Exploring how Australian occupational therapists and physiotherapists understand each other's professional values: implications for interprofessional education and practice.

This article provides insight into the values Australian occupational therapists and physiotherapists consider essential for their practice and the values that they perceive as important for each other. Findings from a study that employed the Delphi technique to identify the values occupational therapists and physiotherapists consider essential for their practice were compared with interview results that provide insight into how these professionals perceive one another's values. The results from this comparison indicate that occupational therapy and physiotherapy participants have limited knowledge of each other's values. This is evidenced by participants only identifying a minority of the values considered essential within the other profession and not identifying many of the values that guide daily practice within the other profession. The results hold implications for interprofessional education and practice, where knowledge of the values of other professions in the team is essential. To enable interprofessional collaboration, professions need to make their values explicit and provide their students, practitioners and educators with opportunities to learn about their own values and the values of other professions.

Towards a definition of professionalism in Australian occupational therapy: using the Delphi technique to obtain consensus on essential values and behaviours.

BACKGROUND/AIM: Professionalism involves practitioners applying the values of their profession and demonstrating essential professional behaviours and attitudes. Within the Australian occupational therapy profession, there is little research on the values, behaviours and attitudes that constitute professionalism. As a result, there is limited understanding of professionalism, and the approaches used to enhance the professionalism of future practitioners are not evidence based. This study aimed to contribute to the understanding of professionalism within the Australian occupational therapy profession, by obtaining consensus among Australian occupational therapists on the professional values and behaviours essential for practice. METHOD: A constructivist paradigm guided this study. The Delphi technique was used to obtain consensus on essential professional values and behaviours among 68 occupational therapists. Consensus was identified by numerical and content analysis. RESULTS: After two Delphi rounds, 61 professional values were identified as essential for practice. These values related to ethical practice, client-centred practice, contemporary practice and to the foundational beliefs of the profession. Seven professional behaviours also achieved consensus, but there was clear disparity in participants' opinions. CONCLUSION: The results provide insight into several professional values and behaviours perceived as essential for practice. Consequently, these professional values need to be taken into consideration when defining the values of the profession. The professional behaviours need to be taken into account when finalising the essential behaviours that constitute professionalism in the profession. This study takes an initial but fundamental step towards defining professionalism within the Australian occupational therapy profession.

Exploring the professional values of Australian physiotherapists.

BACKGROUND AND PURPOSE: A profession's values guide daily practice and professional behaviours. They clarify what professionalism means to a profession, by providing insight into the values that members of the profession aim to uphold and profess. There has been limited research into the values of the Australian physiotherapy profession, and as such, the values that guide practice and constitute professionalism are not explicit. This study aimed to make a preliminary identification of the values of the profession, by exploring the shared professional values of 14 Australian physiotherapists. METHODS: This study was guided by a qualitative approach and constructivist paradigm. Purposive sampling was employed to identify physiotherapists who could contribute rich information to the study. Semi-structured interviews were conducted and analysed using an inductive data analysis method. RESULTS: The emerging professional values formed three main themes. The first theme, 'the patient and the patient-therapist partnership', incorporated values such as having patient trust and working collaboratively with patients. The theme labelled 'physiotherapy knowledge, skills and practice' included the values of having an evidence base and respecting professional boundaries. The last theme, 'altruistic values', was inclusive of values such as honesty, empathy and caring. The values that emerged went beyond philanthropic values, to values that guided every day practice, professional relationships and the responsibilities of being a professional. CONCLUSION: The results contribute to research orientated towards identifying the values of the profession and in doing so, clarifying what professionalism means to the Australian physiotherapy profession. Differences between the values identified by the American Physical Therapy Association and the study reported in this paper highlight the importance of identifying the values of the profession within the Australian context. In terms of practice implications, physiotherapists may be prompted to reflect on their values and how these values align with those of their patients.

Exploring professionalism: the professional values of Australian occupational therapists.

BACKGROUND/AIM: There has been limited research into the values of the Australian occupational therapy profession and as such, the values have not been made explicit. Explicit values provide insight into what professionalism means to a profession. They can be used by practitioners for self-reflection purposes, shaping the future practice of individuals. Clear values can also enable the recognition and management of value conflicts between health professions. This study aimed to make a preliminary identification of the values of the profession, by exploring the professional values of 15 Australian occupational therapists. METHODS: A naturalistic approach and constructivist paradigm guided this study. Purposive sampling was employed to identify Australian occupational therapists who could contribute rich information to the study. Data were collected through semi-structured interviews that were recorded and analysed using an inductive data analysis method. RESULTS: The professional values identified encompassed three main areas: the client and the client-therapist partnership; occupational therapy knowledge, skills and practice; and selfless values. The emerging values guided everyday practice, professional relationships and the responsibilities of being a professional. CONCLUSION: This study provides insight into the professional values of Australian occupational therapists and contributes to research orientated towards identifying the values of the profession. The results also contribute to the understanding of what professionalism means to the Australian occupational therapy profession.

