Current perspectives of New Zealand physiotherapists on rehabilitation and return to sport following anterior cruciate ligament reconstruction: A survey.

OBJECTIVE: To investigate the clinical beliefs and practices of New Zealand physiotherapists regarding pre- and post-surgical rehabilitation and return to sport (RTS) criteria following anterior cruciate ligament reconstruction (ACLR). DESIGN: Online cross-sectional survey. METHODS: A survey was adapted from a previously published survey and disseminated to New Zealand physiotherapists who were considered more likely to be involved in post-ACLR rehabilitation. RESULTS: The number of completed surveys was 318. Most physiotherapists (85%) preferred to first consult patients within 14 days of ACLR. In the first six weeks following ACLR, 89% of physiotherapists see patients at least once per week. Between 3- and 6-months post-ACLR, 76% of physiotherapists see patients at least once a fortnight. Pre-operative rehabilitation and post-operative rehabilitation exceeding six months are considered essential or important to patient outcomes by over 95% of physiotherapists. While 63% of physiotherapists support RTS 9-12 months after ACLR, 11% permit RTS within 6-9 months of surgery. Common RTS considerations include functional capacity, movement quality during functional tasks, time from ACLR, and knee strength. CONCLUSION: The survey revealed variability in the beliefs and practices of NZ physiotherapists regarding post-ACLR rehabilitation, and these beliefs and practices are at times inconsistent with best practice recommendations.

Confidence and Attitudes Toward Osteoarthritis Care Among the Current and Emerging Health Workforce: A Multinational Interprofessional Study.

OBJECTIVE: To measure confidence and attitudes of the current and emerging interprofessional workforce concerning osteoarthritis (OA) care. METHODS: Study design is a multinational (Australia, New Zealand, Canada) cross-sectional survey of clinicians (general practitioners [GPs], GP registrars, primary care nurses, and physiotherapists) and final-year medical and physiotherapy students. GPs and GP registrars were only sampled in Australia/New Zealand and Australia, respectively. The study outcomes are as follows: confidence in OA knowledge and skills (customized instrument), biomedical attitudes to care (Pain Attitudes Beliefs Scale [PABS]), attitudes toward high- and low-value care (customized items), attitudes toward exercise/physical activity (free-text responses). RESULTS: A total of 1886 clinicians and 1161 students responded. Although a number of interprofessional differences were identified, confidence in OA knowledge and skills was consistently greatest among physiotherapists and lowest among nurses (eg, the mean difference [95% confidence interval (CI)] for physiotherapist-nurse analyses were 9.3 [7.7-10.9] for knowledge [scale: 11-55] and 14.6 [12.3-17.0] for skills [scale: 16-80]). Similarly, biomedical attitudes were stronger in nurses compared with physiotherapists (6.9 [5.3-8.4]; scale 10-60) and in medical students compared with physiotherapy students (2.0 [1.3-2.7]). Some clinicians and students agreed that people with OA will ultimately require total joint replacement (7%-19% and 19%-22%, respectively), that arthroscopy is an appropriate intervention for knee OA (18%-36% and 35%-44%), and that magnetic resonance imaging is informative for diagnosis and clinical management of hip/knee OA (8%-61% and 21%-52%). Most agreed (90%-98% and 92%-97%) that exercise is indicated and strongly supported by qualitative data. CONCLUSION: Workforce capacity building that de-emphasizes biomedical management and promotes high-value first-line care options is needed. Knowledge and skills among physiotherapists support leadership roles in OA care for this discipline.

Primary care doctor and nurse utilisation rates for billed consultations across the Comprehensive Care Primary Health Organisation.

AIM: To examine socio-demographic trends in doctor and nurse utilisation rates for invoiced consultations across Comprehensive Care Primary Health Organisation (PHO). METHOD: De-identified enrolled patient information and Service Utilisation Reporting data for invoiced consultations were extracted from all general practices for January 2013-December 2016. Utilisation rates were calculated using the number of enrolled patients as the denominator. RESULTS: Data for 3,657,873 invoiced consultations across 66 general practices were analysed, including 2,941,624 doctor and 716,249 nurse consultations. Average utilisation rates were 3.1 visits per patient year for doctors and 0.7 visits for nurses, with considerable variability between practices. Utilisation rates were higher for females (3.3 visits for doctors; 0.8 for nurses), older adults (5.0-6.9; 1.3-1.6 visits) and patients residing in the most socially deprived quintile (3.3; 1.6 visits). European patients had the highest doctor utilisation rates (3.2 visits), while Maori and Pacific patients had the highest nurse utilisation rates (1.1 and 1.3 visits, respectively). CONCLUSION: Females, older adults and people residing in socially deprived areas utilise primary care more frequently according to invoiced consultation data. Analysis of all other consultations, including immunisations, Accident Corporation Claims and non-billed services is needed to more accurately capture utilisation rates, particularly for nurses, to better inform national decision-making, workforce planning and funding assumptions.

