Several strategies for clinical partners and universities are perceived to enhance physiotherapy student engagement in non-metropolitan clinical placements: a mixed-methods study.

QUESTION: What strategies can clinical partners and universities implement to enhance physiotherapy student engagement in non-metropolitan clinical placements? DESIGN: Mixed-method research design combining focus groups and survey. PARTICIPANTS: First-year physiotherapy students from one university at the commencement of their course (n=26); third-year and fourth-year students who had completed a non-metropolitan placement (n=39 survey, n=25 focus group); and clinical educators from three non-metropolitan clinical sites (n=15). INTERVENTION: The cohort of first-year physiotherapy students was surveyed to establish their perceptions regarding non-metropolitan clinical education placements. A survey and four focus groups were conducted with third-year and fourth-year students after they had attended non-metropolitan clinical placements, to explore recent experiences. Two focus groups were conducted with clinical educators regarding student engagement at non-metropolitan placements. Quantitative data were summarised with descriptive statistics. Qualitative data were analysed using thematic analysis, synthesising the perspectives of students and clinical educators. RESULTS: At the commencement of their physiotherapy course, interest in undertaking a non-metropolitan clinical placement was higher for students with a non-metropolitan upbringing. Concerns about attending non-metropolitan sites included finances, change in living situation, and perceived inferior quality of clinical education. After completing a non-metropolitan placement, four themes were identified in an analysis of student and educator perceptions: individual factors, clinical experience, logistical challenges and strategies for success. CONCLUSION: Strategies that were perceived to enhance student engagement in non-metropolitan placements included: tailoring preparation for students, paired rather than individual placements, and near-peer presentations for physiotherapy students prior to undertaking non-metropolitan placements. Dedicated clinical coordinator positions at non-metropolitan sites and assistance in accessing affordable accommodation are likely to positively influence the student experience. [Francis-Cracknell A, Maver S, Kent F, Edwards E, Iles R (2017) Several strategies for clinical partners and universities are perceived to enhance physiotherapy student engagement in non-metropolitan clinical placements: a mixed-methods study. Journal of Physiotherapy 63: 243-249].

Lower limb reaction time discriminates between multiple and single fallers.

Despite research supporting its validity in predicting falls, simple reaction time (SRT) is not typically included in a clinical falls assessment battery because there is no standardised, clinically feasible testing protocol with published cutoff scores. This study aimed to determine whether SRT scores obtained using a clinically viable protocol could discriminate between multiple and single fallers. SRT scores were obtained from 147 participants (88 women and 59 men) over the age of 65 years (mean 80.1 years; SD 8.4 years) who had reported one or more falls in the previous 12 months. Forty-eight single and 99 multiple fallers were recruited from the subacute public hospital sector. SRT scores significantly discriminated between faller groups (Wilk's λ = 0.89, p = 0.05), with SRT score being the dominating predictor between groups. A receiver operating characteristic (ROC) curve showed good diagnostic accuracy with the area under curve = 0.78. A cutoff score of 394.5 ms provided the best balance between sensitivity and specificity. Once data were dichotomized as being above or below this cutoff value, a binary regression analysis revealed an odds ratio of 7.18 (95% CI 3.3-15.6), with a positive predictive value of 84.5%. The clinically feasible lower limb SRT testing protocol described provided good discrimination between single and multiple fallers. This test may be useful in clinical practice to help identify older people at greater risk of future falls.