From Muscle-Bone Concept to the ArthroMyoFascial Complex: A Pragmatic Anatomical Concept for Physiotherapy and Manual Therapy.

BACKGROUND: In physiotherapy, the classic muscle-bone concept is used to translate basic and clinical anatomy. By defining the anatomical structures from superficial to deeper layers which frame the ArthroMyoFascial complex, our aim is to offer clinicians a comprehensive concept of within the muscle-bone concept. METHOD: This study is a narrative review and ultrasound observation. RESULTS: Based on the literature and ultrasound skeletonization, the ArthroMyoFascial complex is defined. This model clarifies fascial continuity at the joint level, describing anatomical structures from skin to deeper layers, including superficial fascia, deep fascia, myofascia including skeletal muscle fibers, and arthrofascia all connected via connective tissue linkages. This model enhances the understanding of the muscle-bone concept within the larger ArthroMyoFascial complex. CONCLUSION: The ArthroMyoFascial complex consists of multiple anatomical structures from superficial to deeper layers, namely the skin, superficial fascia, deep fascia, myofascia including muscle fibers, and arthrofascia, all linked within a connective tissue matrix. This model indicates that it is a force-transmitting system between the skin and the bone. This information is crucial for manual therapists, including physiotherapists, osteopaths, chiropractors, and massage therapists, as they all work with fascial tissues within the musculoskeletal domain. Understanding fascia within the muscle-bone concept enhances clinical practice, aiding in therapeutic testing, treatment, reporting, and multidisciplinary communication, which is vital for musculoskeletal and orthopedic rehabilitation.

Exploring the Significance of Abdominal Drawing-in and Segmental Stabilisation Training (SST) for Low Back Pain Management.

Segmental Stabilisation Training (SST) a programme initially conceived by Carolyn Richardson and her team, serves as a specialised approach tailored to alleviate mechanical low back pain. Built upon decades of rigorous research, this exercise model rests upon the foundational principles of core stability. SST is unique due to its singular focus on addressing the root cause of low back pain, thereby presenting a promising avenue for averting the frequent relapses characteristic of this condition. Many fitness regimens that emphasize core stability incorporate the Abdominal Drawing-in manoeuver. However, the efficacy of this technique often remains unrealized due to a lack of awareness regarding its correct execution. It is imperative to note that the true benefits of the Abdominal Drawing-in manoeuver manifest only when performed accurately, ensuring the activation of deep core muscles and, in turn, preventing the recurrence of low back pain. The SST programme offers clear and precise guidance, enabling both clinicians and patients to acquire the requisite skills for its correct implementation. This minireview highlights the significance of SST in low back pain management and also elucidates the crucial role of precise technique execution.

Specialized Allied Health Care for Parkinson's Disease: State of the Art and Future Directions.

People with Parkinson's disease (PD) experience a range of progressive motor and non-motor symptoms, that negatively affect their daily functioning, social participation and quality of life. Allied health therapies have emerged as an effective treatment approach-complementary to pharmacological and neurosurgical treatments-which reduces the impact of PD in daily life. In this article, we propose criteria for what constitutes specialized allied health care for PD, and we review allied health research in PD in terms of meeting these criteria and its outcomes for monodisciplinary approaches as well as multi- or interdisciplinary allied health interventions. We focus on the three most studied allied health disciplines in PD: physical therapy, occupational therapy and speech-language therapy. Overall, the available evidence underscores the importance and potential benefits of specialized allied health care for people with PD. Our proposed criteria and recommendations for future research might help in further delineating specialized allied health care.

Facilitators and Barriers to Implementing High-Intensity Gait Training in Inpatient Stroke Rehabilitation: A Mixed-Methods Study.

