Balance measures for fall risk screening in community-dwelling older adults with COPD: A longitudinal analysis.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) increases fall risk, but consensus is lacking on suitable balance measures for fall risk screening in this group. We aimed to evaluate the reliability and validity of balance measures for fall risk screening in community-dwelling older adults with COPD. METHODS: In a secondary analysis of two studies, participants, aged ≥60 years with COPD and 12-month fall history or balance issues were tracked for 12-month prospective falls. Baseline balance measures - Brief Balance Evaluation Systems Test (Brief BESTest), single leg stance (SLS), Timed Up and Go (TUG), and TUG Dual-Task (TUG-DT) test - were assessed using intra-class correlation (ICC2,1) for reliability, Pearson/Spearman correlation with balance-related factors for convergent validity, t-tests/Wilcoxon rank-sum tests with fall-related and disease-related factors for known-groups validity, and area under the receiver operator characteristic curve (AUC) for predictive validity. RESULTS: Among 174 participants (73 ± 8 years; 86 females) with COPD, all balance measures showed excellent inter-rater and test-retest reliability (ICC2,1 = 0.88-0.97) and moderate convergent validity (r = 0.34-0.77) with related measures. Brief BESTest and SLS test had acceptable known-groups validity (p < 0.05) for 12-month fall history, self-reported balance problems, and gait aid use. TUG test and TUG-DT test discriminated between groups based on COPD severity, supplemental oxygen use, and gait aid use. All measures displayed insufficient predictive validity (AUC<0.70) for 12-month prospective falls. CONCLUSION: Though all four balance measures demonstrated excellent reliability, they lack accuracy in prospectively predicting falls in community-dwelling older adults with COPD. These measures are best utilized within multi-factorial fall risk assessments for this population.

The Relationship between Physical Activity, Depression and Anxiety in People with COPD: A Systematic Review and Meta-analyses.

Depression and anxiety are related to physical activity among people with chronic obstructive pulmonary disease (COPD), although the strength and direction of the reported relationships are inconsistent. This study systematically synthesized the relationships between physical activity and i) depression and ii) anxiety in people with COPD. Physical activity measurement type (objective, self-report) was examined as a moderator of these relationships. A systematic search of physical activity and COPD was conducted from inception to February 2022 across 8 databases. Studies were included if they provided correlation coefficients for the relationship between measures of physical activity and depression or anxiety in people with COPD and were published in English. Two reviewers independently screened, reviewed and extracted data, with discrepancies resolved by a third reviewer. Across 13 studies, a small relationship was found between physical activity and depression, weighted r = -0.15, 95%CI [-0.21, -0.10], which was not moderated by physical activity measurement type. Across 8 studies, a negligible relationship was found between physical activity and anxiety, weighted r = -0.03, 95%CI [-0.11, 0.04], although this was moderated by physical activity measurement type, such that self-reported physical activity had a small negative relationship with anxiety (weighted r = -0.09, 95% CI [-0.15, -0.03]) and objectively measured physical activity had a small positive relationship (weighted r = 0.07, 95% CI [-0.13, 0.26]). In COPD, the bivariate association between physical activity and anxiety and depression are small.

Validity of the Activities-specific Balance Confidence Scale in individuals with chronic obstructive pulmonary disease.

BACKGROUND: Limited research assessed the validity of the Activities-specific Balance Confidence, ABC) Scale in individuals with chronic obstructive pulmonary disease, COPD) at risk of falls. We report on the scale's construct and criterion validity. METHODS: Construct validity was established by assessing known groups, convergent, and divergent validity. A receiver operating characteristic, (ROC) curve and logistic regression examined the criterion validity of the scale. RESULTS: In 223 individuals with COPD, the ABC Scale significantly, (p < 0.001) discriminated between groups, with lower scores for females [Mean difference (MD) = 10%], rollator use [MD = 13%], and fallers [MD = 12%], and had a strong association [r = 0.58, p < 0.001] with Berg Balance Scale. The scale distinguished fallers from non-fallers with a cutoff value of 58% [Area Under the Curve = 0.64, 95% CI = 0.57-0.72, p < 0.001] and significantly identified fall status [B, SE = -0.03, 0.01, p < 0.001] with an odds ratio of 0.97 [95%CI = 0.96-0.99]. The sensitivity, specificity, and test accuracy were: 61, 58, and 60%, respectively. CONCLUSION: The ABC Scale showed evidence for known groups, convergent, and divergent validity and can assist in identifying fall status in individuals with COPD.

