Adolescent idiopathic scoliosis detection and referral trends: impact treatment options.

STUDY DESIGN: Retrospective cross-sectional study. OBJECTIVE: To analyze the patient demographic referred for scoliosis to the Hospital for Sick Children to determine the proportion of patients suitable for brace treatment, as per the Scoliosis Research Society guidelines. There is level 1 evidence that bracing in adolescent idiopathic scoliosis (AIS) decreases the risk of curve progression and need for surgery, but optimal brace treatment requires early curve detection. METHODS: We performed a retrospective review of 618 consecutive patients who underwent initial assessment in our Spine Clinic between Jan. 1 and Dec. 31, 2014. We included children 10-18 years, with scoliosis greater than 10°, excluding those diagnosed with non-idiopathic curves. Primary outcomes were Cobb angle, menarchal status, and Risser score. We analyzed the effect of specific referral variables (family history, the person who first noticed the curve, and geographic location of residence) on presenting curve magnitude. RESULTS: During the study period, 335 children met the inclusion criteria, with an average age of 14.1 ± 1.8 years and a mean Cobb angle of 36.8 ± 14.5°. Brace treatment was indicated in 17% of patients; 18% had curves beyond optimal curve range for bracing (> 40°), and 55% were skeletally mature, therefore not brace candidates. The majority of curves (54%) were first detected by the patient or family member and averaged 7° more than curves first detected by a physician. A family history of scoliosis made no difference to curve magnitude, nor did geographic location of residence. CONCLUSION: The majority of AIS patients present too late for effective management with bracing. LEVEL OF EVIDENCE: III.

Ontario Musculoskeletal Physiotherapists' Attitudes toward and Beliefs about Managing Chronic Low Back Pain.

Purpose: The purpose of this study was to explore Ontario musculoskeletal physiotherapists' attitudes toward and beliefs about managing chronic low back pain (CLBP), and their biomedical (BM) and bio-psychosocial (BPS) treatment orientation. Method: Through a link in the Ontario Physiotherapy Association newsletter, we administered an electronic survey to registered physiotherapists via SurveyMonkey. We used a modified three-step Dillman approach to encourage participation. The questionnaire included the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) measure, and demographic-practice items. Results: A total of 99 physiotherapists met the eligibility criteria and completed the PABS-PT (72.7% women; mean 17 years of experience). Respondents scored a mean of 26.98 (SD 7.69) on the BM sub-scale and 34.43 (SD 4.84) on the BPS sub-scale. Physiotherapists in public practice had a stronger BPS orientation (mean 36.52) than those in private practice (33.80; p = 0.01). Less experienced physiotherapists (<10 y) had a higher BM sub-scale score (mean 29.33) than more experienced physiotherapists (25.24, p = 0.013), and 78.8% of physiotherapists reported an awareness of clinical practice guidelines. Conclusions: Our preliminary findings suggest that Ontario physiotherapists' attitudes and beliefs align with a BPS orientation. Future studies should explore the impact of education that promotes a BPS approach to the management of CLBP.

Objectif : explorer les attitudes et les convictions des physiothérapeutes musculosquelettiques de l'Ontario à l'égard de la gestion de la douleur lombaire chronique (DLC), de même que leur orientation de traitement biomédical (BM) et biopsychosocial (BPS). Méthodologie : sondage électronique aux physiothérapeutes par SurveyMonkey, diffusé par le bulletin de l'Ontario Physiotherapy Association. Les chercheurs ont utilisé une méthodologie de Dillman modifiée en trois étapes pour favoriser la participation. Le questionnaire incluait la mesure Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT ­ échelle des attitudes et des convictions envers la douleur pour les physiothérapeutes) et des éléments sur la démographie. Résultats : au total, 99 physiothérapeutes respectaient les critères d'admissibilité et ont rempli le PABS-PT (72,7 % de femmes; moyenne de 17 ans d'expérience). Les répondants ont obtenu un score moyen de 26,98 (ÉT 7,69) au volet BM, et de 34,43 (ÉT 4,84) au volet BPS. Les physiothérapeutes en pratique publique adoptaient une orientation BPS plus marquée (moyenne de 36,52) que ceux en pratique privée (33,80; p = 0,01). Les physiothérapeutes moins expérimentés (< 10 ans) ont obtenu un score BM plus élevé (moyenne de 29,33) que les plus expérimentés (25,24, p = 0,013), et 78,8 % des physiothérapeutes ont déclaré connaître des directives cliniques. Conclusion : selon les résultats préliminaires, les attitudes et les convictions des physiothérapeutes de l'Ontario ont une orientation BPS. De prochaines études devraient explorer les répercussions d'un enseignement qui favorise une approche BPS à la prise en charge des DLC.

