A qualitative study of physiotherapy education for parents of toddlers with cystic fibrosis.

BACKGROUND: Education and daily physiotherapy are often highlighted as difficult and stressful tasks for parents of young children with cystic fibrosis. This study aimed to identify factors that impair the delivery and retention of physiotherapy education for parents of these children and factors that impair effective physiotherapy treatment in the home environment. METHODS: A focus group of physiotherapists and six semi-structured interviews of parents with children with cystic fibrosis were conducted. The qualitative method of Grounded Theory was used to analyse the information and develop key themes. RESULTS: Major emergent themes were 'transitions', 'psychological distress' and 'connectedness'. Factors influencing the effectiveness of parental physiotherapy education include the large volumes of information, appropriateness of educational resources and timing of education. Factors influencing home physiotherapy management for toddlers include mastering techniques, the transition from infant to toddler and time management. CONCLUSION: Physiotherapy education and management were key causes of psychological distress for parents. This research suggests that significant targeted development of educational resources is warranted, in conjunction with dedicated and ongoing formal psychosocial support for parents.

Can interdisciplinary clinical DVD simulations transform clinical fieldwork education for paramedic, occupational therapy, physiotherapy, and nursing students?

UNLABELLED: The aim of this study was to examine the usefulness of DVD simulations in a clinical teaching context, their impact on student learning, and their potential as a supplemental learning option for clinical placements/fieldwork education rotations that might assist in reducing the burden on the health care system. METHODS: Eleven clinical DVD simulations were developed by Monash University academic staff from four academic departments: nursing, occupational therapy, paramedics, and physiotherapy. Undergraduate students (n = 394) from these health science groups viewed the DVD simulations. Student perceptions and attitudes about the clinical relevance of the DVD simulations were assessed on a 7-point Likert-type scale standardized questionnaire (7 indicating the highest satisfaction score). Qualitative data were also collected from three focus groups that involved 24 students, assessing if and how the DVD simulations influenced the clinical fieldwork education placement learning experiences of the students. RESULTS: Overall, students' responses to the questionnaire indicated that they were satisfied with the DVD simulations with relation to attention (mean 4.25, SD 0.95), learning potential (mean 5.25, SD 1.16), clinical relevance to practice (mean 4.36, SD 0.60), and information-processing quality (mean 5.45, SD 0.23). Qualitative data supported the notions of interdisciplinary teamwork, clinical placements, clinical placement education, and DVD quality evaluation and feedback. CONCLUSION: Students viewed the simulations as being educationally, professionally, and clinically relevant. The cost benefit of using DVD simulations to replace or supplement components of clinical fieldwork education should be investigated further.

Duration of anaesthesia, type of surgery, respiratory co-morbidity, predicted VO2max and smoking predict postoperative pulmonary complications after upper abdominal surgery: an observational study.

QUESTION: Can the risk of developing postoperative pulmonary complications be predicted after upper abdominal surgery? DESIGN: Prospective observational study. PARTICIPANTS: 268 consecutive patients undergoing elective upper abdominal surgery who received standardised pre- and postoperative prophylactic respiratory physiotherapy. OUTCOME MEASURES: Predictors were 17 preoperative and intraoperative risk factors. A postoperative pulmonary complication was diagnosed when four or more of the following criteria were present: radiological evidence of collapse/consolidation, temperature > 38 degrees C, oxyhaemoglobin saturation < 90%, abnormal sputum production, sputum culture indicating infection, raised white cell count, abnormal auscultation findings, or physician's diagnosis of pulmonary complication. RESULTS: 35 participants (13%) developed postoperative pulmonary complications. Five risk factors predicted postoperative pulmonary complications: duration of anaesthesia (OR 4.3, 95% CI 1.7 to 10.8); surgical category (OR 2.3, 95% CI 1.1 to 4.7); current smoking (OR 2.1, 95% CI 1.0 to 4.5); respiratory co-morbidity (OR 2.1, 95% CI 1.0 to 4.4); and predicted maximal oxygen uptake (OR 2.0, 95% CI 1.0 to 4.3). A clinical rule for predicting the development of postoperative pulmonary complications predicted 82% of participants who developed complications. The odds of high risk participants developing pulmonary complications were 8.4 (95% CI 3.3 to 21.3) times that of low risk participants. CONCLUSION: This clinical rule for predicting the risk of developing postoperative pulmonary complications from five risk factors may prove useful in prioritising postoperative respiratory physiotherapy. Further research is needed to validate the rule.

The quantity of early upright mobilisation performed following upper abdominal surgery is low: an observational study.

QUESTIONS: How much upright mobilisation, particularly uptime, is performed in the first four days following upper abdominal surgery? In what part of the day is the greatest uptime achieved? Is length of stay related to uptime? Is there any difference in uptime in terms of postoperative factors? DESIGN: Prospective observational study. PARTICIPANTS: Fifty patients who had undergone upper abdominal surgery after receiving standardised preoperative education and physiotherapy intervention on the first postoperative day. OUTCOME MEASURES: An activity logger recorded uptime continuously for the first four postoperative days. Postoperative factors such as postoperative pulmonary complications, surgical attachments, pain relief, duration of anaesthesia, and intensive care admission were collected daily. RESULTS: Total median uptime was 3.0 (IQR 8.2), 7.6 (IQR 11 .5), 13.2 (IQR 26.6) and 34.4 (IQR 65.6) minutes for the first four postoperative days respectively. Morning uptime was greater than both afternoon uptime (p = 0.001) and evening uptime (p < 0.001). Uptime over the first four postoperative days predicted length of stay (r2 = 0.50, p < 0.001). Uptime was not significantly less in those who developed postoperative pulmonary complications (p = 0.08 to 0.17). CONCLUSION: This is the first study to quantify upright mobilisation following upper abdominal surgery. The results show that the quantity of upright mobilisation performed is low. Given that uptime predicted length of stay, increasing early upright mobilisation may have a positive effect on reducing length of stay following upper abdominal surgery.