Maori lived experience of osteoarthritis: a qualitative study guided by Kaupapa Maori principles.

INTRODUCTION Osteoarthritis adversely affects people's quality of life; however, the effects of osteoarthritis on Maori in New Zealand remain unknown. AIM To explore the Maori lived experience of osteoarthritis. METHODS A qualitative study guided by Kaupapa Maori principles. Maori adults (≥30 years) with clinical knee or hip osteoarthritis took part in semi-structured interviews that were recorded and transcribed. Thematic analysis and a model of Maori health (Te Whare Tapa Wha, outlining four dimensions of wellbeing (taha tinana- physical; taha hinengaro- mental; taha wairua- spiritual; and taha whanau- family)) were used to analyse data. RESULTS Seven Maori females aged 44-71 years participated. Physical manifestations of osteoarthritis, namely pain and limited daily activities, affected mental, spiritual and family wellbeing. Participants experienced whakama (shame) and frustration. Cultural duties such as attending the marae were impeded, affecting spiritual wellbeing and cultural identity. Participants described drawing on the strength of their ancestors to cope with their impairments. Western medicine was commonly used, although side-effects were prominent and few participants had received information about the condition from health professionals. Both positive and negative experiences of health-care and treatments were reported. DISCUSSION Osteoarthritis inflicts a substantial burden on the physical, mental, spiritual and family wellbeing of Maori women. Primary care practitioners must consider spiritual and family wellbeing when providing care for Maori with osteoarthritis. Culturally sensitive education for patients and their whanau is needed.

Proposal for a National Interprofessional School of Rural Health.

Shortages of health professionals persist in much of rural New Zealand despite a range of targeted university and professional college initiatives. In response to this a collective of universities, professional colleges and sector groups have put a proposal to Government for a National Interprofessional School of Rural Health. If adopted, this proposal would embed rural health professional education and research in rural communities around New Zealand, empowering them to organise the education that occurs in their community, in a coherent and coordinated way. What is being proposed is not a new or separate education provider but rather an 'enabling body' that would lever off the expertise and resources of the existing tertiary institutions, colleges and rural communities. It calls for an 'all of systems' approach that encompasses all the health professions that practise in rural areas, undergraduate education and postgraduate training, and rural health research. Although modelled on successful Australian rural clinical schools, it is a uniquely New Zealand solution that is cognisant of the New Zealand context and resources.

Use of a functional mobility measure to predict discharge destinations for patients admitted to an older adult rehabilitation ward: A feasibility study.

OBJECTIVE: To investigate whether the discharge destination for older adults can be predicted using functional mobility as measured by the Modified Elderly Mobility Scale (MEMS), associated with demographic and primary reason for admission variables. METHODS: A retrospective cohort population audit of 257 patients admitted and discharged from four tertiary older adult rehabilitation wards in a three-month period. A number of predictor variables were considered alongside the discharge destination. RESULTS: Multinomial statistical modelling established that MEMS prior to (P < 0.001), MEMS on completion (P = 0.009) of rehabilitation physiotherapy and primary reason for admission (P = 0.002) were significant variables to predict discharge destination. The model correctly predicted 71% of observed patient discharge destinations. CONCLUSION: The MEMS in conjunction with primary reason for admission was able to predict discharge destination with 71% accuracy in a heterogeneous population of older adults following rehabilitation.

The inter and intra rater reliability of the Netball Movement Screening Tool.