Motor Proficiency and Generalized Self-Efficacy Toward Physical Activity in Children With Intestinal Failure.

OBJECTIVE: Survival rates of children with intestinal failure have increased; however, associated co-morbidities may affect long-term motor developmental outcomes. This study evaluates motor proficiency and generalized self-efficacy toward physical activity (PA) in children ages 6 to 12 years with intestinal failure. METHODS: This is an observational, cross-sectional study of children followed in a multidisciplinary intestinal rehabilitation program. Motor proficiency was assessed using the Bruininks-Oseretsky Test of Motor Proficiency-2 Short Form (BOT-2 SF) and the Scales of Independent Behavior (parent-proxy report). Children completed the Children's Self-Perceptions of Adequacy in and Predilection for Physical Activity (CSAPPA) and a PA questionnaire. Relevant demographic and medical variables were correlated with assessment results. RESULTS: Participants include 30 children (18 males), median age 7 years (interquartile range [IQR] 6-9) with gestational age 35 weeks (IQR 32-39) and birth weight 2.13 kg (IQR 1.68-2.77). Thirteen (43%) were dependent on parenteral nutrition. Fifteen (50%) scored below average on the BOT-2 SF. Lower BOT-2 SF scores were significantly associated with lower CSAPPA scores (r = 0.480, P = 0.01), with a common barrier to PA being the presence of a central line or enterostomy tube. Gestational age, height z scores, length of hospital admissions, and number of septic events were all significantly correlated with lower scores in motor proficiency. Number of septic events and total parenteral nutrition days were significant predictors of lower BOT-2 SF scores, when adjusting for birth weight. CONCLUSIONS: Multiple medical variables related to intestinal failure may affect motor proficiency and PA self-efficacy. Developmental follow-up is important to optimize motor skill development and promote PA participation.

Mobilization patterns of children on a hematology/oncology inpatient ward.

BACKGROUND: Children being treated for cancer are admitted to the hospital for treatment of their disease or complications of therapy. Periods of bed rest during hospitalization can cause impairments detrimental to children with cancer who endure many side effects of therapy. Little is known about how these children mobilize while admitted to the hospital. The purpose of this study was to examine how children admitted to a hematology/oncology ward are mobilizing and analyze factors associated with delayed or infrequent mobility. PROCEDURE: A retrospective chart review was conducted on 228 charts with data recorded on documented mobilization and referrals to physiotherapy. Primary outcome was related to mobility including timing, frequency, type, and nature of mobilization. RESULTS: Almost half of children (43%) mobilized between 3 and 5 days per week, with median time to first mobilization being 2 days (interquartile range 1-3). Caregivers assisted with mobilization 91% of the time. Children isolated to their room and those reporting fever had a statistically significant decrease in the percent of admission days involving mobilization (mean difference 15 and 8%, respectively) than those not isolated and without fever. Children who were isolated also mobilized 1 day later (P = 0.016) than children who were not isolated. Percentage of time in isolation was positively correlated with timing (P = 0.04) and negatively correlated with frequency of mobilization (P < 0.001). CONCLUSION: Most children admitted to the hospital for treatment of oncologic or hematologic conditions were noted to mobilize early, but frequency of mobilization could be improved. Periods of time in isolation appear to negatively affect mobilization.

Reaching Consensus on Measuring Professional Behaviour in Physical Therapy Objective Structured Clinical Examinations.

