E-learning communication skills training for physiotherapy students: A two phased sequential mixed methods study.

OBJECTIVE: Test whether a single e-learning session can improve empathy and communication across pre-registration and postgraduate physiotherapy students. METHODS: Design: Two-phase sequential mixed methods study. Phase 1: Pilot randomised control trial. Phase 2: Qualitative study using interpretive phenomenological analysis. SAMPLING: A purposive sample for both phases. OUTCOME MEASURES: Phase 1: At baseline, post and 6-week follow up. Demographics. PRIMARY OUTCOME: Inter-personal Reactivity Index (IRI). Phase 2: Demographics and interview schedule. INTERVENTION: An e-learning (E) narrative intervention group or active control condition. ANALYSIS: Phase 1: Descriptive statistics and confidence intervals. Mann-Whitney U test to compare across group change. Phase 2: Thematic analysis. RESULTS: Thirty-nine participants took part in the mixed methods study (Phase 1 n = 25; Phase 2 n = 14). Phase 1: No significant differences between groups were identified. Potentially importance changes across time were found for the intervention group and control group. Phase 2 results identified 5 themes and 12 sub-themes. CONCLUSION: The e-learning groups identified an increase in the perceived ability to handle distressing communication. Other important findings from the e-learning are discussed. Further research is warranted. Practical Implications Novel e-learning intervention may have an important role in curriculum development and clinical practice to promote therapeutic communication. PRACTICAL IMPLICATIONS: Novel e-learning intervention may have an important role in curriculum development and clinical practice to promote therapeutic communication.

Improving Real-Time Position Estimation Using Correlated Noise Models.

We provide algorithms for inferring GPS (Global Positioning System) location and for quantifying the uncertainty of this estimate in real time. The algorithms are tested on GPS data from locations in the Southern Hemisphere at four significantly different latitudes. In order to rank the algorithms, we use the so-called log-score rule. The best algorithm uses an Ornstein-Uhlenbeck (OU) noise model and is built on an enhanced Kalman Filter (KF). The noise model is capable of capturing the observed autocorrelated process noise in the altitude, latitude and longitude recordings. This model outperforms a KF that assumes a Gaussian noise model, which under-reports the position uncertainties. We also found that the dilution-of-precision parameters, automatically reported by the GPS receiver at no additional cost, do not help significantly in the uncertainty quantification of the GPS positioning. A non-learning method using the actual position measurements and employing a constant uncertainty does not even converge to the correct position. Inference with the enhanced noise model is suitable for embedded computing and capable of achieving real-time position inference, can quantify uncertainty and be extended to incorporate complementary sensor recordings, e.g., from an accelerometer or from a magnetometer, in order to improve accuracy. The algorithm corresponding to the augmented-state unscented KF method suggests a computational cost of O(dx2dt), where dx is the dimension of the augmented state-vector and dt is an adjustable, design-dependent parameter corresponding to the length of "past values" one wishes to keep for re-evaluation of the model from time to time. The provided algorithm assumes dt=1. Hence, the algorithm is likely to be suitable for sensor fusion applications.

Comparison of Enhanced Noise Model Performance Based on Analysis of Civilian GPS Data.

We recorded the time series of location data from stationary, single-frequency (L1) GPS positioning systems at a variety of geographic locations. The empirical autocorrelation function of these data shows significant temporal correlations. The Gaussian white noise model, widely used in sensor-fusion algorithms, does not account for the observed autocorrelations and has an artificially large variance. Noise-model analysis-using Akaike's Information Criterion-favours alternative models, such as an Ornstein-Uhlenbeck or an autoregressive process. We suggest that incorporating a suitable enhanced noise model into applications (e.g., Kalman Filters) that rely on GPS position estimates will improve performance. This provides an alternative to explicitly modelling possible sources of correlation (e.g., multipath, shadowing, or other second-order physical phenomena).

The experience of fatigue in neurological patients with Multiple Sclerosis: a thematic synthesis.