Age and Sex Differences in Balance Outcomes among Individuals with Chronic Obstructive Pulmonary Disease (COPD) at Risk of Falls.

No previous research has examined age and sex differences in balance outcomes in individuals with chronic obstructive pulmonary disease (COPD) at risk of falls. A secondary analysis of baseline data from an ongoing trial of fall prevention in COPD was conducted. Age and sex differences were analyzed for the Berg Balance scale (BBS), Balance Evaluation System Test (BEST test) and Activities-specific Balance Confidence Scale (ABC). Overall, 223 individuals with COPD were included. Females had higher balance impairments than males [BBS: mean (SD) = 47 (8) vs. 49 (6) points; BEST test: 73 (16) vs. 80 (16) points], and a lower confidence to perform functional activities [ABC = 66 (21) vs. 77 (19)]. Compared to a younger age (50-65 years) group, age >65 years was moderately associated with poor balance control [BBS (r = - 0.37), BEST test (r = - 0.33)] and weakly with the ABC scale (r = - 0.13). After controlling for the effect of balance risk factors, age, baseline dyspnea index (BDI), and the 6-min walk test (6-MWT) explained 38% of the variability in the BBS; age, sex, BDI, and 6-MWT explained 40% of the variability in the BEST test; And BDI and the 6-MWT explained 44% of the variability in the ABC scale. This study highlights age and sex differences in balance outcomes among individuals with COPD at risk of falls. Recognition of these differences has implications for pulmonary rehabilitation and fall prevention in COPD, particularly among females and older adults.

Feasibility of a 6-Month Home-Based Fall Prevention Exercise Program in Older Adults with COPD.

Purpose: Older adults with chronic obstructive pulmonary disease (COPD) have a high risk and rate of falls. Home-based fall prevention exercise programs reduce falls in older adults and may be an alternative approach for people with COPD without access to hospital-based rehabilitation. Therefore, we aimed to determine the feasibility of a home-based fall prevention exercise program in older adults with COPD and to examine the effect of the program on fall-related outcomes at baseline, 3 and 6 months. Patients and Methods: Adults ≥60 years with COPD at risk for falls participated in a single group study. The intervention was a 6-month home-based fall prevention program which included 40 minutes of independent exercise three times per week, four physiotherapist home visits, bimonthly phone calls, and an optional booster session post-exacerbation. An independent assessor collected outcome measures at home at baseline, 3- and 6-months. Primary feasibility criteria were recruitment and retention rates (≥70%) and exercise adherence (≥60%). Functional outcomes included the Berg Balance Scale (BBS), the Balance Evaluation Systems Test (BESTest), the Activities-Specific Balance Confidence (ABC) scale, the repeated chair-stand test, self-reported function, and fall history. Results: Thirty-six patients (female 63.8%, mean age 74.4 ± 6.1 years; mean FEV1 45.0 ± 13.8% predicted) were enrolled. The recruitment rate was 46.8%, participant retention rate was 69.4%, and exercise adherence rate was 73.6%. Repeated measures ANOVA showed improvements at 3- and 6-months compared to baseline in the BBS (p=0.001) and the BESTest total scores and sub-scores (p=0.001). Conclusion: The home-based fall prevention exercise program met one of the three pre-specified feasibility criteria (exercise adherence), and improved balance-related measures of fall risk in older adults with COPD. Our findings highlight important opportunities for refinement of the study design prior to undertaking a full-scale trial.

Validity of balance and mobility screening tests for assessing fall risk in COPD.

