Primary care physiotherapists' performance in the fight against COVID 19: an experience report / Atuação do Fisioterapeuta na saúde primária no enfrentamento da COVID 19: relato de experiência / Actuación del fisioterapeuta en la atención primaria de salud para el afrontamiento de la COVID 19: relato de experiencia

Objetivo: Relatar a experiência de residentes de fisioterapia em saúde coletiva no enfrentamento multidisciplinar e desenvolvimento de ações frente à coronavirus disease 2019 (COVID-19). Síntese dos dados: Trata-se de um relato de experiência a partir da vivência prática dos residentes, em decorrência da pandemia da COVID 19, em duas cidades, Datas e Presidente Kubitschek, no interior de Minas Gerais, Brasil. As atividades ocorreram de março a junho de 2020. As ações foram realizadas por meio de orientações, roda de conversa, atendimento por videochamadas e fôlderes. As propostas sintetizaram: Ações de prevenção à saúde; Atenção à saúde mental e física dos trabalhadores da saúde; Educação em saúde aos trabalhadores de outros setores das prefeituras; Monitoramento de pacientes crônicos; e Educação permanente dos agentes comunitários de saúde. As atividades colaboraram com a prática clínica dos residentes, permitindo a construção com a equipe de saúde de propostas para um enfrentamento seguro no manejo da COVID 19. Conclusão: As propostas elaboradas no início da pandemia permitiram realizar ações que auxiliaram a atuação da equipe de Saúde da Família no enfrentamento à COVID 19. A experiência dos residentes contribuiu para a construção dos saberes e da experiência de gestão no enfrentamento da pandemia, colaborando para a formação dos residentes.

Objective: To report on the experience of public health physiotherapy residents in the multidisciplinary fight and development of actions against the coronavirus disease 2019 (COVID-19). Data synthesis: This is an experience report on the practical work develop by the residents during the COVID-19 pandemic in two cities, Datas and Presidente Kubitschek, located in countryside of Minas Gerais, Brazil. The activities took place from March to June 2020. The activities consisted of guidelines, conversation circles, video calls, and flyers. The proposals summarized: Disease prevention actions; Health workers' mental and physical health care; Health Education for workers in other sectors of city halls; Monitoring of chronic patients; and Permanent education of community health workers. The activities contributed to the residents' clinical practice and allowed them to partner up with the health care team for the development of proposals for safely tackling and managing COVID-19. Conclusion: The proposals developed at the beginning of the pandemic allowed taking action to help the Family Health Team to tackle COVID-19. The residents' experience contributed to the development of knowledge and management experience in tackling the pandemic, thus contributing to the residents' training.

Objetivo: Relatar la experiencia de residentes de fisioterapia en salud colectiva para el afrontamiento multidisciplinar y el desarrollo de acciones contra el coronavirus disease 2019 (COVID-19). Síntesis de los datos: Se trata de un relato de experiencia a partir de la práctica de los residentes decurrente de la pandemia de la COVID 19, en dos ciudades, Datas y Presidente Kubitschek del interior de Minas Gerais, Brasil. Las actividades se dieron entre marzo y junio de 2020. Se realizaron las acciones a través de orientaciones, rueda de conversación, atención por video-llamadas y folletos. Las propuestas sintetizaron: Acciones de prevención a la salud; Atención a la salud mental y física de los trabajadores sanitarios; Educación en salud para los trabajadores de otros sectores de los ayuntamientos; Monitoreo de pacientes crónicos; y Educación permanente de los agentes comunitarios de salud. Las actividades colaboraron con la práctica clínica de los residentes permitiendo la construcción de propuestas para el afrontamiento seguro del manejo de la COVID-19 con el equipo de salud. Conclusión: Las propuestas elaboradas en el principio de la pandemia permitieron la realización de acciones que ayudaron la actuación del equipo de Salud de la Familia para el afrontamiento de la COVID 19. La experiencia de los residentes ha contribuido para la construcción de los saberes y de la experiencia de gestión para el afrontamiento de la pandemia contribuyendo para la formación de los residentes.

Distance learning in the COVID-19 pandemic: acceptance and attitudes of physical therapy and rehabilitation students in Turkey.