(1) Background: High-intensity gait training (HIT) is a recommended intervention that improves walking function (e.g., speed and distance) in individuals who are undergoing stroke rehabilitation. This study explored clinicians' perceived barriers and facilitators to implementing HIT utilizing a mixed-methods approach comprising a survey and exploratory qualitative research. (2) Methods: Clinicians (n = 13) who were implementing HIT at three facilities participated. We collected and analyzed data using the consolidated framework for implementation research. Three focus groups were recorded and transcribed, and data were coded and thematically categorized. (3) Results: Survey results identified that the facilitators with a strong impact on implementation were access to knowledge/resources and intervention knowledge/beliefs. The only agreed-upon barrier with a strong impact was lack of tension for change. The focus groups resulted in 87 quotes that were coded into 27 constructs. Frequently cited outer setting facilitators were cosmopolitanism and peer pressure, and the only barrier was related to the patient needs. Innovation characteristics that were facilitators included relative advantage and design quality and packaging, and complexity was a barrier. Inner setting facilitators included networks and communication, learning climate, leadership engagement, and readiness for implementation. However, communication, leadership engagement, and available resources were also barriers. Regarding characteristics of individuals, knowledge and beliefs were both barriers and facilitators. In the implementation process domain, common facilitators were formally appointed implementation leaders and innovation participants. Barriers in this domain were related to the patients. (4) Conclusions: Clinicians identified many barriers and facilitators to implementing HIT that often varied between facilities. Further research is warranted to deepen our understanding of clinicians' experiences with HIT implementation.

Electronic documentation burden among outpatient rehabilitation therapists: a qualitative descriptive study and quality improvement initiative.

OBJECTIVES: Outpatient rehabilitation (rehab) physical, occupational, and speech therapists use electronic health records (EHR), yet their documentation experiences, including any documentation burden, are not well researched. Therapists are a growing portion of the U.S. healthcare workforce, whose need is critical to the health of an aging population. We aimed to describe outpatient rehab therapists' documentation experiences and identify strategies for mitigating any documentation burden. MATERIALS AND METHODS: We used qualitative descriptive methodology to conduct 4 focus groups with outpatient rehab therapists at Hospital for Special Surgery, a multi-site orthopedic institution. Transcripts were inductively coded to identify themes and actionable strategies for improving the therapists' documentation experiences. Therapists provided feedback and prioritization of proposed strategies. RESULTS: A total of 13 therapists were interviewed. Five themes and 10 subthemes characterize the therapists' documentation experience by a feeling that documentation inhibits clinical care and work/life balance, a perceived lack of support and efficiencies, the desire to document to communicate clinical care, and a design vision for improving the EHR. Top prioritized strategies for improvement included use of timesaving templates, expanding dictation, decluttering the EHR interface, and support for free texting over discrete data capture. DISCUSSION: Outpatient rehab therapists experience documentation burden similar to that documented of physicians and nurses. Manual data entry imposes burden on therapists' time and clinical care. CONCLUSION: A multi-faceted approach is needed for improving therapists' experiences including EHR redesign, technology supporting dictation and narrative to discrete data capture, and support from leadership and regulators.

The perceptions of nurses and physicians in primary care of rehabilitation for frail older adults.

OBJECTIVES: To investigate the perceptions of primary care nurses and physicians of the potential contributions of physiotherapists (PTs) and occupational therapists (OTs) in the treatment of frail older persons, as well as the obstacles to, and opportunities for, collaboration. DESIGN: A qualitative study. PARTICIPANTS AND SETTING: Nurses (n = 9) and physicians (n = 8) in primary care in the county council [14 women (82%)] with experience working with older people. METHOD: Interview study conducted with a semi-structured interview guide. Analyses were carried out with content analysis with an inductive approach. RESULTS: The analysis resulted in six categories: knowledge of physiotherapy and occupational therapy interventions; what triggers the need for physiotherapy and occupational therapy?; the availability of rehabilitation interventions; teamwork opportunities and difficulties; motivating the patient; the site of the rehabilitation. CONCLUSIONS: Close and clear collaboration between nurses and physicians and PTs and OTs is an important factor in ensuring that rehabilitation interventions provide the greatest possible benefit to the patient. Improving communication between different healthcare providers and clarifying the contact routes is a prerequisite for patients to be able to get the rehabilitation they need. More research is needed to determine the best approach to achieving this goal.

Analysis of losses in physiotherapy students during the COVID-19 pandemic: a phenomenological approach.