OBJECTIVES: To identify the experiences that result from MS-related fatigue (MSRF) through a systematic review and thematic synthesis of qualitative literature. DESIGN: The thematic synthesis was undertaken in three stages: (1) a systematic review of the literature, searching relevant databases from their inception to March 2016. (2) A critical appraisal of included studies, and (3) a double blind 2-phase synthesis of results was undertaken. SETTING: Participants were included from articles using primary and secondary care settings. PARTICIPANTS: The synthesis included nine articles that incorporated a total of one hundred and fifty two participants (103 females and 49 males) in the review. RESULTS: No articles were excluded following critical appraisal. Two major themes were synthesised: (1) biopsychosocial experiences of fatigue, which illustrated the physical, cognitive and social challenges patients experience and (2) experiences that alter the impact of fatigue including the strategies individual employ to help manage fatigue. These major themes were further split into five subthemes. LIMITATIONS: Only the most common experiences of MSRF were identified. Findings did not break down results by key demographics e.g. disease type. Only English language studies were included. CONCLUSION: Physiotherapists are able to support the management by: (a) having a greater understanding of MSRF and (b) being able to help patients manage the factors that influence it.

Shared decision-making within goal-setting in rehabilitation: a mixed-methods study.

OBJECTIVES:: To assess the extent of shared decision-making within goal-setting meetings and explore patient-reported factors that influenced their participation to shared decision-making about their goals. DESIGN:: A two-phase explanatory sequential mixed-methods study, using questionnaires and interviews. SETTING:: A rehabilitation centre and patients' homes. SUBJECTS:: Frail elderly patients. MAIN MEASURES:: Quantitative data were collected after every patient's goal-setting meeting using the Multifocal Approach to Sharing in Shared Decision Making (MAPPIN'SDM) questionnaire that assesses competencies relevant to shared decision-making. Shared decision-making was rated by an observer, patients and staff and compared. Qualitative data were collected through semi-structured interviews. RESULTS:: A total of 24 rehabilitation team members and 40 patients (mean age: 83 years) participated. All study participants felt that competency 7a (the language used by staff made sense to the patient) was observed in all meetings. Patients reported that for 22 of the meetings competency 4a, the advantages and disadvantages of rehabilitation, was not discussed. Games-Howell tests for direction of differences between groups showed significant difference ( P = 0.001) between patients and staff in whether patients' problems were discussed. Nine patients' interviews suggested that motivation, self-confidence, family support, preparing themselves, getting information about goal-setting and rehabilitation options could enable them to participate in shared decision-making. They suggested that staff should communicate clearly and demonstrate that they are listening to patients but without a paternalistic approach. CONCLUSION:: Staff exhibited most shared decision-making competencies at a good level. However, patients highlighted problems with information sharing and felt staff might not be listening to them. Research and practice should explore tools to address these shortfalls.

Psycho-emotional content of illness narrative master plots for people with chronic illness: Implications for assessment.

Illness narratives are stories of illness told by patients with chronic illness. One way of studying illness narratives is by considering illness narrative master plots. An examination of illness narrative master plots has revealed the importance of psycho-emotional information contained within the story that is told. There is a need for research to capture this information in order to better understand how common stories and experiences of illness can be understood and used to aid the mental well-being of individuals with chronic illness. The current editorial provides a suggestion of how this is possible. This editorial identifies that stories can be "mapped" graphically by combining emotional responses to the illness experience with psychological responses of the illness experience relating to hope and psychological adaptation. Clinicians and researchers should consider the evidence presented within this editorial as: (1) A possible solution for documenting the mental well-being of individuals with chronic illness; and (2) As a tool that can be used to consider changes in mental well-being following an intervention. Further research using this tool will likely provide insights into how illness narrative master plots are associated together and change across the course of a chronic illness. This is particularly important for illness narrative master plots that are difficult to tell or that are illustrative of a decline in mental well-being.

The experience of informal caregivers of patients with motor neurone disease: A thematic synthesis.