INTRODUCTION: To reduce the rate of spread of the COVID-19 pandemic in Turkey, distance education was initiated in all universities on 23 March 2020. Distance learning had not been experienced in physical therapy and rehabilitation education before the COVID-19 outbreak. This study aimed to (a) determine the acceptance and attitudes of Pamukkale University Physical Therapy and Rehabilitation undergraduate students towards distance learning during the COVID-19 outbreak and (b) compare the results among years. METHODS: This study was conducted from May 2020 to June 2020 at the Pamukkale University School of Physical Therapy and Rehabilitation in Turkey. A total of 381 students (271 female, 110 male) participated. The Distance Learning Systems Acceptance Scale (ease of use, benefit), the Community Feeling Scale (affective and actional dimension), and the Distance Learning Attitude Scale (general acceptance, individual awareness, perceived usefulness, effective participation) were used to measure students' acceptance and attitudes towards distance education. RESULTS: Students had partly positive attitudes towards distance learning but were undecided about individual awareness, usefulness, and effective participation. The sense of community among students was moderate in the distance learning environment. Distance learning acceptance and attitude, and the sense of community levels, were highest in fourth-year students (last year of the school), followed by first-, third-, and then second-year students. The distance learning and sense of community scores of first- and fourth-year students were significantly higher than those of second- and third-year students (p≤0.01). CONCLUSION: Physical therapy and rehabilitation undergraduate students' attitudes towards distance learning during the COVID-19 outbreak were positive. However, when comparing between years, students in the second and third academic years had less positive attitudes. This may be because most of their curricula consisted of practical courses and summer field internships, and there were no opportunities to practise on mannequins, peers, and patients in distance education. In this study, the sense of community among students in the distance learning environment was also moderate. This may be because students were not enthusiastic about attending course lectures online, and because they did not have to view the lectures at a set time.

Identifying and Addressing Social Determinants of Learning During the COVID-19 Pandemic.

The COVID-19 pandemic has negatively impacted the health of people from communities of color and people of limited socioeconomic means in a disproportionate way due to social determinants of health (SDoH). The Centers for Disease Control defines SDoH as the "conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life-risks and outcomes." A related construct, social determinants of learning (SDoL), includes contextual conditions and variables that impact students' ability to optimally participate in their education, including academic and clinical development. SDoL directly impact students' ability to participate in the educational process. During the COVID-19 pandemic, students struggling with SDoH and, by extension SDoL, may be more likely to have sick family members, caregiving responsibilities, food and housing insecurity, and obligations to supplement lost family wages. SDoL are also influenced by individual experiences within and outside of the classroom. Beyond bringing this matter to the attention of our profession, especially clinical and academic educators, we must take action to reach and support students who are at higher academic risk due to the SDoL. The purpose of this paper is to (1) define SDoL, (2) explain how SDoL are impacting doctor of physical therapy and physical therapist assistant students, and (3) discuss actions that physical therapists and physical therapist assistants can take to mitigate the effects of SDoL on current doctor of physical therapy and physical therapist assistant students. IMPACT: This Perspective is one of the first explorations of how SDoL affect physical therapy students during the pandemic and provides concrete suggestions on how educators in both academic and clinical settings can help students succeed when they are negatively affected by SDoL.

Suggestions for changes in professional procedures and adaptation to COVID-19: new models of care in the rehabilitation setting.

Abstracts: The COVID-19 (COrona Virus Disease 2019), due to the SARS-COV-2 (Severe Acute Respiratory Syndrome Corona Virus 2) has been an unprecedented global challenge for the healthcare systems (1).

Clinical Update for Physical Therapists: Coagulopathy and COVID-19.

Physical therapists have a unique role in both prevention of venous thromboembolism (VTE) through the promotion of early mobility and physical activity and diagnosis through discovery of signs and symptoms of VTE. This Perspective updates clinicians on the latest information regarding pathophysiology of coagulopathy associated with COVID-19 and applies VTE clinical practice guidelines to COVID-19 in order to provide guidance on physical therapist management.

Experiences of telehealth e-mentoring within postgraduate musculoskeletal physical therapy education in the UK and Canada: a protocol for parallel mixed-methods studies and cross-cultural comparison.