Purpose: We determined which professional behaviours (PBs) are important and feasible to measure in an objective structured clinical examination (OSCE) intended to assess the hands-on skills and knowledge of students in a Canadian physical therapy (PT) program. Methods: We used a modified Delphi technique to identify the criteria required to assess PBs in PT students during an OSCE. We conducted a focus group to better understand the results of the modified Delphi process. Results: Experienced local OSCE examiners participated in the modified Delphi panel, which consisted of two rounds of surveys: round 1 (n=12) and round 2 (n=10). A total of 31 PBs were reduced to 18 through the two rounds. Five of the panellists participated in the focus group, reduced the 18 PBs to 15, and then identified 4 as clinical skills. Participants categorized the remaining 11 as mixed PBs and clinical skills (1 item), PBs (4 items), or communication skills (6 items). Conclusion: This study provides preliminary evidence to support the feasibility and importance of evaluating 5 PB items in practical skills OSCEs for entry-to-practice PT students.

Objectif : déterminer les comportements professionnels (CP) qui sont importants et évaluables durant un examen clinique objectif structuré (ECOS) afin d'évaluer les compétences et les connaissances pratiques des étudiants d'un programme de physiothérapie au Canada. Méthodes : nous avons utilisé une méthode Delphi modifiée pour cibler les critères requis pour évaluer les CP des étudiants en physiothérapie durant un ECOS. Nous avons mené un groupe de discussion pour mieux comprendre les résultats du processus Delphi modifié. Résultats : des examinateurs ECOS expérimentés locaux ont participé au groupe d'experts sur la méthode Delphi modifiée, qui consistait en deux rondes de sondages : ronde 1 (n=12) et ronde 2 (n=10). Un total de 31 CP ont été réduits à 18 au cours des deux rondes. Cinq des experts ont participé au groupe de discussion et ont réduit les 18 CP à 15, puis en ont ciblé quatre comme étant des compétences cliniques. Les participants ont catégorisé les 11 CP restants comme étant des compétences cliniques et des CP mixtes (un élément), des CP (quatre éléments) ou des compétences en communication (six éléments). Conclusion : cette étude fournit des données probantes préliminaires pour appuyer la faisabilité et l'importance d'évaluer cinq CP faisant partie des compétences pratiques de l'ECOS nécessaires à l'admissibilité à la pratique des étudiants en physiothérapie.

Exploring Parents' Perceptions and How Physiotherapy Supports Transition from Rehabilitation to School for Youth with an ABI.

AIMS: To explore parents' perceptions of their youth's transition from rehabilitation to school following an Acquired Brain Injury (ABI) and how physiotherapy influenced the youth's participation and physical function during the transition. METHODS: The study utilized phenomenological qualitative methodology using semi-structured interviews with 11 parents of youth 10 to 18 years of age recruited from one pediatric rehabilitation hospital in Ontario. Each interview was audiotaped, transcribed verbatim, and thematically analyzed. RESULTS: Parents valued physiotherapy and highlighted potential areas of improved service delivery to promote participation in an active lifestyle during this transition. In addition to being parents, they had to assume new roles and responsibilities in order to motivate their youth to continue with therapy and physical activity and had to facilitate their participation in school, recreational and social activities. CONCLUSION: For youth following an ABI, the transition back to school is complex and strategies should be supportive and responsive. Implications for physiotherapists include improved collaboration with community partners to motivate youth and promote physical activity; engage youth with their peers early in the rehabilitation process; and ongoing support for parents.

More than just dancing: experiences of people with Parkinson's disease in a therapeutic dance program.

PURPOSE: To understand why individuals with Parkinson's disease (PD) participate in a community-based therapeutic dance program and to explore its influence on perceived physical, social and emotional well-being of participants. METHODS: A qualitative descriptive design was employed using one-on-one semi-structured interviews. Individuals with PD who participated in the Dancing with Parkinson's program were recruited from two locations. Interviews were audio-recorded, transcribed, de-identified and then placed into NVivo 10 software for analysis. A content analysis approach was used with an inductive analysis method to generate a coding scheme. Group discussion facilitated development of overarching themes. RESULTS: Ten participants' responses revealed that the dance program allows for self-improvement and regaining identity through disease self-management. Positive influences of socialization arose through the class, decreasing isolation and improving quality of life. Participants communicate through music and dance to enhance connection with others. CONCLUSIONS: Dancing with Parkinson's classes allow for re-development of the social self, which can increase sense of enjoyment in life. Dance programs provide opportunities for social interaction, non-verbal communication and self-improvement, reestablishing self-identity and a sense of usefulness. This study provides unique insight into the experience of participating in a dance program from the perspective of individuals with PD. Implications for rehabilitation Dance is emerging as a strategy to address the physical and psychosocial effects of Parkinson's disease (PD), but little is known regarding participants' perceptions of community-based therapeutic dance programs for PD. This study found that Dancing with Parkinson's (DWP) facilitated an improvement in social participation, resulting in decreased isolation and improved quality of life. Participation in the DWP program can facilitate a positive change in perspective and attitude toward a PD diagnosis, thereby increasing feelings of self-efficacy and improving self-management of the disease. Participants of this study emphasized the multifaceted benefits of DWP, suggesting that it has great potential for addressing not only the physical challenges, but also the cognitive and emotional challenges associated with PD.