People with chronic obstructive pulmonary disease (COPD) have balance impairments and an increased risk of falls. The psychometric properties of short balance tests to inform fall risk assessment in COPD are unknown. Our objective was to determine the validity (concurrent, convergent, and known-groups) of short balance and mobility tests for fall risk screening. Participants with COPD aged ≥ 60 years attended a single assessment. Correlation coefficients described the relationships between the Brief Balance Evaluation Systems Test (Brief BESTest), Single-Leg Stance (SLS), Timed Up and Go (TUG), and Timed Up and Go Dual-Task (TUG-DT) tests, with the comprehensive Berg Balance Scale (BBS), chair-stand test, and measures of exercise tolerance, functional limitation, disability, and prognosis. Independent t-tests or Mann-Whitney U tests were used to examine differences between groups with respect to fall risk. Receiver operating characteristic curves examined the ability of the screening tests to identify individuals with previous falls. A total of 86 patients with COPD completed the study (72.9 ± 6.8 years; forced expiratory volume in 1 second: 47.3 ± 20.3% predicted). The Brief BESTest identified individuals who reported a previous fall (area under the curve (AUC) = 0.715, p = 0.001), and the SLS showed borderline acceptable accuracy in identifying individuals with a fall history (AUC = 0.684, p = 0.004). The strongest correlations were found for the Brief BESTest and SLS with the BBS (r = 0.80 and r = 0.72, respectively) and between the TUG and TUG-DT with the chair-stands test (r = 0.73 and r = 0.70, respectively). The Brief BESTest and SLS show the most promise as balance screening tools for fall risk assessment in older adults with COPD. These tests should be further evaluated prospectively.

Pulmonary Rehabilitation With Balance Training for Fall Reduction in Chronic Obstructive Pulmonary Disease: Protocol for a Randomized Controlled Trial.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. A growing body of evidence shows that individuals with COPD have important deficits in balance control that may be associated with an increased risk of falls. Pulmonary rehabilitation (PR) is a key therapeutic intervention for individuals with COPD; however, current international guidelines do not include balance training and fall prevention strategies. OBJECTIVE: The primary aim of this trial is to determine the effects of PR with balance training compared to PR with no balance training on the 12-month rate of falls in individuals with COPD. Secondary aims are to determine the effects of the intervention on balance, balance confidence, and functional lower body strength, and to estimate the cost-effectiveness of the program. METHODS: A total of 400 individuals from nine PR centers across Canada, Europe, and Australia will be recruited to participate in a randomized controlled trial. Individuals with COPD who have a self-reported decline in balance, a fall in the last 2 years, or recent near fall will be randomly assigned to an intervention or control group. The intervention group will undergo tailored balance training in addition to PR and will receive a personalized home-based balance program. The control group will receive usual PR and a home program that does not include balance training. All participants will receive monthly phone calls to provide support and collect health care utilization and loss of productivity data. Both groups will receive home visits at 3, 6, and 9 months to ensure proper technique and progression of home exercise programs. The primary outcome will be incidence of falls at 12-month follow-up. Falls will be measured using a standardized definition and recorded using monthly self-report fall diary calendars. Participants will be asked to record falls and time spent performing their home exercise program on the fall diary calendars. Completed calendars will be returned to the research centers in prepaid envelopes each month. Secondary measures collected by a blinded assessor at baseline (pre-PR), post-PR, and 12-month follow-up will include clinical measures of balance, balance confidence, functional lower body strength, and health status. The cost-effectiveness of the intervention group compared with the control group will be evaluated using the incremental cost per number of falls averted and the incremental cost per quality-adjusted life years gained. RESULTS: Recruitment for the study began in January 2017 and is anticipated to be complete by December 2019. Results are expected to be available in 2020. CONCLUSIONS: Findings from this study will improve our understanding of the effectiveness and resource uses of tailored balance training for reducing falls in individuals with COPD. If effective, the intervention represents an opportunity to inform international guidelines and health policy for PR in individuals with COPD who are at risk of falling. TRIAL REGISTRATION: ClinicalTrials.gov NCT02995681; https://clinicaltrials.gov/ct2/show/NCT02995681 (Archived by WebCite at http://www.webcitation.org/6ukhxgAsg).

Reaching Consensus on Measuring Professional Behaviour in Physical Therapy Objective Structured Clinical Examinations.