INTRODUCTION: Mentored clinical practice is central to demonstrating achievement of International Educational Standards in advanced musculoskeletal physical therapy. While traditionally delivered face-to-face, telehealth e-mentoring is a novel alternative to offering this unique pedagogy to facilitate mentee critical reflection, deeper learning and enhanced knowledge translation to optimise patient care. With COVID-19 resulting in widespread adoption of telehealth and access to mentors often limited by geography or cost, the potential value of telehealth e-mentoring needs investigating. To investigate the experiences and outcomes of multiple stakeholders (student mentees, mentors and patients) engaged in musculoskeletal physical therapy telehealth e-mentoring across two universities (UK and Canada). METHODS AND ANALYSIS: Using case study design, we will use sequential mixed methods involving qualitative and quantitative components based on existing evidence. To examine the influence of telehealth e-mentoring on health outcomes in patients with musculoskeletal complaints, we will use patient-reported outcomes for satisfaction, patient empowerment and change in musculoskeletal health. We will conduct semistructured interviews to explore the development of critical thinking, clinical reasoning, communication skills and confidence of students engaged in telehealth e-mentoring. To explore the mentor acceptability and appropriateness of telehealth e-mentoring, we will conduct a focus group in each site. Finally, we will include a focus group of participants from each site to allow a cross-cultural comparison of findings to inform international stakeholders. Quantitative data will be analysed using descriptive statistics (median and IQR) to describe changes in outcome data and qualitative data will be analysed following the Framework Method. ETHICS AND DISSEMINATION: This study has ethical approval from both institutions: the University of Birmingham (ERN_20-0695) and Western University (2020-116233-47832). Findings will be published in a peer-reviewed journal and disseminated to key stakeholders in musculoskeletal physical therapy education and practice.

Occupational burnout among active physiotherapists working in clinical hospitals during the COVID-19 pandemic in south-eastern Poland.

BACKGROUND: Occupational burnout, which is more and more commonly encountered among medical professionals and investigated by researchers worldwide, may in particular affect health care workers during the COVID-19 pandemic. OBJECTIVES: The aim of the study was to assess the risk of occupational burnout among physiotherapists working actively in clinical hospitals in south-eastern Poland during the COVID-19 pandemic. METHODS: The level of burnout among the studied physiotherapists was assessed using the Polish version of the Maslach Burnout Inventory by Maslach (MBI). The study was conducted from 20 March to 3 May, 2020 among physiotherapists working professionally during the COVID-19 pandemic in the south east of Poland, during which time health services related to therapeutic rehabilitation were suspended. The study was conducted among 1,540 physiotherapists with a license to practice who worked in clinical departments. Considering the inclusion and exclusion criteria, 106 physiotherapists were qualified for the study. RESULTS: The current findings show that during the COVID-19 pandemic physiotherapists present high burnout rates in all three dimensions: EE (Mean 32.31; CI 29.47-35.15); DP (Mean 16.25; CI 14.48-18.03); PA (Mean 26.25; CI 24.41-28.10). As for gender-related effects, higher burnout rates were observed in the male workers, compared to the females, in all three domains: EE (Men: Mean 34.70; CI 29.90-39.50 -Women: Mean 31.03; CI 27.45-34.60); DP (Men: Mean 18.78; CI 15.98-21.59 -Women: Mean 14.90; CI 12.64-17.16) and PA (Men: Mean 24.54; CI 21.32-27.76 -Women: Mean 27.17; CI 24.90-29.44). The highest burnout rates, presented by the physiotherapists working in the profession for more than 20 years, were identified in the domain of EE (Mean: 35.30; CI 30.51-40.10) and in those with 10-15 years of experience, in the domains of DP (Mean: 18.31; CI 14.89-21.73) and PA (Mean: 23.97; CI 20.13-27.81). The highest rate of occupational burnout, reflected by the scores in all three domains (EE, DP, PA), was identified in Department I -Intensive Care and Anaesthesiology Department: EE - (Mean: 40.89, CI 35.27-46.52); DP - (Mean: 21.39, CI 17.90-24.88); and PA - (Mean: 23.07, CI 20.04-26.10), compared to the other departments. The subjects who rarely participated in courses or training programs showed the highest burnout rates (EE- Mean: 33.55, CI 29.33-37.77; DP- Mean: 16.71, CI 13.99-19.43; PA- Mean: 25.45, CI 22.47-28.43). CONCLUSIONS: Occupational burnout during the COVID-19 pandemic is noticeable among physiotherapists working in clinical departments. The current findings show high burnout rates in all three domains: emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA). A comparative analysis of these findings with reference to related studies published before the pandemic shows that the burnout rates among physiotherapists may have significantly increased during the COVID-19 pandemic. However, given the scarcity of scientific evidence related to this specific problem in Poland and worldwide, it is necessary to continue research in occupational burnout affecting physiotherapists, particularly during the second wave of the pandemic, in order to gain a better understanding of the possible effects of social isolation and greater personal work-related health risks on the mental health of these medical professionals.

