The supply and demand for rehabilitation health workforce in Saudi Arabia.

Background: Adequate supply of rehabilitation health workforce is a prerequisite for enhancing access to rehabilitation care. However, there is a lack of comprehensive data regarding the supply of rehabilitation health workers in Saudi Arabia. Aims: To determine the need for, and supply of, rehabilitation workforce, and investigate the relationship between rehabilitation workforce supply and rehabilitation needs in Saudi Arabia. Methodology: This cross-sectional study measured the ratio of physiotherapists and occupational therapists per 10 000 population. Data were obtained from the Ministry of Health, family health survey and census data of the General Authority for Statistics and published literature. To assess the need for rehabilitation services, we computed a composite disability index based on 3 variables: count of individuals with physical disabilities, those with chronic diseases, and those aged > 65 years. Determinants of the supply potential were population size, rural population percentage, and physician supply. Data were analysed using descriptive statistics and simple linear regression. Results: The ratios of physiotherapists and occupational therapists working at the Ministry of Health facilities were 0.69 and 0.03 per 10 000 population, respectively. Overall rehabilitation health workforce ratio was 0.73 per 10 000. Supply varied across regions, from 0.4 for Riyadh to 2.5 for Al Jouf. Nine regions exceeded the overall ratio. Rehabilitation need index ranged from 0.144 in Najran to 0.212 in Aseer. No significant associations were found between rehabilitation workforce supply on one hand, and need and other potential determinants on the other hand. Conclusion: The rehabilitation workforce supply in Saudi Arabia surpassed the regional and global averages, but was lower than the average for high-income countries. Workforce distribution varied by region across the country and was not related to need. It is important to consider the need for rehabilitation services and context-specific factors when determining the optimal size and distribution of the rehabilitation health workforce in Saudi Arabia.

Rapid implementation and improvement of a virtual student placement model in response to the COVID-19 pandemic.

Practice-based learning via clinical placement is a core part of a physiotherapy degree with the Chartered Society of Physiotherapy requiring completion of 1000 placement hours over a preregistration degree programme. In April 2020, as a result of the COVID-19 pandemic and subsequent lockdown Connect Health had to cancel 10 student placements as we transitioned to virtual consultations for all clinics. This cancellation of student placements was replicated across the nation with many Higher Education Institutes reporting a backlog of student placements. Without the requisite placement hours students are unable to progress into the next academic year or are unable to graduate. This then reduces the flow of new-graduate physiotherapists into the workforce at a time when there is a plan to grow the physiotherapy workforce to meet primary care demand. In response to this problem a novel placement model to facilitate virtual student placements ('virtual placements') was developed, tested and then rolled out across Connect Health using the Plan-Do-Study-Act quality improvement methodology. The model combines shadowing a broad range of virtual clinics with delivery of patient-facing online exercise classes via the Facebook Live platform and completion of virtual projects to support knowledge consolidation. This virtual student placement model enabled an increase in student capacity of over 400% compared with 2018-2019 with 182 students starting between May and August 2020. The model runs using widely available technology, requires no additional investment and has enabled these students to continue their studies and progress towards qualifying as physiotherapists.

Physiotherapy services in the face of a pandemic.

BACKGROUND: Physiotherapy services are necessary for hospitalized patients of COVID-19 as well as chronic patients. Thus, physiotherapists present an increased risk of exposure to coronavirus. This study aimed to determine the number of physiotherapists who interrupted their services because of the COVID-19 pandemic and to verify the procedures adopted by the ones who are still working. METHODS: The sample comprised 619 physiotherapists who worked in Portugal, 154 (24.9%) male and 465 (75.1%) female, aged between 22 and 67 years (34.47±8.70). The measurement instrument was an on-line questionnaire applied in late March 2020 through contacts and social networks. RESULTS: 453 (73.2%) physiotherapists interrupted their work activities in person because of the pandemic and 166 (26.8%) continue to work in person. The main measures adopted by physical therapists who continue to work in person included: hand washing (21.5%), mask use (20.3%), material disinfection (19.3%) and, glove use (19.3%). Of the physiotherapists who are not working in person (n = 453), 267 (58.9%) continue to monitor their patients at a distance, and 186 (41.1%) are not monitoring the patients. The main measures used by physiotherapists to monitor their patients at a distance included: written treatment prescription (38%), making explanatory videos (26.7%), and synchronous video conference treatment (23.5%). CONCLUSIONS: Our data revealed that most of the physiotherapists interrupted their face-to-face practices because of the COVID-19 pandemic, however, once they do not follow up their patients' treatment in person, most of them adapted to monitor their patients from a distance.

