The Psychological Impacts of Taking Physiotherapy Teaching Online in 2020: What Did We Learn?

INTRODUCTION: The rapid shift to online learning due to the COVID-19 pandemic presented challenges for physical therapy (PT) education worldwide. This article aims to explore the factors influencing the well-being of the PT faculty and department chairs involved in delivering PT programs during the initial stages of the COVID-19 pandemic. REVIEW OF LITERATURE: The literature has focused on the pedagogical impacts of the rapid shift to online learning. Little is known about the social and psychological impacts of this rapid transition on the well-being of the faculty involved in implementing PT programs. SUBJECTS: Physical therapy faculty and department chairs at 3 universities in metropolitan Sydney, Australia who taught into or led PT programs in 2020. METHODS: Focus group methodology was used to explore the experiences of PT faculty and department chairs during the initial stages of the COVID pandemic. The focus groups were digitally recorded and transcribed verbatim and the transcripts analyzed thematically. RESULTS: The main finding of this study was the extent of stress experienced by PT program faculty and chairs during this period. Both work-related institutional and faculty factors and non-work-related personal factors contributed to perceived high levels of stress. Overall, there was a feeling that the stressors had not improved over the duration of the pandemic and that this had left the faculty and chairs feeling more fatigued, less collegiate, and may have ongoing impacts on their mental health. DISCUSSION: The pandemic created stresses for faculty and program chairs over and above the usual stress of faculty and college work. The reality of taking steps to reduce the stressors in the current climate is very difficult. CONCLUSION: Moving forward, it is vital to secure increased institutional support, including the support for creating realistic boundaries without the risk of penalty, to address the psychological health and well-being of PT faculty and chairs to enable high-quality education in the future.

People with Parkinson's disease are more willing to do additional exercise if the exercise program has specific attributes: a discrete choice experiment.

QUESTION: What specific attributes of exercise programs influence the preferences of people with Parkinson's disease for additional exercise compared with their current practice? What trade-offs are participants willing to make between exercise program attributes? DESIGN: Discrete choice experiment. PARTICIPANTS: Five hundred and forty people with Parkinson's disease. INTERVENTION: Participants decided whether they would adopt a hypothetical program in addition to their current exercise routine. OUTCOME MEASURES: Exercise program attributes included: type, number of sessions/week, location, travel time/session, delivery mode, supervisor's expertise, extent of supervision, benefits for physical and psychological function and out-of-pocket cost/session. RESULTS: Participants preferred additional exercise when programs: provided physical (OR 1.85, 95% CI 1.61 to 2.13) or psychological (OR 1.45, 95% CI 1.26 to 1.67) benefit, involved less travel time (ORs 1.50 to 2.02) and were supervised by qualified professionals with Parkinson's disease expertise (ORs 1.51 to 1.91). Participants were most willing to add multimodal exercise to their exercise routine (ORs 2.01 to 2.19). Participants were less likely to prefer higher cost programs (OR 0.65, 95% CI 0.60 to 0.71, per AU$10 cost increase) or group sessions compared to individual sessions (OR 0.72, 95% CI 0.54 to 0.96). Men preferred adding strengthening exercises (OR 2.00, 95% CI 1.23 to 3.26) and women had a preference against adding aerobic exercise (OR 0.33, 95% CI 0.15 to 0.73). Participants not currently exercising were more likely to prefer adding exercise compared with those already exercising 300 minutes weekly (OR 1.74, 95% CI 1.15 to 2.63). CONCLUSION: People with Parkinson's disease were more willing to participate in exercise programs that cost less, involve less travel, provide physical or psychological benefits and are supervised by qualified professionals. To enable more people with Parkinson's disease to exercise, health services should provide programs addressing these factors and account for sex differences.

Clinical physiotherapists had both positive and negative perceptions about delivering two different interventions in a clinical trial: a mixed methods study.

QUESTION: What are clinical physiotherapists' perceptions about delivering two interventions during a randomised trial: the MOBILISE trial? DESIGN: Mixed methods study using semi-structured interviews involving closed- and open-ended questions. PARTICIPANTS: Thirteen physiotherapists involved in delivering the intervention for the trial. RESULTS: All thirteen physiotherapists (100%) had a preference for their patients to get one of the interventions, mostly dependent on the individual patient. Most were frustrated if their patients were not allocated to their preferred intervention but 62% were satisfied with the intervention they delivered and 100% would be happy to be involved in future research. Two significant themes emerged from the open-ended data: that there were both positive and negative aspects of being involved in the trial. The positive aspects included the trial's value as a way of participating in research and as a way of providing evidence for practice. The negative aspects were that the design of the trial was not always reflective of usual clinical practice and the trial's impact on departments, therapists and patients. CONCLUSION: Clinical physiotherapists had both positive and negative perceptions about delivering two different interventions in a clinical trial. However, they were all interested in participating in future research, suggesting that the positive aspects outweighed the negative.