BACKGROUND: During the COVID-19 pandemic, young people have experienced numerous personal losses across various aspects, impacting their quality of life. This study aimed to explore and analyze the losses experienced by physiotherapy students during the first year of the COVID-19 pandemic. METHODS: A qualitative phenomenological study was conducted using an open-format exercise carried out during the Clinical Specialties class from February to May 2021. Thirty-four (83% female) third-year physical therapy students participated. ATLAS.ti software was used for the analysis and coding by three researchers. RESULTS: Analysis of the categories revealed various losses experienced by the participants, including losses in psychological well-being, physical health, the social sphere (friendships, relationships with partners and family members, and experiences of death), spiritual losses (loss of freedom and identity), leisure time (travel, recreational activities and physical exercise), and different losses related to university studies (motivation and enthusiasm and clinical practices). CONCLUSION: The COVID-19 pandemic has led to significant losses among physiotherapy students, with losses in the social sphere being the most prevalent. This study can serve as a foundation for developing resources aimed at enhancing the well-being of physiotherapy students, promoting optimal academic performance, improving self-care, and reducing psychosocial problems.

"You don't know what you don't know": Knowledge, attitudes, and current practice of physiotherapists in recognising and managing metabolic syndrome, a mixed methods study.

OBJECTIVES: To determine the knowledge, attitudes, and current practice of primary care physiotherapists in recognising and managing clients with metabolic syndrome. DESIGN: Mixed-methods research design comprising an online survey and focus groups. PARTICIPANTS: Australian and English physiotherapists (n = 183) working in a primary care setting responded to the survey. Twelve physiotherapists participated in focus groups. RESULTS: Metabolic syndrome was not on physiotherapists radar. They did not screen for metabolic syndrome nor provide management for it in primary care. Although most physiotherapists had some awareness of metabolic syndrome, they were not knowledgeable. Physiotherapists reported a need to focus on their clients' presenting condition, and there was uncertainty on whether metabolic syndrome management was within their scope of practice. Despite this, physiotherapists felt they had an important role to play in exercise and physical activity prescription for chronic disease management and were keen to further their knowledge and skills related to metabolic syndrome. Survey responses and focus group data were convergent. CONCLUSION: Physiotherapists working in primary care settings are well-placed to identify metabolic risk factors in their clients and provide physical activity interventions to enhance management but currently lack knowledge to embed this in clinical practice. Training and resources are required to enable physiotherapists to identify and manage metabolic syndrome within their practice. CONTRIBUTION OF PAPER.

Metabolic syndrome is prevalent and undiagnosed in clients attending private practice physiotherapy: a cross-sectional study.

OBJECTIVES: To determine the prevalence of metabolic syndrome in clients presenting for primary care physiotherapy within private practice settings, and the factors that may be associated with metabolic syndrome. The secondary aim was to determine client's attitudes towards lifestyle change. DESIGN: A cross-sectional study in which self-report and biometric data were collected. The study was conducted in physiotherapy private practices across metropolitan and regional areas, Australia. PARTICIPANTS: 230 clients (mean age 54 (SD18) years, 64% women) presenting for physiotherapy participated. MAIN OUTCOME MEASURES: Participant socio-demographic and lifestyle characteristics were collected. Metabolic syndrome presence was determined by the existence of three or more risk factors on physical examination and capillary blood sample: abdominal obesity, hypertension, elevated random blood glucose, elevated triglycerides and/or reduced HDL cholesterol. RESULTS: Thirty-seven percent of participants had metabolic syndrome, but none knew they had it. Metabolic syndrome was associated with older age and poorer socio-economic status and may have been associated with lower levels of physical activity but not diet. Of those identified as having hypertension and elevated triglycerides, many were undiagnosed (56% and 29% respectively). CONCLUSION: Metabolic syndrome is prevalent and undiagnosed in clients attending private practice physiotherapy. Clients felt lifestyle change was important and they were willing to make changes. This study highlights the need for greater screening of metabolic risk factors in primary care and presents an opportunity for physiotherapists in private practice to identify risk and intervene to improve the overall health of their clients and contribute to chronic disease prevention. CONTRIBUTION OF THE PAPER.

Physical activity with person-centered guidance supported by a digital platform or with telephone follow-up for persons with chronic widespread pain: Health economic considerations along a randomized controlled trial.