Physiotherapy services in the face of a pandemic

SUMMARY BACKGROUND Physiotherapy services are necessary for hospitalized patients of COVID-19 as well as chronic patients. Thus, physiotherapists present an increased risk of exposure to coronavirus. This study aimed to determine the number of physiotherapists who interrupted their services because of the COVID-19 pandemic and to verify the procedures adopted by the ones who are still working. METHODS The sample comprised 619 physiotherapists who worked in Portugal, 154 (24.9%) male and 465 (75.1%) female, aged between 22 and 67 years (34.47±8.70). The measurement instrument was an on-line questionnaire applied in late March 2020 through contacts and social networks. RESULTS 453 (73.2%) physiotherapists interrupted their work activities in person because of the pandemic and 166 (26.8%) continue to work in person. The main measures adopted by physical therapists who continue to work in person included: hand washing (21.5%), mask use (20.3%), material disinfection (19.3%) and, glove use (19.3%). Of the physiotherapists who are not working in person (n = 453), 267 (58.9%) continue to monitor their patients at a distance, and 186 (41.1%) are not monitoring the patients. The main measures used by physiotherapists to monitor their patients at a distance included: written treatment prescription (38%), making explanatory videos (26.7%), and synchronous video conference treatment (23.5%). CONCLUSIONS Our data revealed that most of the physiotherapists interrupted their face-to-face practices because of the COVID-19 pandemic, however, once they do not follow up their patients' treatment in person, most of them adapted to monitor their patients from a distance.

SUMMARY INTRODUÇÃO Os serviços de fisioterapia são necessários para o tratamento de pacientes hospitalizados com COVID-19 e também para pacientes crônicos. Assim, os fisioterapeutas apresentam um maior risco de exposição ao coronavírus. O objetivo deste estudo foi determinar o número de fisioterapeutas que interromperam seus serviços devido à pandemia do COVID-19 e verificar os procedimentos adotados pelos fisioterapeutas que continuam trabalhando. METODOLOGIA A amostra foi constituída por 619 fisioterapeutas, que trabalhavam em Portugal, sendo 154 (24,9%) do sexo masculino e 465 (75,1%) do sexo feminino, com idades compreendidas entre os 22 e 67 anos (34,47 ± 8,70 anos). O instrumento de medida utilizado consistiu num questionário online, tendo sido aplicado em finais de março de 2020, através de contatos e redes sociais. RESULTADOS 453 (73.2%) fisioterapeutas interromperam as suas atividades laborais de forma presencial por causa da pandemia e 166 (26.8%) continuam a trabalhar presencialmente. As principais medidas adotadas pelos fisioterapeutas que continuam a trabalhar presencialmente incluíram: lavagem das mãos (21.5%), uso de máscaras (20.3%), desinfecção do material (19.3%) e uso de luvas (19.3%). Dos fisioterapeutas que não estão a trabalhar presencialmente (n=453), 267 (58.9%) continuam a acompanhar os seus pacientes à distância e 186 (41.1%) não estão a acompanhar os pacientes. As principais medidas utilizadas pelos fisioterapeutas para acompanhar os seus pacientes à distância incluíram: prescrição do tratamento por escrito (38%), realização de vídeos explicativos (26.7%) e tratamento por videoconferência de forma síncrona (23.5%). CONCLUSÕES Os dados do presente estudo revelaram que a maioria dos fisioterapeutas interromperam as suas práticas presenciais em virtude da pandemia COVID-19, no entanto, apesar de não estarem a acompanhar os seus pacientes pessoalmente, a maioria deles elaborou ferramentas para monitorar seus pacientes à distância.

ICU staffing feature phenotypes and their relationship with patients' outcomes: an unsupervised machine learning analysis.

PURPOSE: To study whether ICU staffing features are associated with improved hospital mortality, ICU length of stay (LOS) and duration of mechanical ventilation (MV) using cluster analysis directed by machine learning. METHODS: The following variables were included in the analysis: average bed to nurse, physiotherapist and physician ratios, presence of 24/7 board-certified intensivists and dedicated pharmacists in the ICU, and nurse and physiotherapist autonomy scores. Clusters were defined using the partition around medoids method. We assessed the association between clusters and hospital mortality using logistic regression and with ICU LOS and MV duration using competing risk regression. RESULTS: Analysis included data from 129,680 patients admitted to 93 ICUs (2014-2015). Three clusters were identified. The features distinguishing between the clusters were: the presence of board-certified intensivists in the ICU 24/7 (present in Cluster 3), dedicated pharmacists (present in Clusters 2 and 3) and the extent of nurse autonomy (which increased from Clusters 1 to 3). The patients in Cluster 3 exhibited the best outcomes, with lower adjusted hospital mortality [odds ratio 0.92 (95% confidence interval (CI), 0.87-0.98)], shorter ICU LOS [subhazard ratio (SHR) for patients surviving to ICU discharge 1.24 (95% CI 1.22-1.26)] and shorter durations of MV [SHR for undergoing extubation 1.61(95% CI 1.54-1.69)]. Cluster 1 had the worst outcomes. CONCLUSION: Patients treated in ICUs combining 24/7 expert intensivist coverage, a dedicated pharmacist and nurses with greater autonomy had the best outcomes. All of these features represent achievable targets that should be considered by policy makers with an interest in promoting equal and optimal ICU care.