Sever's disease: a prospective study of risk factors.

BACKGROUND: Sever's disease, also known as calcaneal apophysitis, is thought to be an inflammation of the apophysis of the heel, which is open in childhood. This condition has been commented on and looked at in a retrospective manner but has not been examined systematically. We assembled the most commonly cited theoretical causative models identified from the literature and tested them to determine whether any were risk factors. METHODS: Children with Sever's disease were compared with a similarly aged nonsymptomatic population to determine whether identifiable risk factors exist for the onset of Sever's disease. Areas raised in the literature and, hence, compared were biomechanical foot malalignment, as measured by Root et al-type foot measurements and the Foot Posture Index; ankle joint dorsiflexion, measured with a modified apparatus; body mass index; and total activity and types of sport played. RESULTS: Statistically significant but small odds ratios were found in forefoot to rearfoot determination and left ankle joint dorsiflexion. CONCLUSIONS: This study suggests that there is no evidence to support that weight and activity levels are risk factors for Sever's disease. The statistically significant but clinically negligible odds ratio (0.93) on the left side for decreased ankle joint dorsiflexion and statistically significant and clinically stronger odds ratio bilaterally for forefoot to rearfoot malalignment suggest that biomechanical malalignment is an area for further investigation.

Static ankle joint equinus: toward a standard definition and diagnosis.

Equinus is characterized by reduced dorsiflexion of the ankle joint, but there is a lack of consensus regarding criteria for definition and diagnosis. This review examines the literature relating to the definition, assessment, diagnosis, prevalence, and complications of equinus. Articles on equinus and assessment of ankle joint range of motion were identified by searching the EMBASE, Medline, PubMed, EBSCOhost, Cinahl, and Cochrane databases and by examining the reference lists of the articles found. There is inconsistency regarding the magnitude of reduction in dorsiflexion required to constitute a diagnosis of equinus and no standard method for assessment; hence, the prevalence of equinus is unknown. Goniometric assessment of ankle joint range of motion was shown to be unreliable, whereas purpose-built tools demonstrated good reliability. Reduced dorsiflexion is associated with alterations in gait, increased forefoot pressure, and ankle injury, the magnitude of reduction in range of motion required to predispose to foot or lower-limb abnormalities is not known. In the absence of definitive data, we propose a two-stage definition of equinus: the first stage would reflect dorsiflexion of less than 10 degrees with minor compensation and a minor increase in forefoot pressure, and the second stage would reflect dorsiflexion of less than 5 degrees with major compensation and a major increase in forefoot pressure. This proposed definition of equinus will assist with standardizing the diagnosis and will provide a basis for future studies of the prevalence, causes, and complications of this condition.

Sever's disease--does it effect quality of life?

BACKGROUND: Sever's disease is a condition which has been described inconsistently in the literature with respect to pathology, aetiology and management. In particular, the impact of this condition has been overlooked, probably because it is usually self-limiting. METHOD: This study used a prospective comparative design study to determine the impact of Sever's disease on the quality of life of its sufferers. RESULTS: Three scales--Happiness, Satisfaction with symptoms and Pain/comfort scale--from the POSNA musculoskeletal questionnaire showed significant differences between the symptomatic and control groups. CONCLUSION: Although the condition may resolve with time, these results show that it has a considerable impact on children's lives.

Sever's disease: what does the literature really tell us?

BACKGROUND: Sever's disease is typical of many musculoskeletal conditions where observational annotations have slowly been accepted as fact with the passing of years. Acceptance of these nontested observations means that health professionals seeking information on this condition access very low-level evidence, mainly being respectable opinion or poorly conducted retrospective case series. METHODS: A comprehensive review of the literature was undertaken gathering available articles and book references relating to Sever's disease. This information was then reviewed to present what is actually known about this condition. RESULTS: Respectable opinion and poorly conducted retrospective case series make up the majority of evidence on this condition. CONCLUSION: The level of evidence for most of what we purport to know about Sever's disease is at such a level that prospective, well-designed studies are a necessity to allow any confidence in describing this condition and its treatment.

Are foot posture and functional health different in children with growing pains?