OBJECTIVES: To establish the inter- and intra-rater reliability of the Netball Movement Screening Tool, for screening adolescent female netball players. DESIGN: Inter- and intra-rater reliability study. METHODS: Forty secondary school netball players were recruited to take part in the study. Twenty subjects were screened simultaneously and independently by two raters to ascertain inter-rater agreement. Twenty subjects were scored by rater one on two occasions, separated by a week, to ascertain intra-rater agreement. Inter and intra-rater agreement was assessed utilising the two-way mixed inter class correlation coefficient and weighted kappa statistics. RESULTS: No significant demographic differences were found between the inter and intra-rater groups of subjects. Inter class correlation coefficients' demonstrated excellent inter-rater (two-way mixed inter class correlation coefficients 0.84, standard error of measurement 0.25) and intra-rater (two-way mixed inter class correlation coefficients 0.96, standard error of measurement 0.13) reliability for the overall Netball Movement Screening Tool score and substantial-excellent (two-way mixed inter class correlation coefficients 1.0-0.65) inter-rater and substantial-excellent intra-rater (two-way mixed inter class correlation coefficients 0.96-0.79) reliability for the component scores of the Netball Movement Screening Tool. Kappa statistic showed substantial to poor inter-rater (k=0.75-0.32) and intra-rater (k=0.77-0.27) agreement for individual tests of the NMST. CONCLUSIONS: The Netball Movement Screening Tool may be a reliable screening tool for adolescent netball players; however the individual test scores have low reliability. The screening tool can be administered reliably by raters with similar levels of training in the tool but variable clinical experience. On-going research needs to be undertaken to ascertain whether the Netball Movement Screening Tool is a valid tool in ascertaining increased injury risk for netball players.

Systematic review of guidelines for the physical management of osteoarthritis.

OBJECTIVE: To undertake a systematic critical appraisal of guidelines to provide a summary of recommendations for the physical management of osteoarthritis (OA). DATA SOURCES: The Cochrane Library, MEDLINE, CINAHL, SPORTDiscus with Full Text, Scopus, ScienceDirect, PEDro, and Google Scholar databases were searched (2000-2013) to identify all guidelines, protocols, and recommendations for the management or treatment of OA. In addition, Internet searches of all relevant arthritis organizations were undertaken. All searches were performed between July 2012 and end of April 2013. Guidelines that included only pharmacological, injection therapy, or surgical interventions were excluded. Guidelines published only in English were retrieved. STUDY SELECTION: OA guidelines developed from evidence-based research, consensus, and/or expert opinion were retrieved. There were no restrictions on severity or site of OA, sex, or age. Nineteen guidelines were identified for evaluation. DATA EXTRACTION: The quality of all guidelines was critically appraised using the Appraisal of Guidelines for REsearch and Evaluation II instrument. Each guideline was independently reviewed. All relevant recommendations for the physical management of OA were synthesized, graded, and ranked according to available evidence. DATA SYNTHESIS: Seventeen guidelines with recommendations on the physical management of OA met the inclusion criteria and underwent a full critical appraisal. There were variations in the interventions, levels of evidence, and strength of recommendations across the guidelines. Forty different interventions were identified. Recommendations were graded from "strongly recommended" to "unsupported." Exercise and education were found to be strongly recommended by most guidelines. CONCLUSIONS: Exercise and education were key recommendations supporting the importance of rehabilitation in the physical management of OA. This critical appraisal can assist health care providers who are involved in the management of people with OA.

Insights from a physiotherapist's lived experience of osteoarthritis.

Osteoarthritis (OA) of a hip joint, with subsequent total hip joint replacement surgery, is portrayed in the literature in terms of quantitative research studies, where the person living with the hip disappears in objective statistical analyses, or in qualitative studies where one person's story is fragmented within thematic findings. This phenomenological study of a physiotherapist's (Peter) lived experience of OA offers insights relevant to practice. In the initial stages of the disease, Peter was too close to 'see' the possibility of OA as a diagnosis. As the pain limited what he could do, he needed to reinvent ways of retaining his sense of 'self'. The pain worsened; there was nothing that relieved it. The experience became one of endurance, leading to a moment when he decided the time had come to have surgery. Post-surgery, the journey of recovery was one of the feelings vulnerable. He wanted guidance and re-assurance. Paradoxically, recovery showed itself as 'forgetting' the body. The insights call for therapists to listen to the experience of clients and be alongside side them as they struggle with vulnerability. Sharing an understanding of the nature of the experience can bring confidence to clients.

Ankle sprains: patient perceptions of function and performance of physical tasks. A mixed methods approach.

PURPOSE: To investigate patient's perceptions of function and performance of physical tasks after discharge from treatment for an ankle sprain. METHODS: Using a mixed methods approach, 40 participants who presented with an acute sprained ankle and their treating clinicians completed two questionnaires related to function at the start and end of a rehabilitation programme. Additionally, participants completed the questionnaires at 6 weeks following discharge at which time they also performed physical tasks that were still perceived as difficult. Ten participants also completed a semi-structured interview. RESULTS: There were no significant differences (p > 0.05) in the participant's and clinician's initial assessment of function. However, at discharge participants scored their function significantly (p < 0.05) lower than clinicians. This difference was not apparent 6 weeks later (p > 0.05). However, there was a significant difference (p  < 0.05) following actual performance of tasks with an effect size of 1.58. Participant interviews confirmed that patients had a fear of re-injury until they actually performed tasks that were perceived as difficult. CONCLUSIONS: Clinicians and participants do not have a similar perception of the recovery of an ankle sprain at discharge. Performing tasks which were perceived as difficult were valuable in assisting participants gain an improved appreciation of their function.