ABSTRACTObjective:Research is required in order to illustrate and detail the experiences of informal caregivers of patients with motor neurone disease (pwMND) to further advance the research base and to inform the development of future support structures and services. Due to the heterogeneous nature of caregiving for pwMND, one way in which this can be achieved is through a qualitative review. A qualitative thematic analysis of existing qualitative studies has not, to the best of the authors' knowledge, been previously undertaken. Thus, the present synthesis aims to identify caregivers' experiences and to suggest factors that contribute to these experiences in order to fulfill the required research needs. METHOD: A thematic synthesis of qualitative literature was conducted. AMED, Medline, SPORTDiscus, CINAHL, and PubMed were electronically searched from inception until September of 2015. Studies were eligible if they included qualitative literature reporting on firsthand experience of informal caregivers of patients with MND, were published in English, and contained verbatim quotations. Critical appraisal was undertaken using a 13-item consolidated criteria for reporting qualitative studies (COREQ) checklist. RESULTS: A total of 10 studies met the inclusion criteria, with 148 (50 male) current or previous informal caregivers of pwMND identified. Critical appraisal demonstrated that study design and reflexivity were underreported. The synthesis derived three themes: (1) loss of control, (2) inability to choose, and (3) isolation. SIGNIFICANCE OF RESULTS: The synthesis highlighted the factors that contribute to both positive and negative caregiving experiences. Through these experiences, such suggestions for service provision as improving communication with healthcare professionals and having a single point of contact emerged. However, the outcome of such suggestions on the experience of caregivers is beyond the scope of our synthesis, so that further research is required.

Autonomous motivation is associated with the maintenance stage of behaviour change in people with affective disorders.

The present study examined whether in people with affective disorders motives for adopting and maintaining physical activity recommendations (as formulated by the self-determination theory) differed across the stages of behaviour change (identified by the transtheoretical model). A total of 165 (105♀) persons (45.6±14.2years) with affective disorders [major depressive disorder (n=96) or bipolar disorder (n=69)] completed the Behavioural Regulation in Exercise Questionnaire-2 and the Patient-centred Assessment and Counselling for Exercise questionnaire. Discriminant and multivariate analyses demonstrated that persons with affective disorders at the early stages of change have less autonomous and more controlled physical activity motives than those at the later stages. Our results suggest that autonomous motivation may have an important role to play in the maintenance of health recommendations in persons with affective disorders. Longitudinal and intervention studies should be designed in people with affective disorders to identify the causal pathways between motives for maintaining health recommendations, effective changes in health behaviour and physical and mental health outcomes.

Considering the Role of Physical Therapists Within the Treatment and Rehabilitation of Individuals With Eating Disorders: An International Survey of Expert Clinicians.

PURPOSE: Recent research has demonstrated that physical therapy may benefit the physical and mental health of people with eating disorders (EDs). Because this is a new and developing field, this study aimed to investigate the experience, practices and knowledge of international physical therapy experts to inform clinical practice, education and research. METHODS: An international cross-sectional survey design was undertaken with experienced physical therapists within the field of EDs. Physical therapist responses were analysed with descriptive statistics and thematic analysis as appropriate. RESULTS: Twenty-eight international physical therapists participated. On average, participants had 6.9 years (95% confidence interval: 3.1-10.7, n = 27) of clinical experience working in ED settings and devoted approximately 39.3% (95% confidence interval: 23.8-54.8, n = 27) of their time to treating individuals with EDs. Participants reported that physical therapy interventions have a diverse range of benefits on the physical, mental and disease-specific factors (e.g. binges) in people with EDs. The key role of physical therapists includes improving body awareness, especially during physical activity combined with psycho-education about healthy doses of physical activity. Physical therapists were able to identify a range of barriers and facilitators to physical activity in people with EDs. DISCUSSION: This paper provides a first step towards understanding the role and value of physical therapists working with individuals with EDs. Copyright © 2015 John Wiley & Sons, Ltd.

Understanding health beliefs and behaviour in workers with suspected occupational asthma.