OBJECTIVES: The aim was to investigate the resource use and costs associated with the co-creation of a physical activity plan for persons with chronic widespread pain (CWP) followed by support through a digital platform, compared to telephone follow-up. METHODS: In this 12-month cost comparison study following up results after a randomized controlled trial, individuals with CWP, aged 20-65 years, were recruited at primary healthcare units in Western Sweden. All participants developed a person-centered health-enhancing physical activity plan together with a physiotherapist. Participants were then randomized to either an intervention group (n = 69) who had a follow-up visit after 2 weeks and was thereafter supported through a digital platform, or an active control group (n = 70) that was followed up through one phone call after a month. Costs to the health system were salary costs for the time recorded by physiotherapists when delivering the interventions. RESULTS: The reported time per person (2.8 h during the 12 months) corresponded to costs of SEK 958 (range: 746-1,517) for the initial visits and follow-up (both study groups), and an additional 2.5 h (corresponding to a mean SEK 833; range: 636-1,257) for the time spent in the digital platform to support the intervention group. CONCLUSION: After co-creation of a physical activity plan, it was more costly to support persons through a digital platform, compared to telephone follow-up.

Efficacy of a Psychologically-Informed Physiotherapy Intervention in Patients with Chronic Low Back Pain at High Risk of Poor Prognosis: A Pilot and Feasibility Randomized Controlled Trial.

Purpose: To determine the feasibility of a randomized controlled trial (RCT) testing the efficacy of psychologically-informed physiotherapy (PIPT), which includes usual physiotherapy (UP) interventions, compared with UP, and to explore the preliminary effectiveness of the interventions. Method: People with chronic low back pain at high risk of poor prognosis (using the STarT Back screening tool) were recruited and allocated to PIPT or UP. Effectiveness of recruitment strategies, adherence to intervention, risk of contamination, and specific challenges were assessed. Functional capacity, pain, quality of life, kinesiophobia, catastrophization, central sensitization, and self-efficacy were measured at baseline, 6-, 12- and 24-week follow-ups. Results: Forty participants were recruited mainly by diffusing through Laval University's email list, and 10 physiotherapists treated the participants recruited. The retention rate of participants at 24 weeks was 72.5%. Adherence to treatment by participants and physiotherapists was very good. The risk of contamination was low, and the specific challenges identified were modifiable. Significant improvement over time in all clinical variables of interest, except self-efficacy, was observed with no difference between groups. Conclusions: As most success criteria were met, conducting an RCT evaluating PIPT and PU is feasible with modifications. PIPT and UP appear to be similarly effective.

Objectif: déterminer la faisabilité d'une étude randomisée et contrôlée (ÉRC) évaluant l'efficacité de la physiothérapie fondée sur la psychologie (PTFP), qui inclut les interventions de physiothérapie conventionelle (PC), par rapport à la PC, et explorer l'efficacité préliminaire des interventions. Méthodologie: les chercheurs ont recruté des personnes qui souffrent de douleurs lombaires chroniques, ayant une probabilité élevée de mauvais pronostic (au moyen de l'outil de dépistage STarT Back) et les ont réparties entre la PTFP et la PC. Ils ont évalué l'efficacité des stratégies de recrutement, l'adhésion à l'intervention, le risque de contamination et les difficultés particulières. Ils ont également mesuré la capacité fonctionnelle, la douleur, la qualité de vie, la kinésiophobie, la catastrophisation, la sensibilisation centrale et l'autoefficacité en début d'étude ainsi que lors des suivis à six, 12 et 24 semaines. Résultats: les chercheurs ont recruté 40 participants, principalement en diffusant le projet par courriel à la communauté de l'Université Laval, et dix physiothérapeutes les ont traités. Le taux de rétention des participants était de 72,5 % à 24 semaines. Les participants et les physiothérapeutes ont démontré une très bonne adhésion au traitement. Le risque de contamination était faible, et les difficultés particulières constatées pouvaient être modifiées. Les chercheurs ont observé une amélioration considérable au fil du temps pour toutes les variables cliniques d'intérêt, sauf l'autoefficacité, sans différence entre les groupes. Conclusions: puisque la plupart des critères de succès étaient respectés, il est faisable de réaliser une ÉRC pour évaluer la PTFP et la PU, sous réserve de modifications. La PTFP et la PC semblent avoir une efficacité similaire.

Management of recurrent benign paroxysmal positional vertigo.