Purpose: We determined which professional behaviours (PBs) are important and feasible to measure in an objective structured clinical examination (OSCE) intended to assess the hands-on skills and knowledge of students in a Canadian physical therapy (PT) program. Methods: We used a modified Delphi technique to identify the criteria required to assess PBs in PT students during an OSCE. We conducted a focus group to better understand the results of the modified Delphi process. Results: Experienced local OSCE examiners participated in the modified Delphi panel, which consisted of two rounds of surveys: round 1 (n=12) and round 2 (n=10). A total of 31 PBs were reduced to 18 through the two rounds. Five of the panellists participated in the focus group, reduced the 18 PBs to 15, and then identified 4 as clinical skills. Participants categorized the remaining 11 as mixed PBs and clinical skills (1 item), PBs (4 items), or communication skills (6 items). Conclusion: This study provides preliminary evidence to support the feasibility and importance of evaluating 5 PB items in practical skills OSCEs for entry-to-practice PT students.

Objectif : déterminer les comportements professionnels (CP) qui sont importants et évaluables durant un examen clinique objectif structuré (ECOS) afin d'évaluer les compétences et les connaissances pratiques des étudiants d'un programme de physiothérapie au Canada. Méthodes : nous avons utilisé une méthode Delphi modifiée pour cibler les critères requis pour évaluer les CP des étudiants en physiothérapie durant un ECOS. Nous avons mené un groupe de discussion pour mieux comprendre les résultats du processus Delphi modifié. Résultats : des examinateurs ECOS expérimentés locaux ont participé au groupe d'experts sur la méthode Delphi modifiée, qui consistait en deux rondes de sondages : ronde 1 (n=12) et ronde 2 (n=10). Un total de 31 CP ont été réduits à 18 au cours des deux rondes. Cinq des experts ont participé au groupe de discussion et ont réduit les 18 CP à 15, puis en ont ciblé quatre comme étant des compétences cliniques. Les participants ont catégorisé les 11 CP restants comme étant des compétences cliniques et des CP mixtes (un élément), des CP (quatre éléments) ou des compétences en communication (six éléments). Conclusion : cette étude fournit des données probantes préliminaires pour appuyer la faisabilité et l'importance d'évaluer cinq CP faisant partie des compétences pratiques de l'ECOS nécessaires à l'admissibilité à la pratique des étudiants en physiothérapie.

Measuring professional behaviour in canadian physical therapy students' objective structured clinical examinations: an environmental scan.

PURPOSE: To identify professional behaviours measured in objective structured clinical examinations (OSCEs) by Canadian university physical therapy (PT) programs. METHOD: A cross-sectional telephone survey was conducted to review current practice and determine which OSCE items Canadian PT programs are using to measure PT students' professional behaviours. Telephone interviews using semi-structured questions were conducted with individual instructors responsible for courses that included an OSCE as part of the assessment component. RESULTS: Nine PT programmes agreed to take part in the study, and all reported conducting at least one OSCE. The number and characteristics of OSCEs varied both within and across programs. Participants identified 31 professional behaviour items for use in an OSCE; these items clustered into four categories: communication (n=14), respect (n=10), patient safety (n=4), and physical therapists' characteristics (n=3). CONCLUSIONS: All Canadian entry-level PT programmes surveyed assess professional behaviours in OSCE-type examinations; however, the content and style of assessment is variable. The local environment should be considered when determining what professional behaviours are appropriate to assess in the OSCE context in individual programmes.