INTRODUCTION: Long delays from symptom onset to the diagnosis of occupational asthma have been reported in the UK, Europe and Canada and workers are often reluctant to seek medical help or workplace solutions for their symptoms. Reducing this delay could improve workers' quality of life, and reduce the societal cost of occupational asthma. This study aimed to explore reasons behind such delays. METHODS: A purposive sample of 20 individuals diagnosed with, or under investigation for, occupational asthma (median age = 52; 70% male; 80% white British) undertook a single semi-structured interview. Interviews were transcribed verbatim and thematic analysis was undertaken in order to explore health beliefs and identify barriers to diagnosis. RESULTS: Four themes were identified: (1) workers' understanding of symptoms, (2) working relationships, (3) workers' course of action and (4) workers' negotiation with healthcare professionals. Understanding of symptoms varied between individuals, from a lack of insight into the onset, pattern and nature of symptoms, through to misunderstanding of what they represented, or ignorance of the existence of asthma as a disease entity. Workers described reluctance to discuss health issues with managers and peers, through fear of job loss and a perceived lack of ability to find a solution. The evolution of workers' understanding depended upon how actively they looked to define symptoms or seek a solution. Proactive workers were motivated to seek authoritative help and negotiate inadequate healthcare encounters with GPs. CONCLUSION: Understanding workers' health beliefs will enable policy makers and clinicians to develop better workplace interventions that may aid diagnosis and reduce delay in identifying occupational asthma.

The prevalence and moderators of clinical pain in people with schizophrenia: a systematic review and large scale meta-analysis.

BACKGROUND: People with schizophrenia frequently have physical comorbidities that can cause pain. Experimental studies report reduced pain sensitivity among schizophrenia patients, but it remains unclear if clinically relevant pain is less prevalent in schizophrenia. METHOD: We systematically searched major electronic databases from inception till 03/2014. Articles were included that reported the prevalence of clinical pain in people with schizophrenia. Two independent authors conducted searches, completed methodological quality assessment and extracted data. A random effects relative risks (RR) meta-analysis was conducted to determine the prevalence of all-cause and specific pain in schizophrenia, and the relative prevalence compared to the general population, and to assess moderators. RESULTS: Altogether, 14 studies were included encompassing 242,703 individuals with schizophrenia (30.2-55.8 years) and 4,259,221 controls. Different types of pain were considered. The overall pooled prevalence of clinical pain in people with schizophrenia was 34.7% (95% CI=23.6-46.6). In the comparative analysis involving 7 studies with controls, the RR was 0.99 (95% CI=0.83-1.19). The pooled prevalence of headache among 94,043 individuals with schizophrenia was 29.9% (95% CI=3-69%) and the RR compared to 4,248,284 controls was 1.32 (95% CI=0.85-2.07). In moderator analyses, neither age, sex, study quality or pain assessment method influenced pain prevalence. CONCLUSION: Clinical pain affects a third of people with schizophrenia and levels are similar with age- and sex-comparable controls. Future research is needed to determine if similar clinical pain prevalences in schizophrenia occur despite having more painful conditions, resulting from under-reporting, higher pain thresholds or lower help seeking behaviours.

The avoidance of activities due to fear of falling contributes to sedentary behavior among community-dwelling older adults with chronic musculoskeletal pain: a multisite observational study.

OBJECTIVE: Physical inactivity and sedentary behavior (SB) are leading causes of mortality. We investigated if older adults with chronic musculoskeletal pain (CMP) are more sedentary than a group of similar age and sex without CMP and possible contributory factors to this. METHOD: In this multisite observational study, 285 community-dwelling older adults (response rate 71%) took part. One hundred forty-four had CMP (78.4 years, 65.9% female), and 141 formed the comparison group without CMP. Details regarding falls were collected, and all participants completed the brief pain inventory (BPI), modified version of the survey of activities and fear of falling in elderly scale (mSAFFE), and the International Physical Activity Questionnaire (IPAQ) to measure SB. Data were analyzed with hierarchical regression analysis. RESULTS: Older adults with CMP spent approximately 3 1/2 hours a day more being sedentary than the comparison group (11.5 hours vs 7.9, P<0.001). The addition of BPI interference and mSAFFE scores in the regression analysis resulted in an R(2) change of 10.4% in IPAQ scores, over and above the variance explained by the background demographic, medical, and mobility factors. Excessive concerns about the consequences of falling did not increase the variance in SB. Within the final model, mSAFFE scores were the largest independent predictor of SB (ß=0.461, P<0.001). CONCLUSIONS: Older adults with CMP are significantly more sedentary than those of a similar sex and age without CMP. It appears that the avoidance of activities due to fear of falling is a significant contributory factor to SB in older adults with CMP.