BACKGROUND: The aim of the present paper was to investigate and compare findings of foot posture and functional health between groups of children aged 4-6 years with and without leg pain (described as "growing pains"). The null hypothesis: that there is no difference in measures of either foot posture or functional health between groups of children with and without leg pain. METHODS: A stratified random sample of children was obtained. The children were identified with and without leg pain using a validated questionnaire for parents. The examiner was blind to the children's pain status. The schools and child care centers were from each geographical quadrant of metropolitan Adelaide and a northern rural region of South Australia. One hundred and eighty children (94 boys, 86 girls) entered and completed the study. Children whose parents returned a completed questionnaire and consent form were entered into the study. All participants were assessed by the one examiner. The foot posture measures used were those found to be most reliable in previous studies and for which the intra-rater reliability of the examiner was ascertained. RESULTS: Initial analysis of foot posture measures between the leg pain and no leg pains groups indicated a statistically significant result for the measure of navicular height, but only on the left side (P = 0.033). Logistic regression modeling showed that navicular height (left foot only) was positively yet weakly related to growing pains (odds ratio, 1.072; 95% confidence interval: 0.991-1.160) and the effect was not significant (P = 0.08). Measures of functional health returned many statistically significant yet weakly correlated relationships. CONCLUSIONS: The null hypothesis of the present study was supported in terms of clinical significance. While the foot posture measure of navicular height on the left foot was statistically significant it was not predictive for growing pains nor clinically significant as a measure between groups. The present study does not support the anatomical theory for growing pains and does not find a meaningful relationship between foot posture or functional health measures and leg pain in young children.

The role of the breast care nurse during treatment for early breast cancer: the patient's perspective.

INTRODUCTION: Women who are diagnosed with breast cancer require the support of a range of people during their treatment. Although the role of the breast care nurse in providing support has recently been investigated in several Australian studies the patients' perspective on the role of the breast care nurse in Australian hospitals has not previously been described in detail. The aim of this paper is to explore patients' perspectives on the role of the breast care nurse. METHODS: In-depth interviews were conducted with 18 women who had completed treatment for early breast cancer. The women were asked to describe their experiences from the time of diagnosis through to treatment completion. Thematic analysis was used to analyse the data. FINDINGS: Breast cancer patients repeatedly emphasised the importance of the role of their breast care nurses throughout their experience of breast cancer. The support that breast care nurses provided incorporated the following components: communication, rapport and an awareness of the women's needs, availability, reassurance and practical information. CONCLUSION: This study provides an understanding of women's perspectives on the role of breast care nurses and confirms that breast care nurses play an important support role during the experience of early breast cancer. Oncology clinics should focus on ensuring that all women who are diagnosed with breast cancer have adequate access to the support that breast care nurses are able to provide.

Sagittal plane range of motion of the pediatric ankle joint: a reliability study.

Measurement of ankle dorsiflexion is a routine part of the podiatric examination of children, yet the reliability of this measure is largely unknown in healthy individuals. This study assessed the intrarater and interrater reliability of the first and second resistance levels of sagittal ankle range of motion in 4- to 6-year-old children. The results show that measures of ankle dorsiflexion in children are highly variable among examiners, and, in general, gastrocnemius range of motion is more reliable than soleal range of motion.

Flexor carpi radialis motoneuron pool in subjects with chronic carpal tunnel syndrome are more excitable than matched control subjects.

We compared excitability of the flexor carpi radialis (FCR) motoneuron pool in subjects with and without carpal tunnel syndrome (CTS). The study involved 11 subjects with chronic idiopathic CTS and 11 asymptomatic subjects as controls. The H-reflex and M-response of FCR muscle were obtained by stimulating the median nerve in the cubital fossa in the presence of an isometric background contraction using surface stimulating and recording electrodes. There was a significantly higher H-reflex latency and amplitude and Hmax/Mmax in CTS subjects (P<0.05). Latency and amplitude of the M-response remained unaffected in CTS group. The results support the hypothesis that central hypersensitivity does occur in chronic CTS. Therefore even in the presence of pathology in peripheral structures central mechanisms should be considered by clinicians.

2D versus 3D radiation therapy for prostate carcinoma: a direct comparison of dose volume parameters.

That three dimensional (3D) planning for radiation therapy (RT) of carcinoma of the prostate (CaP) improves radiation dosimetry to the tumour and reduces dose to the rectum and bladder compared with 2D planning, has not been properly evaluated. We addressed this by downloading the CT data files of twenty-two patients who had completed 2D planned RT for CaP onto a 3D planning system and re-planning RT using the same four field technique and dose prescription as the 2D technique. The radiation dose at 100%, 90%, 50% and 0% volumes (D100, D90, D50 and D0) of the Dose Volume Histograms (DVH's) of the GTV, PTV, rectum and bladder, the area under the curves of each DVH and the field sizes were evaluated and compared between the two sets of plans. Repeated measured t-tests were used to compare the means of the different measurements. The D100, D90 and D50 of the GTV, PTV and rectum were increased for the 3D versus the 2D plans (p < 0.05 for each parameter). The area under the rectal DVH was also greater for the 3D plans (p < 0.05). These changes are attributable to the larger field sizes, particularly the length in the 3D compared with the 2D plans.