BACKGROUND: Benign paroxysmal positional vertigo is the most common episodic vestibular disorder, although it is often quiescent by the time patients visit a specialist clinic, making the diagnosis difficult to confirm. Patients fear the consequences of a relapse and it is not clear what follow up should be provided. OBJECTIVE: This evaluation reviewed the results of an open access pathway that offered priority appointments to patients with a history of positional vertigo. RESULTS AND CONCLUSION: In total, 664 patients were included in the analysis, 52 per cent of whom had unconfirmed benign paroxysmal positional vertigo. Open follow up improved diagnostic rates by approximately 40 per cent. The rate of benign paroxysmal positional vertigo recurrence was 34 per cent in patients with follow up of at least one year, 41 per cent with follow up of one to two years, and 53 per cent with follow up of two years or more. One in five recurrences occurred in a different semi-circular canal. These results suggest that specialist follow up is required for management of recurrent benign paroxysmal positional vertigo.

Prevalence and associated factors of sexual, psychological, and physical violence among physical therapists in their clinical role in Spain: a national web-based cross-sectional survey.

OBJECTIVES: To determine the extent of career-long and 12-month exposure to sexual, physical, and psychological/verbal violence committed by patients or their companions among physical therapists in Spain. Additionally, to identify the factors associated with such exposure. METHODS: This study employed an observational cross-sectional approach. Initially, a questionnaire was developed and validated using a convenience sample. Subsequently, it was distributed via email to all physical therapists registered in Spain in the first quarter of 2022. Individual risk models were created for each type of violence experienced within the past 12 months. RESULTS: The prevalence of violence encountered by physical therapists throughout their careers was 47.9% for sexual violence, 42.7% for psychological/verbal abuse, and 17.6% for physical abuse. Lower values were observed within the last 12 months (13.4%, 15.8%, and 5.2%, respectively). Statistical risk modeling for each type of violence experienced in the past 12 months indicated that the common precipitating factor for all forms of violence was working with patients with cognitive impairment. Working part-time appeared to be a protective factor. Other factors, such as the practitioners' gender, practice setting, or clinic location showed variations among the diverse types of violence. CONCLUSIONS: The exposure to type II workplace violence within the last 12 months among physical therapists in Spain (Europe) is not so high as in some other world regions. Various individual, clinical, and professional/organizational risk factors have been identified in connection with type II workplace violence. Further research is warranted to compare the violence experienced once the COVID pandemic has subsided.

Conservative Treatment of Sever's Disease: A Systematic Review.

Background: Sever's disease, or calcaneal apophysitis, stands as the most prevalent cause of heel pain in children, often linked to sports like soccer, Australian football, and basketball. While various therapies are documented in the scientific literature, the standard choice is conservative treatment. Thus, the objective of this research was to assess the effectiveness of diverse conservative methods and techniques in alleviating Sever's disease symptoms. Methods: Systematic searches were conducted in October 2023 in PubMed, Web of Science, Scopus, SportDiscus, and PEDro, using terms like Osteochondritis, Osteochondrosis, Apophysitis, Sever's disease, Calcaneus, Adolescent, Child, and Childhood. The PEDro scale gauged methodological quality, and the Cochrane Risk of Bias tool evaluated the risk of bias. Results: Eight randomized controlled studies were included, featuring commonly used treatments such as insoles, therapeutic exercises, Kinesio taping, and foot orthoses. The methodological quality was generally good, with an average PEDro score of 6.75 points. Regarding bias, four articles had low risk, three had high risk, and one had some concern. Conclusions: Conservative treatment emerges as an effective option for alleviating symptoms associated with Sever's disease.

Patient, surgical and hospital factors predicting actual first-day mobilisation after hip fracture surgery: An observational cohort study.