Objet : Cerner les comportements professionnels mesurés dans les examens cliniques objectifs structurés dans le cadre des programmes de physiothérapie des universités canadiennes. Méthode : Un sondage téléphonique transversal a été effectué pour examiner la pratique actuelle et déterminer les éléments des examens cliniques objectifs structurés (ECOS) utilisés dans le cadre des programmes canadiens de physiothérapie pour mesurer les comportements professionnels des étudiants en physiothérapie. On a mené des entrevues téléphoniques dans lesquelles on posait des questions semi-structurées aux instructeurs chargés des cours comportant un ECOS dans la composante d'évaluation. Résultats : Neuf programmes de physiothérapie ont accepté de participer à l'étude, et les répondants ont tous déclaré qu'ils effectuaient au moins un examen clinique objectif structuré. Le nombre et les caractéristiques des ECOS variaient à la fois au sein d'un même programme et entre les programmes. Les participants ont cerné 31 éléments de comportement professionnel à mesurer dans un ECOS; ils se regroupent en quatre catégories: communication (n=14), respect (n=10), sécurité des patients (n=4) et caractéristiques des physiothérapeutes (n=3). Conclusions : Tous les programmes de physiothérapie sondés au niveau débutant évaluent les comportements professionnels à l'aide d'examens de type ECOS; toutefois, le contenu et le style de l'examen sont variables. Il faut tenir compte de l'environnement local lorsqu'on détermine les comportements professionnels qu'il faut évaluer dans le contexte de l'ECOS dans les programmes individuels.

Developing a physiotherapy-specific preliminary clinical decision-making tool for oxygen titration: a modified delphi study.

PURPOSE: To develop and evaluate a preliminary clinical decision-making tool (CDMT) to assist physiotherapists in titrating oxygen for acutely ill adults in Ontario. METHODS: A panel of 14 experienced cardiorespiratory physiotherapists was recruited. Factors relating to oxygen titration were identified using a modified Delphi technique. Four rounds of questionnaires were conducted, during which the goals were to (1) generate factors, (2) reduce factors and debate contentious factors, (3) finalize factors and develop the preliminary CDMT, and (4) evaluate the usability of the tool in a clinical context. RESULTS: The panel reached consensus on a total of 89 factors, which were compiled to create the preliminary CDMT. The global tool reached consensus for sensibility, receiving a mean score of 6/7 on a 7-point Likert-type scale (1=unacceptable; 7=excellent). Five of the nine individual components of evaluation of the tool achieved scores ≥6.0; the remaining four had mean scores between 5.4 and 5.9. CONCLUSION: This study produced a preliminary CDMT for oxygen titration, which the panel agreed was highly comprehensible and globally sensible. Further research is necessary to evaluate the sensibility and applicability of the tool in a clinical setting.

Objectif : Élaborer et évaluer un outil préliminaire de prise de décision clinique pour aider les physiothérapeutes à doser l'oxygène pour le traitement des adultes gravement malades en Ontario. Méthodes : Un groupe de 14 physiothérapeutes chevronnés en physiothérapie cardiorespiratoire a été recruté. Les facteurs liés au dosage de l'oxygène ont été cernés à l'aide d'une technique Delphi modifiée. Quatre séries de questionnaires ont été distribuées, dans le but de (1) produire les facteurs, (2) réduire le nombre de facteurs et débattre des facteurs controversés, (3) mettre au point les facteurs et élaborer l'outil préliminaire, et (4) évaluer la sensibilité de l'outil. Résultats : Le groupe est parvenu à un consensus sur un total de 89 facteurs qui ont permis de constituer l'outil préliminaire. Il est ensuite arrivé à un consensus concernant la sensibilité de l'outil global, ce dernier ayant reçu une note moyenne de 6 sur 7 sur l'échelle Likert (1 étant inacceptable et 7, excellent). Cinq des neuf composantes individuelles de l'évaluation de l'outil ont obtenu des notes ≥6,0, tandis que les quatre autres composantes obtenaient des notes moyennes s'échelonnant de 5,4 à 5,9. Conclusion : Cette étude a produit un outil préliminaire pour le dosage de l'oxygène qui, de l'avis du groupe, est tout à fait compréhensible et généralement pratique. Il faudra effectuer une recherche approfondie pour évaluer la sensibilité et l'applicabilité de l'outil dans le contexte clinique.

Examining interrater reliability and validity of a paediatric cardiopulmonary physiotherapy discharge tool.