Physical Therapist Education and the Labor Market in Brazil: Advances and Challenges.

BACKGROUND: In Brazil, the number of physical therapy education programs and, consequently, of professionals has been growing for the past 20 years. OBJECTIVES: The objective of the study was to describe the evolution and distribution of physical therapist education programs in Brazil and to analyze the impact of workforce growth on the labor market for these professionals. DESIGN: This was a descriptive, exploratory, quantitative study. METHODS: Secondary data collected from official sources in Brazil were used. RESULTS: The first physical therapist education program was created in 1958, and, after significant growth, 536 programs were active in 2014. The historical series (1996-2014) shows a corresponding increase in the number of admissions by higher educational institutions. This expansion resulted in an increase in the number of professionals, with an impact on the labor market. The workforce in physical therapy is predominantly female, and women increased their participation in this labor market from 59% in 1996 to 81% in 2014. An increase in nominal monthly salaries was observed over the years from US $797.00 in 1996 to US $1056.00 in 2014. Nevertheless, the real average salaries, that is, salaries adjusted to inflation, have followed a trend of devaluation. LIMITATIONS: Results of this study must be interpreted in terms of overall trends rather than as precise absolute numbers due to the inherent nature of the varied secondary data sources. CONCLUSIONS: These data can support further discussion on training and the labor market in the field of physical therapy.

Characteristics and determinants of community physiotherapy utilization and supply.

BACKGROUND: Demand for Physiotherapy is on the rise due to increasing ageing population and consequent disability and morbidity. However, the costs of healthcare in developing countries are rising, and healthcare resources are limited making the supply of Physiotherapy services challenging in rural communities. Availability of Physiotherapy may help to reduce the burden of disability and enhance efficiency of healthcare systems. This study investigated the characteristics and associations of utilization and supply of community Physiotherapy in Nigeria. METHODS: Cross-sectional survey of 336 consenting community dwelling individuals from three selected communities in Nigeria was carried out. A three-section validated self-developed questionnaire which sought information on socio-demographics, utilization and supply of community Physiotherapy, as well as how to improve community Physiotherapy services was used. A household was used as the primary sampling unit in the study. Inferential and Descriptive statistics were used to assess the data. RESULTS: Lifetime, 12-month and point utilization of physiotherapy was 21.7, 7.4 and 2.7% respectively. Physiotherapy utilization was significantly associated with level of education (p = 0.007), belief on pain as "spiritual" (p = 0.020) and religious belief (p = 0.001). The respondents with primary, secondary and tertiary education were 14.3, 13.9 and 26 times more likely to utilize physiotherapy services, respectively. Those who 'agree' or were 'not sure' that their religious belief was against physiotherapy were 92 and 83% less likely to utilize physiotherapy services, respectively compared with those who 'disagree'. Availability and supply of Physiotherapy services were mostly at the township teaching hospital (47.9%) and private hospitals (20.5%). The supply of Physiotherapy services within the communities was mostly on temporary basis (24.7%) and through visiting Physiotherapists (21.4%). Physiotherapy services utilized was mainly exercise (46.6%) and soft tissue mobilization (41.1%). Travel costs (32.6%), time constraints (27.9%) and work commitments (24.8%) were the constraints for Physiotherapy utilization while positive beliefs and higher education improved Physiotherapy utilization. CONCLUSIONS: Utilization and supply of Physiotherapy services in Nigerian rural community was low. Low utilization of Physiotherapy services in Nigerian rural communities were most significantly influenced by low educational status and beliefs about pain.

A profile of physiotherapy supply in Ireland.