An Innovative Program to Support Internationally Educated Health Professionals and Their Instructors: Role of the Clinical Practice Facilitator.

INTRODUCTION: Internationally educated health professionals immigrating to other countries may experience difficulty in clinical practice, due to linguistic and cultural factors. An important element of bridging is the opportunity for internationally educated health professionals to practice in a clinical environment. To support these health professionals and their clinical instructors, a Clinical Practice Facilitator (CPF) role was created. This study aimed to examine the CPF from internationally educated health professionals and clinical instructors' perspective. METHODS: A quantitative survey was conducted with two cohorts (2013 and 2015) of internationally educated physical therapists and clinical instructors who were asked about the nature of interaction with CPFs, mentor, and education roles and the benefits and challenges of the role. RESULTS: Thirty-five internationally educated physical therapists and 37 clinical instructors participated and were satisfied with the interaction with CPFs via face-to-face or e-mail communication. There was strong agreement (>80%) that the CPF educator role was to facilitate learner's reflection on clinical practice while the mentor role (>70%) was to answer questions, provide feedback, and investigate clinical concerns and conflicts. There was insufficient time for access to CPFs and resolution of learners' learning needs. There were differences (P = 0.04) in perspective on the benefit of the CPF in assisting with cultural differences. DISCUSSION: An innovative CPF role provided support encouragement, clinical, and professional advice. There were discordant views regarding the benefits of the CPF role in addressing cultural issues, which requires further examination.

Measuring professional behaviour in canadian physical therapy students' objective structured clinical examinations: an environmental scan.

PURPOSE: To identify professional behaviours measured in objective structured clinical examinations (OSCEs) by Canadian university physical therapy (PT) programs. METHOD: A cross-sectional telephone survey was conducted to review current practice and determine which OSCE items Canadian PT programs are using to measure PT students' professional behaviours. Telephone interviews using semi-structured questions were conducted with individual instructors responsible for courses that included an OSCE as part of the assessment component. RESULTS: Nine PT programmes agreed to take part in the study, and all reported conducting at least one OSCE. The number and characteristics of OSCEs varied both within and across programs. Participants identified 31 professional behaviour items for use in an OSCE; these items clustered into four categories: communication (n=14), respect (n=10), patient safety (n=4), and physical therapists' characteristics (n=3). CONCLUSIONS: All Canadian entry-level PT programmes surveyed assess professional behaviours in OSCE-type examinations; however, the content and style of assessment is variable. The local environment should be considered when determining what professional behaviours are appropriate to assess in the OSCE context in individual programmes.

Objet : Cerner les comportements professionnels mesurés dans les examens cliniques objectifs structurés dans le cadre des programmes de physiothérapie des universités canadiennes. Méthode : Un sondage téléphonique transversal a été effectué pour examiner la pratique actuelle et déterminer les éléments des examens cliniques objectifs structurés (ECOS) utilisés dans le cadre des programmes canadiens de physiothérapie pour mesurer les comportements professionnels des étudiants en physiothérapie. On a mené des entrevues téléphoniques dans lesquelles on posait des questions semi-structurées aux instructeurs chargés des cours comportant un ECOS dans la composante d'évaluation. Résultats : Neuf programmes de physiothérapie ont accepté de participer à l'étude, et les répondants ont tous déclaré qu'ils effectuaient au moins un examen clinique objectif structuré. Le nombre et les caractéristiques des ECOS variaient à la fois au sein d'un même programme et entre les programmes. Les participants ont cerné 31 éléments de comportement professionnel à mesurer dans un ECOS; ils se regroupent en quatre catégories: communication (n=14), respect (n=10), sécurité des patients (n=4) et caractéristiques des physiothérapeutes (n=3). Conclusions : Tous les programmes de physiothérapie sondés au niveau débutant évaluent les comportements professionnels à l'aide d'examens de type ECOS; toutefois, le contenu et le style de l'examen sont variables. Il faut tenir compte de l'environnement local lorsqu'on détermine les comportements professionnels qu'il faut évaluer dans le contexte de l'ECOS dans les programmes individuels.