Measurement of foot dorsiflexion: a modified Lidcombe template.

The Lidcombe template was introduced in 1991 for the nonweightbearing assessment of ankle joint dorsiflexion, and it has shown excellent reliability in impaired and unimpaired adult populations. We discuss limitations of the original template and test the reliability of a modified apparatus in an adolescent population. Intrarater and interrater reliability were assessed for 14 children (28 limbs) aged 7 to 14 years, returning intraclass correlation coefficient (1,1) results of greater than 0.99 for both aspects of reliability.

Prevalence of "growing pains" in young children.

We estimated the prevalence of recurrent leg pains, often described as "growing pains" in children 4 to 6 years of age in South Australia. We used a survey of the parents of children 4 to 6 years of age, using a validated questionnaire previously developed for this purpose. The sample was systematic and randomized across rural and urban regions, with a total of 1445 valid responses achieved. Frequency statistics were used to obtain the prevalence estimate. The prevalence estimate obtained was 36.9% (95% CI, 32.7-41.1). This study estimated the prevalence of growing pains in a well-designed sample by using a validated instrument of measure. Previous studies have not addressed this age range discretely. The prevalence estimate demonstrates the community impact of this often disregarded condition.

Between-days reliability of H-reflexes in human flexor carpi radialis.

OBJECTIVES: To assess between-day reliability of the latency and peak-to-peak amplitude of a technique to elicit the H-reflex and M response of the flexor carpi radialis (FCR) and the ratio of maximum H-reflex and M-response amplitude (Hmax/Mmax). DESIGN: Test-retest reliability study. SETTING: Electrophysiology laboratory at a university. PARTICIPANTS: Fifteen consecutively recruited healthy volunteers (8 men, 7 women; age range, 22-65y). INTERVENTION: Volunteers were tested on 2 separate days at the same time of day for H-reflex and M response by stimulating the median nerve in the cubital fossa in the presence of a standardized voluntary contraction of the FCR muscle. MAIN OUTCOME MEASURES: Onset latencies, peak-to-peak amplitudes, and Hmax/Mmax. RESULTS: Latency measurements of H-reflex and M response showed excellent reliability between days, as did the maximum amplitude of the M response. The maximum amplitudes of the H-reflex and Hmax/Mmax ratio were less reliable but still within acceptable limits. CONCLUSIONS: The H-reflex and M response can be reliably elicited in the FCR. This technique provides a useful clinical tool for diagnostic purposes during the course of neurologic disorders and in preclinical and postclinical intervention studies.

Criterion validation of four criteria of the foot posture index.

The Foot Posture Index is a new multidimensional and multiplanar tool aimed at quantifying the degree of pronation to supination of the foot, comprising eight criteria that sum to produce a final "score" of foot posture. In an initial study involving 31 subjects, angulations measured from dorsoplantar and lateral radiographs were compared with the corresponding Foot Posture Index criteria using Spearman's rho and the generalized linear model of analysis of variance. Eleven of the participants from Study 1 completed a second study in which wedges were used to alter foot position to determine whether changes to foot position were sensitively reflected in Foot Posture Index criterion scores and associated radiographic images. Study 1 demonstrated a significant correlation for only one criterion (talar head palpation), while Study 2 demonstrated intrasubject sensitivity to overall changes from supinated to pronated and supinated to resting positions but insensitivity to changes from resting to pronated positions. The results suggest that although the Foot Posture Index could be a useful tool to broadly classify foot postures, it is not sensitive to all small movements when assessed by this method.

Reliability of the foot posture index and traditional measures of foot position.

Repeatable measures are essential for clinicians and researchers alike. Both need baseline measures that are reliable, as intervention effects cannot be accurately identified without consistent measures. The intrarater and interrater reliability of the new Foot Posture Index and current podiatric measures of foot position were assessed using a same-subject, repeated-measures study design across three age groups. The Foot Posture Index total score showed moderate reliability overall, demonstrating better reliability than most other current measures, although navicular height (normalized for foot length) was the single most reliable measure in adults. None of the tested measures exhibited adequate reliability in young children, and, with less-than-desirable reliability being demonstrated, most measures need to be interpreted accordingly when repeated measures are involved.