Treadmill walking with body weight support in subacute non-ambulatory stroke improves walking capacity more than overground walking: a randomised trial.

QUESTIONS: Is treadmill walking with body weight support during inpatient rehabilitation detrimental to walking quality compared with assisted overground walking? Does it result in better walking capacity, perception of walking or community participation? DESIGN: Analysis of secondary outcomes of a randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis. PARTICIPANTS: 126 patients unable to walk within 4 weeks of a stroke who were undergoing inpatient rehabilitation. INTERVENTION: The experimental group undertook up to 30 minutes of treadmill walking with body weight support via an overhead harness per day while the control group undertook up to 30 minutes of overground walking. OUTCOME MEASURES: The secondary outcomes were walking quality and capacity, walking perception, community participation and falls. RESULTS: Six months after entering the study, there was no difference between the groups of independent walkers in terms of speed (MD 0.10 m/s, 95% CI -0.06 to 0.26) or stride (MD 6 cm, 95% CI -7 to 19). The independent walkers in the experimental group walked 57 m further (95% CI 1 to 113) in the 6 min walk than those in the control group. The experimental group (walkers and non-walkers) rated their walking 1 point out of 10 (95% CI 0.1 to 1.9) higher than the control group. There was no difference between the groups in community participation or number of falls. CONCLUSION: Treadmill training with body weight support results in better walking capacity and perception of walking compared to overground walking without deleterious effects on walking quality.

Thirty minutes of positioning reduces the development of shoulder external rotation contracture after stroke: a randomized controlled trial.

OBJECTIVE: To determine the efficacy of positioning the affected shoulder in flexion and external rotation to prevent contracture shortly after stroke. DESIGN: Prospective, parallel-group, randomized controlled trial. SETTING: Four metropolitan mixed rehabilitation units. PARTICIPANTS: A volunteer sample of 36 subjects (minus 5 dropouts), whose mean age was 68 years and had had their first stroke within the past 20 days. INTERVENTIONS: The experimental group received two 30-minute sessions a day, 5 days a week, for 4 weeks, during which the affected upper limb was placed in maximum comfortable external rotation and 90 degrees of flexion. Both the experimental and control groups received up to 10 minutes of shoulder exercises and standard upper-limb care. MAIN OUTCOME MEASURES: Contracture was measured as the maximum passive shoulder external rotation and flexion of the affected side as compared with the intact side. Measures were taken at 2 and 6 weeks after stroke by an assessor blinded to group allocation. RESULTS: The 30-minute program of positioning the shoulder in maximum external rotation significantly reduced the development of contractures in the experimental group, compared with the control group ( P =.03). The 30-minute program of positioning the shoulder in 90 degrees of flexion did not prevent contractures in the experimental group as compared with the control group ( P =.88). CONCLUSIONS: At least 30 minutes a day of positioning the affected shoulder in external rotation should be started as soon as possible for stroke patients who have little activity in the upper arm.

A treadmill and overground walking program improves walking in persons residing in the community after stroke: a placebo-controlled, randomized trial.

OBJECTIVE: To evaluate the effectiveness of a treadmill and overground walking program in reducing the disability and handicap associated with poor walking performance after stroke. DESIGN: Randomized, placebo-controlled clinical trial with a 3-month follow-up. SETTING: General community. PARTICIPANTS: A volunteer sample of 29 ambulatory individuals (less 2 dropouts) who were living in the community after having suffered a stroke more than 6 months previously. INTERVENTIONS: The experimental group participated in a 30-minute treadmill and overground walking program, 3 times a week for 4 weeks. The control group received a placebo consisting of a low-intensity, home exercise program and regular telephone contact. MAIN OUTCOME MEASURES: Walking speed (over 10 m), walking capacity (distance over 6 min), and handicap (stroke-adapted 30-item version of the Sickness Impact Profile) measured by a blinded assessor. RESULTS: The 4-week treadmill and overground walking program significantly increased walking speed (P=.02) and walking capacity (P<.001), but did not decrease handicap (P=.85) compared with the placebo program. These gains were largely maintained 3 months after the cessation of training (P