Exercise therapy for the management of osteoarthritis of the hip joint: a systematic review.

INTRODUCTION: Recent guidelines pertaining to exercise for individuals with osteoarthritis have been released. These guidelines have been based primarily on studies of knee-joint osteoarthritis. The current study was focused on the hip joint, which has different biomechanical features and risk factors for osteoarthritis and has received much less attention in the literature. The purpose was to conduct a systematic review of the literature to evaluate the exercise programs used in intervention studies focused solely on hip-joint osteoarthritis, to decide whether their exercise regimens met the new guidelines, and to determine the level of support for exercise-therapy interventions in the management of hip-joint osteoarthritis. METHODS: A systematic literature search of 14 electronic databases was undertaken to identify interventions that used exercise therapy as a treatment modality for hip osteoarthritis. The quality of each article was critically appraised and graded according to standardized methodologic approaches. A 'pattern-of-evidence' approach was used to determine the overall level of evidence in support of exercise-therapy interventions for treating hip osteoarthritis. RESULTS: More than 4,000 articles were identified, of which 338 were considered suitable for abstract review. Of these, only 6 intervention studies met the inclusion criteria. Few well-designed studies specifically investigated the use of exercise-therapy management on hip-joint osteoarthritis. Insufficient evidence was found to suggest that exercise therapy can be an effective short-term management approach for reducing pain levels, improving joint function and the quality of life. CONCLUSIONS: Limited information was available on which conclusions regarding the efficacy of exercise could be clearly based. No studies met the level of exercise recommended for individuals with osteoarthritis. High-quality trials are needed, and further consideration should be given to establishing the optimal exercises and exposure levels necessary for achieving long-term gains in the management of osteoarthritis of the hip.

A framework for the classification and diagnosis of work-related upper extremity conditions: systematic review.

OBJECTIVE: A frequently cited problem in epidemiological research is the inadequate operational definition of umbrella terms such as Musculoskeletal Disorders (MSD). Specific conditions attached to these labels and their corresponding signs and symptoms are also poorly defined. The purpose of this study was to identify internationally applied terminology and definitions appropriate to work-related upper extremity (UE) conditions. METHODS: An extensive literature search of 15 electronic databases supplemented by personal communications with representatives from national and international health and safety organizations was undertaken to identify recognized terminology and definitions appropriate to work-related UE conditions. RESULTS: Information specific to the umbrella terms and their corresponding conditions was obtained from 15 countries. The findings revealed a lack of international consensus over appropriate terminology to encapsulate the wide range of conditions falling within the umbrella terms used by these countries. UE conditions could be classified into 3 broad categories: (1) 14 "specific conditions" with evidence-based diagnostic criteria; (2) 34 "other specific conditions" with no clearly defined diagnosis; and (3) "nonspecific conditions" requiring a clear pattern of signs and symptoms to be present for a diagnosis to be made. A dynamic model for classifying work-related UE conditions is proposed which places greater emphasis on specific diagnosis. CONCLUSIONS: A systematic approach to the classification and diagnosis of work-related UE conditions is attractive, as it is likely to lead to more precise estimates of the prevalence and cost of UE conditions, as well as improved quality of information on the efficacy of medical and workplace interventions.

Evidence-based recommendations for hand hygiene for health care workers in New Zealand.

AIM: The aim of this systematic review is to establish evidence-based recommendations for hand hygiene for health care workers in New Zealand. METHODS: Using a systematic approach to literature searching, relevant studies were retrieved and evaluated using a standardised tool. The 23 studies that met the inclusion criteria were categorised into subgroups depending on the type of comparison: hand hygiene product; skin condition; hand drying method. A 'best-evidence synthesis' was utilised for classifying the evidence. RESULTS: Included studies provided evidence to support the use of alcohol-based hand rub as the preferred hand hygiene product. There was conflicting evidence for the use of medicated or plain soap, or any particular method to dry hands. CONCLUSIONS: Hand hygiene is a crucial component of risk management for both health care workers and their patients. It is important that hand hygiene practice is based on the best current evidence. As a result of a systematic review, evidence-based recommendations for hand hygiene for health care workers are proposed.