Comparison of physical therapy anatomy performance and anxiety scores in timed and untimed practical tests.

Students in health care professional programs face many stressful tests that determine successful completion of their program. Test anxiety during these high stakes examinations can affect working memory and lead to poor outcomes. Methods of decreasing test anxiety include lengthening the time available to complete examinations or evaluating students using untimed examinations. There is currently no consensus in the literature regarding whether untimed examinations provide a benefit to test performance in clinical anatomy. This study aimed to determine the impact of timed versus untimed practical tests on Master of Physical Therapy student anatomy performance and test anxiety. Test anxiety was measured using the State-Trait Anxiety Inventory (STAI). Differences in performance, anxiety scores, and time taken were compared using paired sample Student's t-tests. Eighty-one of the 84 students completed the study and provided feedback. Students performed significantly higher on the untimed test (P = 0.005), with a significant reduction in test anxiety (P < 0.001). Students who were unsuccessful on the timed test showed the greatest improvement on the untimed test ( x¯ = 20.4 ±10%). Eighty-three percent (n = 69) of students preferred the untimed test, 8.4% (n = 7) the timed test, and 8.4% (n = 7) had no preference. Students took on average eight minutes longer on the untimed test. This study found that physical therapy students perform better on untimed tests, which may be related to a reduction in test anxiety. If the intended goal of evaluating health care professional students is to determine fundamental competencies, these factors should be considered when designing future curricula.

An online community of practice to support evidence-based physiotherapy practice in manual therapy.

INTRODUCTION: The purpose of this study was to explore how a community of practice promoted the creation and sharing of new knowledge in evidence-based manual therapy using Wenger's constructs of mutual engagement, joint enterprise, and shared repertoire as a theoretical framework. METHODS: We used a qualitative approach to analyze the discussion board contributions of the 19 physiotherapists who participated in the 10-week online continuing education course in evidence-based practice (EBP) in manual therapy. The course was founded on community of practice, constructivism, social, and situated learning principles. RESULTS: The 1436 postings on 9 active discussion boards revealed that the community of practice was a social learning environment that supported strong participation and mutual engagement. Design features such as consistent facilitation, weekly guiding questions, and collaborative assignments promoted the creation and sharing of knowledge. Participants applied research evidence to the contexts in which they worked through reflective comparison of what they were reading to its applicability in their everyday practice. Participants' shared goals contributed to the common ground established in developing collective knowledge about different study designs, how to answer research questions, and the difficulties of conducting sound research. DISCUSSION: An online longitudinal community of practice utilized as a continuing education approach to deliver an online course based on constructivist and social learning principles allowed geographically dispersed physiotherapists to be mutually engaged in a joint enterprise in evidence-based manual therapy. Advantages included opportunity for reflection, modeling, and collaboration. Future studies should examine the impact of participation on clinical practice.

Dissemination of student research in a canadian master of science in physical therapy programme.

PURPOSE: To determine the extent of presentation and publication, as well as time to publication, of student research completed as a component of a Master of Science in Physical Therapy (MScPT) degree at a Canadian university. METHOD: The authors conducted a retrospective cross-sectional study of MScPT research projects completed between 2003 and 2009, each undertaken by a group of MScPT students who carried out protocol development, ethics submission, data collection, analysis, and manuscript and poster preparation under the supervision of research advisors. Research advisors were e-mailed a request for citations of presentations and publications. RESULTS: Advisors from 102 of 113 research projects completed from 2003 through 2009 provided information, for a response rate of 90.3%. Of the 102 groups, 53.9% disseminated findings through publication or presentation, 33.3% presented at one or more conferences, and 30.4% published at least one peer-reviewed journal article. Median time to publication was 21 months. Almost half the journal articles (47%) were published in Physiotherapy Canada. CONCLUSIONS: MScPT student research groups are disseminating their findings through publication or presentation at a moderate rate. Investigation of factors influencing dissemination is needed to develop strategies to facilitate knowledge transfer.

