Investigating the use of digital health tools in physiotherapy: facilitators and barriers.

BACKGROUND: Digital tools are becoming more and more common in healthcare. Their potential to improve treatment, monitoring, and coaching in physiotherapy has been recognized. Yet studies report that the adoption of digital health tools in ambulatory physiotherapy is rather low and that their potential is underexploited. OBJECTIVE: This paper aims to investigate how digital health tools in general, and the mobile health tool physitrackTM (hereafter the app) more particularly, are used in outpatient physiotherapy clinics and also to identify what facilitates or hinders the app's use. METHODS: The paper is part of a larger study and adopts an ethnographic approach. It is based on observational and interview data collected at two outpatient clinics. RESULTS: We reveal how physiotherapists and patients use the app in physiotherapy and identify 16 interdependent factors, on the macro-, meso-, and micro-level, that either facilitate or hinder its use. CONCLUSIONS: We argue that a single factor's facilitating or hindering impact cannot be grasped in isolation but needs to be investigated as one piece of a dynamic interplay. Further qualitative research is required, especially to shed more light on the app's compatibility with physiotherapy practice and use in therapist-patient interactions.

Diagnostic and decision-making abilities of Swiss physiotherapists in a simulated direct access setting.

BACKGROUND: Direct access to physiotherapy requires physiotherapists to recognize red flags and determine adequate management plans. PURPOSE: Investigate Swiss physiotherapists' ability to diagnose and triage patients in a simulated direct access setting and whether their characteristics were associated with correct diagnoses and decision-making. METHODS: We conducted a national online survey using a questionnaire containing 12 first-contact case scenarios. A linear mixed model estimated scores for correct diagnoses and management decisions, differences between musculoskeletal (MSK), non-critical medical (non-CrM), and critical medical (CrM) case scenarios, and the estimated effects of physiotherapists' characteristics. RESULTS: The linear mixed model of data from 1492 participants estimated 55.0% correct diagnoses (62.7% for non-CrM, 61.7% for MSK, and 40.5% for CrM scenarios) and 71.2% correct management decisions (78.1% for non-CrM, 73.0% for MSK, and 62.3% for CrM scenarios). For correct diagnoses, the 'academic education/continuing education' variable showed significant estimated effects for the MSK and CrM scenarios, as did 'professional experience' for the non-CrM scenarios, and the '≥ 50% musculoskeletal patients in consultations' variable for all scenario groups. For correct management decisions, 'academic education/continuing education' variable showed significant estimated effects in CrM scenarios, as did 'professional experience' in non-CrM and CrM scenarios, and the '≥ 50% musculoskeletal patients in consultations' variable in MSK scenarios. CONCLUSION: The estimated effects of physiotherapists' characteristics on correct diagnoses and management decisions showed substantial heterogeneity. Improving Swiss physiotherapists' screening abilities remains important. Further research is required to develop innovative educational concepts and improve training for screening for red flags.

Physiotherapists' use and perceptions of digital remote physiotherapy during COVID-19 lockdown in Switzerland: an online cross-sectional survey.

BACKGROUND: The Swiss containment strategy for the COVID-19 pandemic during the first wave in spring 2020 resulted in a moratorium on non-urgent physiotherapy via regular direct patient contact. Consequently, such physiotherapy sessions declined by 84%. This study investigates the impact of this moratorium on the use of digital remote physiotherapy in Switzerland during this period and the perceptions of its use by Swiss physiotherapists (PTs). METHODS: A cross-sectional online questionnaire was distributed between June and August of 2020 via the Swiss Physiotherapy Association (physioswiss) and various associations of physiotherapy specialists (e.g., sport, pediatric) working in both inpatient and outpatient settings. The questionnaire was designed to capture the demographics of participants and the perceptions of PTs using 33 questions in the following domains: Demography; Attitudes towards digital technology; Private and professional use of digital technology; Use of digital technology during therapy; and, Support requirements. Closed and open-ended questions were included and the frequency of answers was analyzed. Non-parametric inferential statistics were used to identify differences, where appropriate. The Checklist for Reporting Results of Internet E-Surveys (CHERRIES) was adopted. RESULTS: Participants in the survey were 742 PTs (23.5% male, mean age of 43 years, mean working experience of 18 years) from the German-speaking (75.5%), French-speaking (15.1%), and Italian-speaking (9.4%) regions of Switzerland. The percentage of PTs using digital remote therapy increased from 4.9% prior to the lockdown to 44.6% during the lockdown period. The majority of PTs did not consider that digital remote therapy could complement usual physiotherapy practice and did not plan to continue with digital remote therapy after the pandemic. CONCLUSIONS: During the lockdown, Swiss PTs adopted various low-cost and easily accessible digital technologies. However, several barriers hampered further implementation of this modality. Specific education and training programs need to be provided among PTs, appropriate digital technologies should be introduced, and a correct reimbursement scheme should be developed. TRIAL REGISTRATION: COVIDPhysio Registry of World Physiotherapy, registered 15th June 2020 ( https://world.physio/covid-19-information-hub/covid-19-covidphysio-registry ).

Pembrolizumab-triggered Uveitis: An Additional Surrogate Marker for Responders in Melanoma Immunotherapy?

Immunotherapy leads to significantly prolonged survival of patients with metastatic melanoma. Autoimmune side effects including colitis, dermatitis, and endocrine abnormalities are common in patients treated with ipilimumab [anti-CTLA4 (cytotoxic T-lymphocyte-associated protein 4)]. Antibodies such as pembrolizumab that interfere with the PD-1 (programmed cell death 1)/PD-L1 pathway show greater efficacy and less toxicity than ipilimumab. Here we report 2 cases of pembrolizumab-induced uveitis associated with complete or partial tumor response. We suggest that uveitis may serve as a surrogate marker for a tumor response to therapy with pembrolizumab.