OBJECTIVES: To examine patient, surgical and hospital factors associated with Day-1 postoperative mobility after hip fracture surgery in older adults. METHODS: A cohort study using Australia and New Zealand Hip Fracture Registry was conducted. Participants were aged older than 50 years and underwent hip fracture surgery between 1 January 2020 and 31 December 2020 inclusive. The outcome was standing and step transferring out of bed onto a chair and/or walking Day-1 after hip fracture surgery. RESULTS: Mean age was 82 years and 68% were women. Of 12,318 patients with hip fracture, 5981 (49%) actually mobilised Day-1. Odds of actual first-day mobilisation were lower for individuals usually walking with either stick or crutch (OR = 0.71, 95% CI 0.62-0.82) or two aids or frame (OR = 0.57, 95% CI 0.52-0.64) or wheelchair/bed bound (OR = 0.24, 95% CI 0.17-0.33); who had impaired cognition preadmission (OR = 0.57, 95% CI 0.51-0.64); from aged care facilities (OR = 0.59, 95% CI 0.52-0.67); had an American Society of Anaesthesiologists grade 2 (OR = 0.63, 95% CI 0.41-0.97), 3 (OR = 0.31, 95% CI 0.20-0.47) or 4 or 5 (OR = 0.21, 95% CI 0.14-0.32); surgery delay >48 h (OR = 0.81, 95% CI 0.71-0.91); and restricted/non-weight-bearing status immediately postoperatively (OR = 0.53, 95% CI 0.42-0.67). CONCLUSIONS: Both non-modifiable and modifiable patient and surgical factors influence first-day mobilisation after hip fracture surgery. Reducing time to surgery might assist future quality improvement efforts to increase Day-1 postoperative mobility.

Kinesiología como Programa de Investigación. Una Reflexión respecto a Identidad / Physical therapy as a research program. Ideas regarding professional identity

La Kinesiología chilena ha tenido un desarrollo científico sostenido, particularmente durante las últimas décadas. Este desarrollo ha promovido progresivamente el posicionamiento de kinesiólogos y kinesiólogas como profesionales de la salud dentro de la comunidad, los cuales tienen como fundamento el estudio y aplicación de conocimiento relacionado al movimiento humano. Sin embargo, este desarrollo no ha sido azaroso, sino más bien ha respondido a la creciente actividad científica de los integrantes de la comunidad kinesiológica, además de la cada vez más indispensable utilización de información científica para la toma de decisiones clínicas. Por tanto, el presente artículo discute dos formas de analizar el desarrollo de las disciplinas científicas, y plantea que la kinesiología puede considerarse un programa de investigación, definición desde la cual se pueden analizar los desafíos actuales y futuros respecto al dinamismo necesario de la ciencia y el cómo la kinesiología se relaciona con otras disciplinas para potenciar su crecimiento, sin caer en la redundancia y/o repetición disciplinar.

The physical therapy in Chile has had sustained scientific development, particularly during the last decades. This development has progressively promoted the positioning of physical therapists as health professionals within the community, whose foundation is the study and application of knowledge related to human movement. However, this development has not been random, but rather has responded to the growing scientific activity of members of the physical therapy community, in addition to the essential use of scientific information for clinical decision making. Therefore, this article discusses two ways of analyzing the development of scientific disciplines and proposes that physical therapy can be considered a research program, a definition from which current and future challenges can be analyzed regarding the necessary dynamism of science, and how physical therapy relates to other disciplines to enhance their growth, without falling into professional redundancy and/or repetition.

The Development of the Canadian Physiotherapy Assessment of Clinical Performance (ACP) 2.0 - Alignment with the 2017 Competency Profile.

Purpose: Clinical education and assessment of students' performance during clinical placements are key components of Canadian entry-to-practice physiotherapy curriculum and important in developing entry-level physiotherapy practitioners. The Canadian Physiotherapy Assessment of Clinical Performance (ACP) is the measure currently used to assess physiotherapy student performance on clinical placements in most of the entry-to-practice physiotherapy programmes across Canada. The release of the 2017 Competency Profile by the National Physiotherapy Advisory Group resulted in a revision of the existing ACP. The purpose of this study is to report the process used to develop a revised version of the ACP based on the 2017 Competency Profile, henceforth called the ACP 2.0. Method: Using a multistage process, we sought input from Canadian clinical education academics, an expert consultant panel, as well as physiotherapists across Canada using a questionnaire, meetings, and an online survey, respectively. Results: Twelve of 15 clinical education academics responded to a questionnaire. The expert consultant panel (n = 12) met three times. There were 144 physiotherapists who initiated the national, online, survey and met the inclusion criteria; 84 completed the survey. In the ACP 2.0, rating scales and comments boxes were grouped, and additional text was added to 12 items for further clarification. The ACP 2.0 came to have 18 items and 9 comment boxes in addition to summative comments, in contrast to the original ACP's 21 items and 9 comment boxes. Conclusions: In November 2020, Canadian clinical education academics reviewed the proposed draft ACP 2.0 and unanimously accepted it for implementation in Canadian physiotherapy university programmes.