Objectif : Établir l'étendue de la présentation et de la publication ainsi que le moment de publication des travaux de recherche réalisés par des étudiants dans le cadre de leur maîtrise ès sciences en physiothérapie (M.Sc.PT) dans une université canadienne. Méthodologie : Les auteurs ont réalisé une étude transversale rétrospective des projets de recherche à la maîtrise ès sciences en physiothérapie réalisés de 2003 à 2009 par des groupe d'étudiants à la maîtrise qui ont élaboré un protocole de recherche, préparé les documents d'approbation éthique, recueilli les données, procédé à l'analyse et rédigé le manuscrit et les affiches sous la supervision de conseillers en recherche. Un courriel a été envoyé aux conseillers en recherche en vue d'obtenir des citations des présentations et des publications. Résultats : Les conseillers de 102 des 113 projets de recherche réalisés de 2003 à 2009 ont livré l'information demandée, soit un taux de réponse de 90,3%. Des 102 groupes de ces conseillers, 53,9% ont fait connaître les conclusions des études par des publications ou des présentations, 33,3% ont présenté au moins une conférence et 30,4% ont publié au moins un article dans une revue à comité de lecture. Le délai moyen de publication était de 21 mois. Près de la moitié des articles de revue (47%) ont été publiés dans Physiotherapy Canada. Conclusions : Un nombre modéré de groupes de recherche d'étudiants à la M.Sc.PT font connaître les conclusions de leurs travaux par des publications ou dans le cadre de présentations. Une recherche plus poussée sur les facteurs qui influent sur la diffusion de leurs travaux est nécessaire pour élaborer des stratégies qui pourront faciliter le transfert des connaissances.

Physiotherapists' perceptions of their role in the rehabilitation management of individuals with obesity.

PURPOSE: To examine physiotherapists' perceptions of their role in the rehabilitation management of individuals with obesity. METHODS: A Web-based survey was conducted in 2008. Participants were recruited through the Canadian Physiotherapy Association (CPA) via electronic communication and were eligible if they had entry level to practice qualifications and were residents of Canada. The online questionnaire consisted of 61 statements pertaining to potential PT roles, barriers, and learning needs, developed using the framework of CPA's position statement on obesity. Frequencies were computed for all Likert-scale response items on the questionnaire. RESULTS: A total of 851 physiotherapists, representative of CPA membership, participated in the study. There was strong agreement that physiotherapists have a role to play in the management of clients who are obese through exercise interventions (96%), mobility training (97%), and cardiorespiratory programmes for impairments associated with obesity (95%). Respondents were less clear about their role in the assessment of body fat or patients' weight loss. Lack of client motivation was identified as a barrier to treatment. CONCLUSION: Physiotherapists were clear that they see their role as largely focused on exercise and education to treat conditions associated with obesity. These are important components but do not by themselves constitute an overall management plan.Purpose: To examine physiotherapists' perceptions of their role in the rehabilitation management of individuals with obesity. Methods: A Web-based survey was conducted in 2008. Participants were recruited through the Canadian Physiotherapy Association (CPA) via electronic communication and were eligible if they had entry level to practice qualifications and were residents of Canada. The online questionnaire consisted of 61 statements pertaining to potential PT roles, barriers, and learning needs, developed using the framework of CPA's position statement on obesity. Frequencies were computed for all Likert-scale response items on the questionnaire. Results: A total of 851 physiotherapists, representative of CPA membership, participated in the study. There was strong agreement that physiotherapists have a role to play in the management of clients who are obese through exercise interventions (96%), mobility training (97%), and cardiorespiratory programmes for impairments associated with obesity (95%). Respondents were less clear about their role in the assessment of body fat or patients' weight loss. Lack of client motivation was identified as a barrier to treatment. Conclusion: Physiotherapists were clear that they see their role as largely focused on exercise and education to treat conditions associated with obesity. These are important components but do not by themselves constitute an overall management plan.