BACKGROUND: The lack of information on public and private physiotherapy supply in Ireland makes current and future resource allocation decisions difficult. AIM: This paper estimates the supply of physiotherapists in Ireland and profiles physiotherapists across acute and non-acute sectors, and across public and private practice. It examines geographic variation in physiotherapist supply, examining the implications of controlling for healthcare need. METHODS: Physiotherapist headcounts are estimated using Health Service Personnel Census (HSPC) and Irish Society of Chartered Physiotherapists (ISCP) Register data. Headcounts are converted to whole-time equivalents (WTEs) using the HSPC and a survey of ISCP members to account for full- and part-time working practices. Non-acute supply per 10,000 population in each county is estimated to examine geographic inequalities and the raw population is adjusted in turn for a range of need indicators. RESULTS: An estimated 3172 physiotherapists were practising in Ireland in 2015; 6.8 physiotherapists per 10,000, providing an estimated 2620 WTEs. Females accounted for 74% of supply. Supply was greater in the non-acute sector; 1774 WTEs versus 846 WTEs in the acute sector. Physiotherapists in the acute sector were located mainly in publicly financed institutions (89%) with an even public/private split observed in the non-acute sector. Non-acute physiotherapist supply is unequally distributed across Ireland (Gini coefficient = 0.12; 95% CI 0.08-0.15), and inequalities remain after controlling for variations in healthcare needs across counties. CONCLUSION: The supply of physiotherapists in Ireland is 30% lower than the EU-28 average. Substantial inequality in the distribution of physiotherapists across counties is observed.

A review advocating caution with Major League Soccer expansion and investment in more rehabilitation professionals.

BACKGROUND AND PURPOSE: Major League Soccer (MLS) has aggressively expanded from 10 teams to 23 teams. With the addition of more teams, the league will have to dictate a schedule that maximizes the league's popularity, while also maintaining the health of the players. A longer season and congested game schedule could increase the risk of injury for players. The purpose of this commentary is to make recommendations for the prevention of injuries among MLS players with respect to proposed league expansion. DESCRIPTION OF TOPIC: MLS has lengthened the regular season with each expansion in teams. An increase in season length was seen in conjunction with the MLS expansion from 14 to 19 teams during the 2008 through 2013 seasons. Data from the inaugural MLS season found injury rates were higher in games compared to practices and more injuries occurred later in the season. With the expansion of MLS, anterior cruciate ligament tears appeared to have increased each year. DISCUSSION: Current evidence suggests the implementation of a proper preseason in addition to the once-per-week game frequency would best promote player health and well-being. Players may benefit from in-season injury prevention training and weekly load monitoring.

Are There Sufficient Number of Exercise Therapists in South Africa In Order To Equitably Manage the Noncommunicable Disease Epidemic?

The mortality of South African noncommunicable diseases (NCDs) is rising. One of its primary contributors is physical inactivity. Therefore, South African National Health Plan included exercise therapy as part of their strategy to inhibit the NCDs upsurge. This study aimed to determine whether the number of South African exercise therapists is sufficient to equitably manage this NCD epidemic. The 2013 and 2017 Health Professions Council of South Africa reports identified the number of physiotherapists, biokineticists, and their respective students-in-training. In 2012, 10,623,820 people were identified with NCDs; however, South African Department of Health only treated 6,058,186 patients (57.0%) ( p < .05). South African Health Review has estimated a 28.7% increase in the number of NCDs patients treated from 2012 (6,058,186) to 2025 (7,799,770) ( p < .05). The average yearly growth of practicing physiotherapists (3.4%) and the physiotherapy student-in-training (2.2%) is inequitable to manage this NCD epidemic. In 2012, the extrapolated physiotherapist-to-NCD patient ratio was 1:5667. The South African Department of Health should consider including biokineticists to aid in the management of the NCD epidemic.

Classifying and Measuring Human Resources for Health and Rehabilitation: Concept Design of a Practices- and Competency-Based International Classification.

The burden of physical impairments and disabilities is growing across high-, middle-, and low-income countries, but populations across the globe continue to lack access to basic physical rehabilitation. Global shortages, uneven distributions, and insufficient skill mix of human resources for health and rehabilitation (HRH&R) contribute to such inequitable access. However, there are no international standards to classify HRH&R and to promote their global monitoring and development. In this article, we conceptually develop an international classification of HRH&R based on the concept of monitoring HRH&R through their stock of practices and competencies, and not simply counting rehabilitation professionals such as physical or occupational therapists. This concept accounts for the varying HRH&R configurations as well as the different training, competencies, or practice regulations across locations, even within the same profession. Our perspective specifically develops the concept of a proposed classification, its structure, and possible applications. Among the benefits, stakeholders using the classification would be able to: (1) collect locally valid and internationally comparable data on HRH&R; (2) account for the rehabilitation practices and competencies among nonspecialized rehabilitation workers (eg, in less resourced/specialized contexts); (3) track competency upgrades or practice extensions over time; (4) implement competency-based human resources management practices, such as linking remuneration to competency levels rather than to professional categories; and (5) inform the development of (inter-)professional education, practice regulation, or even task-shifting processes for the whole of HRH&R. The proposed classification standard, still in a concept-development stage, could help drive policies to achieve the "right" stock of HRH&R, in terms of practices and competencies.