The transcending benefits of physical activity for individuals with schizophrenia: a systematic review and meta-ethnography.

A systematic review and meta-ethnographic synthesis exploring the experiences of people with schizophrenia and healthcare professionals (HCPs) towards physical activity was undertaken. Major electronic databases were searched from inception until January 2014. Studies were eligible if they considered the experiences and perceptions of people with schizophrenia or the perceptions of HCPs towards physical activity. All included studies were synthesised within a meta-ethnographic approach, including completing a methodological quality assessment. The search strategy identified 106 articles, 11 of which were included in the final analysis. Eight articles considered patients׳ experiences and perceptions, and three articles considered the experiences and perceptions of HCPs. A total of 108 patients and 65 HCPs were included. Three main themes were identified: (1) the influence of identity, culture and the environment on physical activity engagement, (2) access and barriers to participation in physical activity, and (3) the benefits of engaging in physical activity. Aspects within the built, social and political environment as well as aspects of social cognition and perceptual biases influence participation in physical activity for individuals with schizophrenia. Specific recommendations for HCPs are given to help promote physical activity in this population group.

Changes in physical activity, physical fitness, self-perception and quality of life following a 6-month physical activity counseling and cognitive behavioral therapy program in outpatients with binge eating disorder.

The aim of the current study was to explore the associations between changes in the number of binges, physical activity participation, physical fitness, physical self-perception and quality of life following a 6-month physical activity counseling and cognitive behavioral program in patients with binge eating disorder (BED). In total 34 (31 women) outpatients with BED (38.5±10.7 years) completed a 6-month 1-day per week group-based program. Participants completed the 36-item Short Form Health Survey, the Baecke Physical Activity questionnaire, the Physical Self Perception Profile and performed a 6-min walk test (6MWT) at baseline, after 3 and 6 months. Except for physical activity at work, physical strength and self-worth perception, all parameters significantly improved after 6 months. The effect sizes ranged from -0.33 for the number of binges to 1.67 for participation in sports activities. Significant increases in leisure time physical activity were associated with significant improvements in physical health related quality of life, perceived sports competence and physical fitness and in perceived body attractiveness. The significant reduction in the number of binges was associated with significant improvements in physical health related quality of life. Future research should focus on detailing which techniques can stimulate physical activity participation in patients with BED.

The assessment, benefits and delivery of physical activity in people with schizophrenia: a survey of members of the International Organization of Physical Therapists in Mental Health.

BACKGROUND: People with schizophrenia typically die over a decade before members of the general population. Physical activity is a low cost and effective intervention that can have a multitude of beneficial effects on people with schizophrenia. Physical therapists lead in the delivery of physical activity in many of the commonly observed co-morbidities in schizophrenia, yet their role in the delivery of physical activity in patients with schizophrenia remains unclear. OBJECTIVE: This study aimed to establish an international consensus on physical therapists' beliefs, potential benefits and practices in the use of physical activity in schizophrenia. METHOD: All members of the International Organization of Physical Therapists in Mental Health were invited to take part in a cross-sectional online survey. All data were analysed using descriptive statistics and quantitative content and/or thematic analysis. RESULTS: One hundred and fifty-one physical therapists from 31 countries responded. Almost all respondents (92%) felt that physical activity benefited patients with schizophrenia, and 75.2% and 22.5%, respectively, felt that it was very important and important that physical therapists oversee in the delivery of physical activity in psychiatric services. Resultant themes established that physical activity has a plethora of beneficial effects on people with schizophrenia including physical health benefits and biopsychosocial effects such as improved mental health, socialization and quality of life. In addition, participants felt they have the necessary theoretical knowledge and clinical skills required for leading and overseeing physical activity programmes in this complex patient group. CONCLUSION: Physical therapists identified that physical activity has a plethora of benefits for patients with schizophrenia and that they have the necessary knowledge and skills to lead and oversee the successful delivery of physical activity in patients with schizophrenia in clinical practice.