RÉSUMÉ Objectif : Examiner les perceptions qu'ont les physiothérapeutes de leur rôle dans la gestion de la réadaptation des personnes souffrant d'obésité. Méthode : Un sondage par Internet a été réalisé en 2008. Les participants ont été recrutés par l'intermédiaire de l'Association canadienne de physiothérapie (ACP) par communication électronique. Pour être admissibles, ils devaient posséder les compétences de base nécessaires à la pratique de la physiothérapie et être résidents du Canada. Le questionnaire en ligne qui leur a été soumis comportait 61 affirmations relatives au rôle potentiel des physiothérapeutes, aux obstacles et aux besoins de formation en pratique. Ces affirmations ont été préparées à partir des grandes lignes de l'énoncé de position de l'ACP en matière d'obésité. Les fréquences ont été calculées pour toutes les réponses du questionnaire recueillies à l'aide de l'échelle de Likert. Résultats : Au total, 851 physiothérapeutes représentatifs des membres de l'ACP ont participé à l'étude. Les répondants se sont dits fortement en accord avec le fait que les physiothérapeutes ont un rôle à jouer dans la gestion des clients obèses, par des interventions en matière d'exercices (96 %), par de l'entraînement à la mobilité (97 %) et par des programmes cardiorespiratoires pour faire face aux incapacités associées à l'obésité (95 %). Les répondants n'étaient pas aussi clairs quant à leur rôle dans l'évaluation du gras corporel ou de la perte de poids des patients. La motivation des clients a été citée comme un obstacle au traitement. Conclusion : Les physiothérapeutes perçoivent clairement leur rôle comme celui de professionnels centrés sur l'exercice et l'éducation pour le traitement de problèmes associés à l'obésité. Ces résultats semblent indiquer que leur rôle constitue une composante importante mais incomplète d'un plan de gestion global de l'obésité.

Achieving consensus on recommendations for the clinical management of overweight and obese adults for canadian physiotherapy practice.

PURPOSE: The purpose of this study was to reach consensus on the importance and feasibility of clinical practice guideline (CPG) recommendations for physiotherapy practice for the prevention and management of overweight and obesity in Canadian adults. METHODS: We used a modified Delphi method to achieve consensus. Participants rated the importance and feasibility of recommendations using a nine-point scale in two rounds of electronic surveys and a conference call. The mean and distribution of ratings were analyzed to determine consensus. RESULTS: Twenty-one physiotherapists experienced in the management of patients with obesity and representing diverse regions of Canada and areas of practice participated. Seventeen (81.0%) completed survey 1. Ten (47.6%) participated in the conference call and survey 2. Eight of 34 strategies received mean ratings of 7.00 or more for both importance and feasibility from at least two-thirds of participants. These strategies were related to physical activity prescription and assessment. CONCLUSIONS: A sample of physiotherapists in Canada agreed that obesity-related CPGs contain recommendations that are important to physiotherapy practice. These findings, along with the Canadian Physiotherapy Association's position statement on obesity, provide support for the argument that physiotherapists, as direct-access practitioners or members of multidisciplinary teams, should play a role in the health care of people with obesity and overweight.

The knowledge, attitudes, and practices of canadian master of physical therapy students regarding peer mentorship.

PURPOSE: To describe Canadian Master of Physical Therapy (MPT) students' knowledge, attitudes, and practices regarding peer mentorship. METHODS: A quantitative cross-sectional survey study was conducted. An online questionnaire was sent to 945 MPT students via e-mail, using a modified Dillman approach. Data were analyzed using descriptive statistics to describe the knowledge, attitudes, and practices of Canadian MPT students. RESULTS: A total of 260 MPT students (27.5%) responded to the questionnaire. Most respondents (68.7%) did not have any experience in a peer mentorship relationship during their MPT programme. A few respondents (5.4%) reported having received formal training on peer mentorship as part of their PT curriculum. Respondents generally held positive attitudes toward peer mentorship: 65.9% agreed that including peer mentorship is important, 89.5% agreed that peer mentorship can assist with learning in clinical internships, and 84.1% agreed that peer mentorship can help the transition from student to professional. Most respondents (52.5%) did not participate in a peer mentorship relationship during a typical month. CONCLUSIONS: MPT students' attitudes toward peer mentorship are positive, yet their knowledge of and resources for peer mentorship are limited, and few students have been involved in peer mentorship practices. The findings highlight the importance of university programme support to provide a nurturing environment and structure to overcome barriers, promote commitment, and facilitate successful participation. The evidence from this study provides a rationale to support and guide peer mentorship programming for Canadian MPT students.