PURPOSE: To determine the interrater reliability (IRR) of the individual items in the Paediatric Cardiopulmonary Physiotherapy (CPT) Discharge Tool. This tool identifies six critical items that physiotherapists should consider when determining a paediatric patient's readiness for discharge from CPT after upper-abdominal, cardiac, or thoracic surgery: oxygen saturation, mobility, secretion retention, discharge planning, auscultation, and signs of respiratory distress. METHODS: A total of 33 paediatric patients (ages 2 to <19 years) who received at least 1 day of CPT following cardiac, thoracic, or upper-abdominal surgery were independently assessed using the Paediatric CPT Discharge Tool by two designated assessors, who assessed each patient within 4 hours of each other. RESULTS: Kappa analysis showed the following levels of interrater agreement for the six items of the Paediatric CPT Discharge Tool: Oxygen Saturation, excellent (κ=0.80); Mobility, substantial (κ=0.62); Secretion Clearance, moderate (κ=0.39); Discharge Planning, fair (κ=0.37); and Auscultation and Respiratory Distress, poor (κ=0.24 and κ=-0.08, respectively). CONCLUSION: Several of the items in the Paediatric CPT Discharge Tool demonstrate good IRR. The discharge tool is ready for further psychometric testing, specifically validity testing.

Objectif : Déterminer la fiabilité entre évaluateurs des six questions contenues dans le questionnaire sur le départ du service de physiothérapie cardiopulmonaire (PTC) pédiatrique qui détermine six éléments critiques dont les physiothérapeutes doivent tenir compte lorsqu'il s'agit de déterminer si un patient en pédiatrie est prêt à quitter le service de PTC après une chirurgie thoracique, cardiaque ou au haut de l'abdomen: saturation en oxygène, mobilité, rétention des sécrétions, préparation du départ, auscultation et signes de détresse respiratoire. Méthodes : Deux évaluateurs désignés ont évalué au total 33 patients en pédiatrie (âgés de 2 à <19 ans) qui ont reçu au moins une journée de PTC à la suite d'une chirurgie cardiaque, thoracique ou au haut de l'abdomen au moyen du questionnaire sur le départ du service de PTC pédiatrique. Les deux évaluateurs ont évalué chaque patient à moins de quatre heures d'intervalle. Résultats : Les six questions du questionnaire sur le départ du service de PTC pédiatrique ont révélé la convergence suivante à la suite d'une analyse kappa: saturation en oxygène, excellente (κ=0,80); mobilité, importante (κ=0,62); dégagement des sécrétions, modéré (κ=0,39); préparation du départ, moyenne (κ=0,37); et auscultation et détresse respiratoire, médiocre (κ=0,24 et κ=−0,08, respectivement). Conclusion : Plusieurs des questions du questionnaire sur le départ du service de PTC pédiatrique démontrent une bonne fiabilité entre évaluateurs. L'outil est prêt à soumettre à d'autres tests psychométriques et en particulier des tests de validité.

Physiotherapists and Physiotherapy Student Placements across Regions in Ontario: A Descriptive Comparison.

PURPOSE: To describe the distribution and type of physiotherapy student placements in one year relative to the number of practising physiotherapists of Ontario. METHODS: Site information about physiotherapy students' clinical placements in Ontario in 2010 was obtained from Academic Coordinators of Clinical Education. Worksite information about physiotherapists who reported providing direct patient care at a primary employment site in Ontario and at least 600 practice hours in their annual renewal was obtained from the College of Physiotherapists of Ontario. Each placement and each physiotherapist was attributed to one of Ontario's 14 local health integration networks (LHINs). For each LHIN, a ratio of student placements to practising physiotherapists was calculated, using summed counts. Counts of placement types by setting, patient mix, and practice area were also calculated for each LHIN. RESULTS: The 5 LHINs in which the university programmes are located had high placement:physiotherapist ratios, from 0.92 to 0.38. The other 9 LHINs had lower ratios, the 3 lowest at approximately 0.15. There was a wide mix of clinical placement types across LHINs. CONCLUSION: Physiotherapists' participation in physiotherapy students' clinical education varied widely among Ontario regions. Future research could explore whether regional differences are persistent, why they occur, and whether they should be reduced.