Understanding the role of physiotherapists in schizophrenia: an international perspective from members of the International Organisation of Physical Therapists in Mental Health (IOPTMH).

BACKGROUND: Patients with schizophrenia have a drastically increased morbidity and mortality. In non-mental health settings, physiotherapists play an integral role in the management of many of the comorbidities seen in schizophrenia (e.g. cardiovascular disease, diabetes, obesity). However, the role of the physiotherapist is not well understood in the treatment of patients with schizophrenia. AIM: To obtain an international perspective of mental health physiotherapists on their role within the treatment of individuals diagnosed with schizophrenia. METHOD: A cross-sectional survey of members of the International Organisation of Physical Therapists interested in mental health (IOPTMH) was undertaken. Free text responses to open-ended questions were analysed with a thematic analysis. RESULTS: Two themes emerged: (1) physiotherapists stated they are physical health experts in the multidisciplinary team (MDT), bridging the gap between physical and mental health. (2) Physiotherapists are integral in health promotion efforts in patients with schizophrenia encouraging healthier lifestyle choices and higher levels of habitual physical activity. Physiotherapists felt their interventions had a diverse range of positive effects on patient's health and well-being. CONCLUSION: Physiotherapists are integral part of the MDT that have a focused role on promoting the physical health needs of patients who are diagnosed with schizophrenia.

Identifying a Framework for Hope in Order to Establish the Importance of Generalised Hopes for Individuals Who Have Suffered a Stroke.

Hope and hopelessness are important psychological constructs that physiotherapists should consider when working with patients who have experienced a stroke. The view of hope in rehabilitation is often focused around the concept of goals and how hope works within this framework. However, the current paper proposes a broader framework for hope and the importance of a more generalised view of understanding why a certain hope exists or is identified by a patient. A narrative review using an a priori thematic analysis was undertaken to consider how more generalised hopes are expressed by individuals who have suffered a stroke. An electronic search of 4 databases from inception until April 2014 was undertaken. Qualitative articles were included if they considered the concept of hope for patients who had suffered a stroke. The results identified three themes which included (1) consideration of the patient's identity/identities, (2) meaningful activities, experiences, and interactions, and (3) the experience of suffering and need for relief. An awareness of patients' generalised hopes should be a priority for HCPs. Detailed implications for HCPs are identified within the discussion.

Physiotherapy students' experiences of bullying on clinical internships: a qualitative study.

OBJECTIVES: To consider the experiences of final-year physiotherapy students who have experienced workplace bullying on a clinical internship. DESIGN: Qualitative methodology using individual semi-structured interviews. SETTING: A university in the Midlands region of the UK. PARTICIPANTS: Eight undergraduate physiotherapy students who had experienced one incident of bullying on a clinical internship. MAIN OUTCOME MEASURES: Thematic analysis of semi-structured interviews. RESULTS: Four main themes were identified: (1) external and situational influences of bullying; (2) students' reactions to the experience of bullying; (3) inability to reveal the experience; and (4) overcoming problems. Bullying had a range of adverse effects on the students, with many expressing self-doubt in their competence and viewing their supervisor as unapproachable and unsupportive. Five students were not initially able to recognise the experience as bullying. In addition, students did not feel able to report the experience and use the support mechanisms in place. This may have been a result of having concerns that the problem would escalate if they reported the experience and, as a consequence, have a negative effect on their grade. Students were keen to offer a range of strategies for clinical practice in order to prevent bullying for future generations of students. CONCLUSIONS: Students' health, security and confidence in their ability as a physiotherapist can be at great risk from bullying. Steps are needed to ensure that students are better protected from bullying, and feel more able to address bullying behaviour during clinical internships.