Objectif: l'enseignement clinique et l'évaluation du rendement des étudiants pendant les stages cliniques sont des éléments clés du programme canadien d'entrée en pratique de la physiothérapie et sont importants pour former des praticiens de la physiothérapie prêts à entrer en pratique. L'évaluation du rendement clinique de la physiothérapie au Canada (ÉPC) est la mesure actuellement en usage pour évaluer le rendement des étudiants en physiothérapie lors de leur stage clinique dans la plupart des programmes d'entrée en pratique de la physiothérapie au Canada. La publication du Profil des compétences par le Groupe consultatif national en physiothérapie en 2017 a donné lieu à une révision de l'ÉPC. La présente étude vise à rendre compte du processus utilisé pour mettre au point une version révisée de l'ÉPC d'après le Profil des compétences de 2017, désormais appelée l'ÉPC 2.0. Méthodologie: au moyen d'un processus échelonné, les chercheurs ont demandé l'apport d'universitaires canadiens en enseignement clinique, d'un groupe d'experts consultants et de physiothérapeutes des diverses régions du Canada dans le cadre d'un questionnaire, de réunions et d'un sondage en ligne, respectivement. Résultats: au total, 12 des 15 universitaires en enseignement clinique ont répondu à un questionnaire. Le groupe d'experts consultants (n = 12) s'est réuni trois fois. Enfin, 144 physiothérapeutes qui respectaient les critères d'inclusion ont entrepris le sondage national en ligne, et 84 l'ont terminé. Dans l'ÉPC 2.0, les échelles d'évaluation et les encadrés de commentaires ont été regroupés et du texte a été ajouté à 12 des points afin de les clarifier. L'ÉPC 2.0 comporte finalement 18 points et neuf encadrés de commentaires en plus des commentaires sommatifs, par rapport aux 21 points et aux neuf encadrés de commentaires de l'ÉPC original. Conclusions: en novembre 2020, les universitaires en enseignement clinique canadiens ont révisé le projet d'ÉPC 2.0 et en ont adopté la mise en œuvre à l'unanimité au sein des programmes universitaires de physiothérapie du Canada.

Pelvic Health Content in Canadian Entry-To-Practice Physiotherapy Programs: An Online Survey.

Purpose: Pelvic health physiotherapy is an emerging and sensitive area of practice that offers effective conservative treatment for pelvic health conditions. Canadian entry-to-practice curriculum guidelines accord programs considerable flexibility regarding incorporating pelvic health content, which may lead to differences between programs and diverse levels of competence among new graduates. The purpose of this study was to determine the nature and extent to which pelvic health content is incorporated in entry-to-practice physiotherapy programs in Canada. Method: We conducted a descriptive cross-sectional e-survey of representatives from Canadian entry-to-practice physiotherapy programs. Results: Ten out of 15 Canadian programs participated. Programs incorporated pelvic health content throughout the required curriculum (n = 9) and in optional courses (n = 6). All participating programs covered musculoskeletal-related conditions, urinary incontinence, and pelvic pain conditions, and included anatomy and physiology, clinical reasoning, subjective assessment and pelvic floor muscle training topics. Three programs trained students in internal pelvic floor techniques in elective courses. All programs covered cisgender women populations, however, transgender populations were seldom covered. Conclusions: This study provides an understanding of pelvic health curricular content that can serve as a first step towards standardizing and improving entry-level pelvic health training in Canada.