Barriers and challenges faced by Brazilian physiotherapists during the COVID-19 pandemic and innovative solutions: lessons learned and to be shared with other countries.

The pandemic caused by SARS-CoV-2 that leads to COVID-19 has had an incalculable impact on society, services, and health professionals, including physiotherapists. The field of physiotherapy is currently facing ongoing challenges and pandemic-related repercussions, with Brazilian physiotherapists being especially affected. This article describes the current scenario in Brazil which has exposed the shortage of professionals and resources and reinforces the need for professional recognition, especially of those working in intensive care units. Barriers and challenges faced by Brazilian physiotherapists during the COVID-19 pandemic are described, followed by innovative solutions. Remote physiotherapy prior to the pandemic was merely one of many patient care options, but now has become a necessity, and several international organizations have provided guidelines for physiotherapists to follow, including guidelines on offering digital physiotherapy. Related demands, challenges, and perspectives of physiotherapy practice are likely to emerge amid the current uncertainties of the COVID-19 crisis, as well as during the post-pandemic period. The lessons learned by the Brazilian physiotherapy community may be of assistance to physiotherapists in other countries particularly those with comparable social and demographic characteristics.

Operational Considerations for Physical Therapy During COVID-19: A Rapid Review.

OBJECTIVE: Physical therapists play an important role in responding to pandemic and physical disaster situations. Existing literature can provide guidance to health care leadership teams to appropriately and safely leverage physical therapy resources and skill sets during the COVID-19 pandemic. The purpose of this study was to provide a review of the pandemic and physical disaster management literature to summarize physical therapy-specific operational considerations to assist hospital-based leadership teams in planning and response efforts during the COVID-19 pandemic. METHODS: A rapid review was conducted over a 4-week time frame (April-May 2020). The review team included 3 physical therapist clinician researchers, a health librarian, and a member of the physical therapy leadership team. The initial search strategy identified 303 articles, 80 of which were retained for full-text screening. Twenty articles were included in the review. RESULTS: Five main categories of operational considerations for physical therapy during the COVID-19 pandemic were identified: (1) organizational actions, (2) staffing considerations, (3) physical therapist roles, (4) physical resources, and (5) other considerations. Additional relevant information from physical therapists' experiences in physical disaster situations was also summarized. CONCLUSION: The evidence presented within this review can be used to inform facility-based and regional planning efforts during the current COVID-19 pandemic and in general preparedness planning. IMPACT: Physical therapists have an important role to play in response efforts related to major events that impact health and wellness, including the COVID-19 pandemic. Evidence-informed, facility-based, and regional planning during the current COVID-19 pandemic will help physical therapists enhance their role in treating patients in physical therapy and rehabilitation settings.

Outpatient Orthopedic Rehabilitation in New York State During the COVID-19 Pandemic: Therapist Perspectives.

The COVID-19 pandemic has had a strong impact on the care of orthopedic patients. This impact has been particularly difficult in New York State, which experienced the largest number of COVID-19 cases and led to a state- mandated pause on all elective surgeries. As a result, physical and occupational therapists became the principal providers of care and had to adjust their workflow to ensure quality care. Understanding the perspectives and needs of therapists relative to the circumstances created by COVID-19 is critical to safe and effective care. The goal of this study was to define the perspectives of therapists in New York State regarding the impact of COVID-19 on their work. An email-based 20-question survey was distributed to 250 therapists from all 10 regions of New York State who treated outpatient orthopedic patients during the peak of the pandemic in early April 2020. The survey collected demographic and practice information as well as responses regarding several clinical practice issues. The results provide insight into the concerns of therapists regarding the delivery of care, and responses clarify indications for therapy and for the use of telemedicine to achieve goals during the pandemic. The COVID-19 pandemic is profoundly impacting the work of therapists worldwide. Therapists responded to this survey expressing concerns about the safe delivery of care, access to personal protective equipment, use of telemedicine, and their role within health care during the pandemic. The results of this study can be used to establish guidelines for safe, effective, and efficient therapy during the pandemic. [Orthopedics. 2020;43(5):292-294.].