Objectif : Mesurer la répartition et décrire le type de stages des étudiants en physiothérapie en une année, comparativement au nombre de physiothérapeutes en exercice en Ontario. Méthode : Les renseignements sur les lieux des stages des étudiants en physiothérapie en Ontario en 2010 ont été obtenus en faisant appel aux coordonnateurs de l'enseignement clinique des universités. Les renseignements sur les milieux de travail des physiothérapeutes qui ont dit offrir des soins directement aux patients dans un établissement de soins de santé primaires en Ontario et qui comptent au moins 600 heures de pratique lors de leur renouvellement annuel ont été obtenus auprès du College of Physiotherapists of Ontario. Chaque stage et chaque physiothérapeute ont été attribués à l'un des 14 Réseaux locaux d'intégration des soins de santé (RLISS) de l'Ontario. Pour chaque RLISS, un rapport entre le nombre de stages étudiants et le nombre de physiothérapeutes en exercice a été calculé à l'aide du total cumulé de chacun. Le nombre de stages d'un type précis par établissement, par type de patients et par domaine de pratique a aussi été calculé pour chaque RLISS. Résultats : Les cinq RLISS situés dans la même région où sont offerts les programmes universitaires affichaient un fort taux de stages: le rapport par physiothérapeute y variait de 0,92 à 0,38. Les neuf autres RLISS affichaient des rapports moins élevés, et les trois RLISS comportant le rapport le plus faible affichaient un coefficient de 0,15. On a dénombré un ensemble très varié de types de stages à travers les différents RLISS. Conclusion : En Ontario, la participation des physiothérapeutes à la formation clinique des étudiants en physiothérapie varie d'une région à l'autre. Des recherches futures pourraient se pencher sur les différences entre les régions et voir si ces différences sont persistantes, pourquoi elles surviennent et s'il serait important de les atténuer.

Weekend physiotherapy practice in community hospitals in Canada.

PURPOSE: To analyze weekend physiotherapy services in acute-care community hospitals across Canada. METHOD: Questionnaires were mailed to acute-care community hospitals (institutions with >100 inpatient beds, excluding psychiatric, mental health, paediatric, rehabilitation, tertiary, and long-term care facilities) across Canada from January to April 2010. The questionnaire collected information on patient referral criteria, staffing, workload, and compensation for weekend physiotherapy services and on the availability of other rehabilitation health professionals. RESULTS: Of 146 community hospitals deemed eligible, 104 (71%) responded. Weekend physiotherapy was offered at 69% of hospitals across Canada, but this rate varied: ≥75% in all regions except Quebec (30%). Hospitals with a high proportion of acute-care beds were more likely to offer weekend physiotherapy services (logistic regression, p=0.021). Services differed among Saturdays, Sundays, and holidays in terms of the numbers of both physiotherapists and physiotherapy assistants working (Kruskal-Wallis, p<0.02 for each). Physiotherapists were predominantly compensated via time off in lieu. Of hospitals not offering weekend physiotherapy, 53% reported that it would benefit patients; most perceived staffing and financial barriers. Social-work services were offered on the weekend at 24% of hospitals and occupational therapy at 16%. CONCLUSIONS: Substantial regional variation exists in access to weekend physiotherapy services in acute-care community hospitals. To address the importance of this variation, research on the efficacy and cost-effectiveness of such services is required.Purpose: To analyze weekend physiotherapy services in acute-care community hospitals across Canada. Method: Questionnaires were mailed to acute-care community hospitals (institutions with >100 inpatient beds, excluding psychiatric, mental health, paediatric, rehabilitation, tertiary, and long-term care facilities) across Canada from January to April 2010. The questionnaire collected information on patient referral criteria, staffing, workload, and compensation for weekend physiotherapy services and on the availability of other rehabilitation health professionals. Results: Of 146 community hospitals deemed eligible, 104 (71%) responded. Weekend physiotherapy was offered at 69% of hospitals across Canada, but this rate varied: ≥75% in all regions except Quebec (30%). Hospitals with a high proportion of acute-care beds were more likely to offer weekend physiotherapy services (logistic regression, p=0.021). Services differed among Saturdays, Sundays, and holidays in terms of the numbers of both physiotherapists and physiotherapy assistants working (Kruskal­Wallis, p<0.02 for each). Physiotherapists were predominantly compensated via time off in lieu. Of hospitals not offering weekend physiotherapy, 53% reported that it would benefit patients; most perceived staffing and financial barriers. Social-work services were offered on the weekend at 24% of hospitals and occupational therapy at 16%. Conclusions: Substantial regional variation exists in access to weekend physiotherapy services in acute-care community hospitals. To address the importance of this variation, research on the efficacy and cost-effectiveness of such services is required.