Perceptions of physiotherapy best practice in total knee arthroplasty in hospital outpatient settings.

PURPOSE: The primary purpose of this study was to examine experienced physiotherapists' perceptions of best practices for patients following total knee arthroplasty (TKA) in publicly funded outpatient hospital settings in the Greater Toronto Area (GTA). The secondary objective was to identify the facilitators of and barriers to implementing best practices in the subacute phase of rehabilitation. METHODS: A qualitative, descriptive, focused ethnographic approach was used to explore physiotherapists' perceptions of best practices for patients with TKA. In-depth semi-structured interviews were conducted with expert physiotherapists acting as key informants. A snowball sampling method was used to recruit physiotherapists in the GTA. Interviews were conducted in person by two of the investigators. RESULTS: Physiotherapists from seven acute-care hospitals in the GTA participated in the study. Analysis of the 140 pages of transcripts from the interviews with 10 physiotherapists revealed that participants perceived best practices as encompassing the adoption of a client-centred approach; inter-professional collaboration; aggressive rehabilitation for patients who are unsuccessful in achieving their outcomes; the use of relevant outcome measures; and consideration of the impact of scarce resources on care. CONCLUSIONS: The findings of this study highlight physiotherapists' perceived best practices for patients with TKA and the unique contribution that hospital-based outpatient physiotherapy can make to patients' rehabilitation.

Health promotion practices in two chiropractic teaching clinics: does a review of patient files reflect advice on health promotion?

PURPOSE: To retrospectively review patient files in two teaching clinics in the United States and to assess the documented attempts to deliver health promotion messages when a chart indicated a need for health promotion or a red-flag condition that could be helped with positive behavioral changes. METHODS: Approximately 100 patient files were randomly selected from each of two separate chiropractic teaching clinics, for patients seen after January 2007. Files were assessed for pertinent family history of diseases, personal medical history, and red-flag conditions of patients that would warrant intervention with health promotion. RESULTS: Health promotion advice on at least one occasion was noted in 108 (53.7%) patient charts. Only 7 of 98 overweight or obese patients and none of those with family history of obesity were advised on weight management. Among 23 hypertensive patients, only 5 were advised and 17 of the 97 patients with risk of cardiovascular disease were advised. CONCLUSION: Chiropractic teaching clinics should assess what they are doing to help Americans reach their health goals. There is an opportunity to shape future practitioners so they include primary prevention as a part of what they do if the profession cares to move in that direction. Future research should look at mechanisms of delivery for health promotion, including better tracking of patients who need it and how staff doctors are trained to deliver oversight to interns in the area of primary prevention.

Clinical specialists and advanced practitioners in physical therapy: a survey of physical therapists and employers of physical therapists in ontario, Canada.

PURPOSE: Opportunities to expand the role of physical therapists (PTs) have evolved to include clinical specialists and advanced practitioners, although the literature on these roles is limited. We examined perceptions of PTs and PT employers in Ontario regarding clinical specialization and advanced practice. METHODS: Using a modified Dillman approach, a cross-sectional survey was conducted with 500 PTs and 500 PT employers in Ontario. Questionnaires were tailored to address specific issues related to each cohort. RESULTS: Sixty percent of PTs and 53% of PT employers responded to the survey. Thirty-three percent of PT respondents already considered themselves "clinical specialists" (CS), and 8% considered themselves "advanced practitioners" (AP), although neither role is yet formally recognized in Canada. Both groups had substantial interest in pursuing formal recognition of CS and AP status. Respondents indicated that their primary motivation to pursue such roles was to enhance clinical reasoning skills with the goal of improving client outcomes (82% for the role of CS, 71% for the role of AP). Respondents supported the involvement of academic institutions in the process (60% for CS, 70% for AP). CONCLUSION: PTs and PT employers are supportive of the roles of the CS and AP within the profession, even though there is currently no formal recognition of either role in Canada.