudes (9.46±8.06 points), beliefs (4.88±3.29 points) and experiences (15.8±11.28 points) out of a total score of 104 points.Conclusions:The focus-group training program produced a significant positive change about palliative care in knowledge, attitudes, beliefs and experiences among student physiotherapists.

Effects of taping on thumb alignment and force application during PA mobilisations

Work related thumb pain (WRTP) is a major problem among manipulative physiotherapists. Therapists who maintain the thumb joints in an extended alignment during PA mobilisation experience less WRTP. The purposes of this study were to investigate what effect taping of the thumbs has on thumb alignment during mobilisation and to gain normative data on the mobilisation forces applied by student physiotherapists. Forty final year student physiotherapists participated and were asked to apply a grade III PA mobilisation onto the C7 vertebra of one of 32 asymptomatic models. Participants were then instructed to apply the same mobilisation onto a force measurement instrument, in both the tape and no tape conditions, while the alignment of their metacarpophalangeal (MCP) and interphalangeal (IP) joints was noted via video recorder. Thumb alignment improved in 72.5% of participants post taping, with significant increases in the number of MCP joints maintained in a neutral alignment (p < 0.05). The mean peak mobilisation force applied by the students was 70.9 N. Taping of the thumbs prior to PA mobilisation improved thumb alignment during mobilisation in this cohort of undergraduate students, thus potentially influencing one of the contributory factors to WRTP.