Objectif: la physiothérapie pelvienne est un domaine de pratique émergent et sensible qui propose des traitements conservateurs efficaces pour les affections pelviennes. Les directives canadiennes sur le cursus d'entrée en pratique prévoient une grande souplesse quant à l'intégration de la matière sur la santé pelvienne, qui peut se solder par des différences entre les programmes et les divers niveaux de compétence chez les nouveaux diplômés. La présente étude visait à déterminer la nature et l'importance du contenu en santé pelvienne intégré aux programmes d'entrée en pratique en physiothérapie au Canada. Méthodologie: les chercheurs ont effectué un sondage descriptif transversal en ligne auprès de représentants des programmes d'entrée en pratique en physiothérapie au Canada. Résultats: dix des 15 programmes canadiens ont participé. Ils intégraient le contenu sur la santé pelvienne tout au long du cursus obligatoire (n = 9) et dans des cours à option. Tous les programmes participants traitaient des affections musculosquelettiques, de l'incontinence urinaire et des douleurs pelviennes et incluaient l'anatomie et la physiologie, le raisonnement clinique, l'évaluation subjective et l'entraînement musculaire du plancher pelvien. Trois programmes formaient les étudiants aux techniques internes du plancher pelvien dans le cadre de cours à option. Tous les programmes couvraient les populations de femmes cisgenres, mais les populations transgenres y étaient rarement intégrées. Conclusions: la présente étude permet de comprendre le cursus en santé pelvienne et peut représenter une première étape vers la standardisation et l'amélioration de la formation en santé pelvienne à l'entrée en pratique au Canada.

Remote Physiotherapy for Children with ASD during the COVID-19 Pandemic: A Thematic Analysis of Physical Therapists' Perspectives.

Background: Physical therapy plays a crucial role in addressing the physical challenges faced by individuals with autism spectrum disorder (ASD). Amidst the COVID-19 pandemic lockdown, physical therapists (PTs) working in special education centers for ASD children were tasked with deploying remote telehealth interventions (RTIs), an uncommon approach in physical therapy until then. The present article aims to describe and discuss the PTs' perspective of using RTI with children with ASD during the national Israeli COVID-19 lockdown. Methods: Reports from 13 experienced PTs who treated and supported 244 children with ASD using RTIs over six weeks were analyzed. The study employed quantitative research methods, including freely written reports and discussions addressing the question "what were your experiences as a PT treating ASD children remotely during the nationwide COVID-19 lockdown?" Results: the reports were categorized into four main themes: (a) the implications of RTIs on the children; (b) the implications of RTIs on the PTs; (c) modifications for applying RTI; and (d) PTs' family rapport as a necessary basis for RTI. Noteworthy findings include the unaffected implementation of RTIs by ASD severity level and the dependence of RTI's success on parental availability and the ability of parents to tailor activities for their child. Conclusions: The findings of the current research suggest that PT services through RTIs are well-suited for individuals with ASD and their families.

Variation in Utilization of Physical Therapist and Occupational Therapist Services After Rotator Cuff Repair: A Population-Based Study.

OBJECTIVE: The objective of this study was to describe the utilization of physical therapist and occupational therapist services after rotator cuff repair (RCR) and examine variation in rehabilitation characteristics by profession. METHODS: This retrospective cohort study used the IBM MarketScan Commercial Claims and Encounters database. Eligible patients were 18 to 64 years old and had undergone outpatient RCR between 2017 and 2020. Physical therapist and occupational therapist services were identified using evaluation and treatment codes with profession-specific modifiers ("GP" or "GO"). Factors predicting utilization of formal rehabilitation and physical therapist versus occupational therapist services were examined; and univariable and multivariable analyses of days to initiate therapy, number of visits, and episode length by profession were completed. RESULTS: Among 53,497 patients with an RCR, 81.2% initiated formal rehabilitation (93.8% physical therapist, 5.2% occupational therapist, 1.0% both services). Patients in the Northeast and West (vs the South) were less likely to receive rehabilitation (odds ratio [OR] = 0.67 to 0.70) and less likely to receive occupational therapist services (OR = 0.39). Patients living in the Midwest (versus the South) were less likely to receive rehabilitation (OR = 0.79) but more likely to receive occupational therapist services (OR = 1.51). Similarly, those living in a rural (versus urban) area were less likely to utilize rehabilitation (OR = 0.89) but more likely to receive occupational therapist services (OR = 2.21). Additionally, receiving occupational therapist instead of physical therapist services was associated with decreased therapist visits (-16.89%), days to initiate therapy (-13.43%), and episode length (-13.78%). CONCLUSION: Most patients in our commercially insured cohort utilized rehabilitation services, with a small percentage receiving occupational therapist services. We identified profession-specific variation in utilization characteristics that warrants further examination to understand predictors and associated outcomes. IMPACT: Variation in rehabilitation utilization after RCR, including profession-specific and regional differences, may indicate opportunities to improve standardization and quality of care.