RÉSUMÉ Objectif : Analyser les services de physiothérapie offerts durant les fins de semaine dans les hôpitaux communautaires de soins de courte durée d'un bout à l'autre du Canada. Méthode : De janvier à avril 2010, des questionnaires ont été postés aux hôpitaux communautaires de soins de courte durée (établissements comptant plus de 100 lits pour hospitalisation, excluant les lits en psychiatrie, en santé mentale, en pédiatrie, en réadaptation, les soins tertiaires et les établissements de soins prolongés) partout au Canada. Le questionnaire visait à recueillir de l'information sur les critères justifiant le renvoi en consultation, le personnel, la charge de travail et la rémunération pour des services de physiothérapie offerts les fins de semaine, et sur la disponibilité d'autres professionnels de la santé œuvrant en réadaptation. Résultats : Des 146 hôpitaux communautaires admissibles, 104 (71 %) ont répondu. Des services de physiothérapie étaient offerts les fins de semaine dans 69 % des hôpitaux au Canada, mais cette proportion varie : ≥75 % dans toutes les régions, sauf au Québec (30 %). Il était plus probable que des services de physiothérapie soient offerts les fins de semaine dans les hôpitaux qui disposent d'une forte proportion de lits en soins de courte durée (régression logistique, p=0,021). Le nombre de physiothérapeutes et d'assistants-physiothérapeutes en poste les samedis, les dimanches et les jours fériés varie, ce qui explique que les services sont différents les samedis, les dimanches et les jours fériés (Kruskal-Wallis, p<0,02 pour chaque profession). Les physiothérapeutes étaient principalement rémunérés par des congés compensatoires. Parmi les hôpitaux n'offrant pas de physiothérapie les fins de semaine, 53 % ont fait savoir que de tels services seraient profitables pour les patients, mais que le manque de personnel et les restrictions financières les empêchaient de les offrir. Des services de travailleurs sociaux étaient offerts les fins de semaine dans 24 % des hôpitaux, et des services en ergothérapie dans 16 % des hôpitaux. Conclusions : L'accès à des services de physiothérapie les fins de semaine fait l'objet de disparités régionales importantes dans les hôpitaux communautaires de soins de courte durée. La mesure de l'étendue de ces disparités pourrait être établie par des recherches sur l'efficacité et sur la rentabilité de tels services.

Preliminary development and validation of a paediatric cardiopulmonary physiotherapy discharge tool.

PURPOSE: The purpose of this study was to develop a paediatric cardiopulmonary physiotherapy (CPT) discharge tool. We report on the initial stages of its development and the tool's sensibility (face/content validity, feasibility, and ease of usage). METHODS: Using a modified Delphi technique, a panel of paediatric physiotherapy clinicians and academic leaders in the area of CPT (n=25) was recruited. Four rounds of discussion among the members of the Delphi panel focused on (1) generation of discharge items, (2) reduction of items, (3) discussion of contentious items and refinement of criterion definitions, and (4) determination of scoring options for the test instrument. The sensibility of a draft of the tool was assessed using a sample of convenience (n=15). RESULTS: Six items (auscultation, discharge planning, mobility, oxygen saturation, secretion clearance, and signs of respiratory distress) were identified for inclusion in the tool. The global mean of all sensibility domains was 6.4 (median=6.6) of a possible 7.0. CONCLUSION: Using a modified Delphi process, we developed a six-item paediatric CPT discharge planning tool with good face and content validity. Future work will determine the scoring method for using this tool, interrater reliability, and predictive validity to facilitate optimal timing of hospital discharge for paediatric CPT patients.