How are balance and mobility problems after stroke treated in England? An observational study of the content, dose and context of physiotherapy.

OBJECTIVE: To describe the dose, intensity and context of physiotherapy for balance and mobility problems after stroke. DESIGN: Process mapping to describe the context and non-participant observation of therapy sessions to describe the dose and content of therapy. SETTING: Four inpatient stroke units in North-West England. PARTICIPANTS: Therapy staff and previously mobile stroke survivors who were treating, or receiving treatment for balance and mobility problems in the participating units. RESULTS: Two units were stand-alone rehabilitation units; two offered a service at the weekends. One had no access to community-based rehabilitation. All had dedicated treatment facilities but often did not use them because of lack of space and difficulty transporting patients. Twenty-two patients participated and 100 treatment sessions were observed. Practicing walking, sit-to-stand and transfers were the most frequent objectives and interventions usually with the therapist(s) physically facilitating the patient's movements. The dose of practise was low; mean repetitions of sit-to-stand per session was 5 (SD 6.4); mean time spent upright per session was 11.24 (SD = 7) minutes, and mean number of steps per session was 202 (SD 118). The mean number of staff per patient was 2.1 (SD = 0.6, mode = 2), usually involving two qualified therapists. Falls prevention or management, wheelchair skills and bed mobility were not practised. CONCLUSION: Stroke physiotherapy for balance and mobility problems features low-dose, low-intensity therapist-led practice, mainly of walking and sit-to-stand. Staff:patient ratios were high. Therapists need to organize treatment sessions to maximize the intensity of functional task practice.

Building the Burn Physician Workforce for the 21st Century: Report From February 2014 Burns Workforce Conference.

American Burn Association Past President Palmer Q. Bessey, MD, orchestrated a Burn Workforce Conference in Washington, DC in February, 2014, with the goal of evaluating the workforce needs for doctors, nurses, and occupational/physical therapists. This report summarizes the issues related to the need for training future surgeons to manage burn patients. General surgery and plastic surgery residents currently have minimal requirements for burn experience during their training. The respective Boards, however, do require knowledge in the management of burn care. The number of surgeons entering burn fellowships is limited to approximately 10 per year and there are only a handful of burn fellowship programs to train future burn surgeons. A survey sent to burn surgeons revealed that the current workforce is aging and needs to a constant supply of new physicians. It is clear that there is a need to formalize burn fellowships and it was felt that the American Burn Association should be responsible for accreditation of those fellowships.

Allied health weekend service provision in Australian rehabilitation units.

OBJECTIVES: To determine current Australian allied health rehabilitation weekend service provision and to identify perceived barriers to and facilitators of weekend service provision. METHODS: Senior physiotherapists from Australian rehabilitation units completed an online cross-sectional survey exploring current service provision, staffing, perceived outcomes, and barriers and facilitators to weekend service provision. RESULTS: A total of 179 (83%) eligible units responded, with 94 facilities (53%) providing weekend therapy. A Saturday service was the most common (97%) with the most frequent service providers being physiotherapists (90%). Rehabilitation weekend service was perceived to increase patient/family satisfaction (66%) and achieve faster goal attainment (55%). Common barriers were budgetary restraints (66%) and staffing availability (54%), with facilitators including organisational support (76%), staff availability (62%) and staff support (61%). CONCLUSION: Despite increasing evidence of effectiveness, only half of Australian rehabilitation facilities provide weekend services. Further efforts are required to translate evidence from clinical trials into feasible service delivery models.

[A new look at physiotherapy in France in 2018]. / Regards sur la kinésithérapie en 2018

The authors review the most significant recent stages in developments concerning physiotherapy in France by assessing its current state. The strength of this profession is that it was reformed in 2015 under the European Agreements of the Bologna Process.With its mutations and achievements in connection with biological, medical, and clinical research progress, physiotherapy is continuing to broaden its fields of practice in order to attract future students. Nevertheless, this remains insufficient to stimulate an exercise in hospitals.Despite macro and micro-economic constraints leading to important repercussions, physiotherapists have been able to adapt to the new management of patients without altering the recognition they receive from patients.The new definition of the profession along with new training techniques should reaffirm their skills, which have not been very visible thus far.The educational reform must be considered as a starting point of a changing profession, whose fields of practice, despite constant expansion since 2016, have not yet interested the majority of professionals.