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PubMed2002

Views of chartered physiotherapists on the psychological content of their practice: a preliminary study in the United Kingdom.

BACKGROUND: Although research into the psychological aspects of sports injury is increasing and psychological interventions have been identified as important in the rehabilitation process, few studies have focused on how sports medicine practitioners deal with psychological problems. OBJECTIVE: To investigate the perceptions of English chartered physiotherapists on the psychological content of their practice. METHODS: The Physiotherapist and Sport Psychology Questionnaire (PSPQ) was adapted slightly from the Athletic Trainer and Sport Psychology Questionnaire and used in this study. A survey package comprising a PSPQ, introductory letter, and self addressed envelope was mailed to 179 chartered physiotherapists registered in the England Eastern Region Sports Medicine Directory. RESULTS: In total, 90 (50% response rate) questionnaires were returned. The sample consisted of 67 women and 23 men with a mean (SD) age of 40.1 (5.4) years and 9.2 (3.1) years of experience as chartered physiotherapists. Descriptive statistical and qualitative analysis showed that physiotherapists believed athletes were often psychologically affected by injury. The physiotherapists also reported often using psychological techniques when treating injured athletes, but few reported having access to a sport psychologist for referral. CONCLUSIONS: This research indicates that future physiotherapy education may need more emphasis on the psychological aspect of injury, and seek to increase knowledge on the potential of using psychological interventions within a physiotherapy rehabilitation programme. Furthermore, some form of referral network should be established between chartered physiotherapists and sport psychologists.

Adaptation, Psychological↗
PubMed2005

Effect on the process of care of an active strategy to implement clinical guidelines on physiotherapy for low back pain: a cluster randomised controlled trial.

OBJECTIVES: To evaluate the effect on the process of care of an active strategy to implement clinical guidelines on physiotherapy for low back pain. DESIGN: A cluster randomised controlled trial comparing an active strategy with standard dissemination. SETTING: Primary care physiotherapy practices. PARTICIPANTS: 113 physiotherapists were randomly allocated to receive the guidelines by mail (control group) or to receive an additional active strategy (intervention group) which consisted of a multifaceted programme including education, discussion, role playing, feedback, and reminders. MAIN OUTCOME MEASURES: Adherence to the guidelines was measured by means of individual patients' forms recording the treatment completed by the physiotherapist. The forms were assessed using an algorithm based on the number of treatment sessions, treatment goals, interventions, and patient education. RESULTS: Physiotherapists in the intervention group more often correctly limited the number of treatment sessions for patients with a normal course of back pain (OR 2.39; 95% CI 1.12 to 5.12), more often set functional treatment goals (OR 1.99; 95% CI 1.06 to 3.72), more often used mainly active interventions (OR 2.79; 95% CI 1.19 to 6.55), and more often gave adequate patient education (OR 3.59; 95% CI 1.35 to 9.55). They also adhered more to all four criteria (OR 2.05; 95% CI 1.15 to 3.65). CONCLUSIONS: The active strategy moderately improved adherence to the guidelines. Active strategies are recommended to implement the clinical guidelines on physiotherapy for low back pain.

Evidence-Based Medicine↗
PubMedDate not supplied

Hands across the water: clinical observations of hand therapy practices in Great Britain and Norway.

The Evelyn Mackin Traveling Hand Therapist Award is a new award established in 2004 by the American Hand Therapy Foundation. This award was named in honor of Evelyn Mackin, a distinguished leader in hand therapy rehabilitation. Ms. Mackin enthusiastically endorses worldwide networking among hand therapists. She strongly believes in the value of sharing knowledge and technical skills. This award enables members of the ASHT to travel, learn new concepts or skills, and share them with the American hand therapy community. Visits to clinics in Great Britain and Norway revealed similarities and differences between European and American hand therapy practice. Clinical observations explore tendon transfer rehabilitation, cold sensitivity, sensory desensitization and re-education, Dupuytren's contracture, and clinic design. Other highlighted topics include delivery of health care services, hand therapist certification, and the unique contributions of Occupational Therapy and Physiotherapy to the practice of hand therapy. A hand therapy practice survey focuses on treatment and practice issues, continuing education, and challenges facing hand therapist colleagues abroad.

Certification↗
PubMed2004

The interrater reliability among physical therapists newly trained in a classification system for acute low back pain.

STUDY DESIGN: A prospective methodological interrater reliability study. OBJECTIVES: To calculate the interrater reliability among clinicians newly trained in a classification system for acute low back pain and to determine the level of agreement at key junctures within the classification algorithm. BACKGROUND: The utility of a classification system for patients with low back pain depends on its reliability and generalizability. To be practical, clinicians must be able to apply the system after a reasonable amount of training. Identifying key points in the classification algorithm where disagreement occurs can lead to better operational definitions. METHODS: Four physical therapists read an article and attended a 1-day training session in the classification system. Randomly paired therapists classified patients referred for treatment of acute low back pain and noted decisions at key junctures in the system algorithm. RESULTS: Forty-five patients were classified. Repeated examinations did not increase the patient's pain (P>.05). For 3 out of the 4 therapists, the interrater reliability showed a kappa value of 0.45. The fourth therapist, excluded from the overall analysis, exhibited a bias towards the immobilization classification. Among the 3 therapists, major disagreement occurred with the determination of symmetry with trunk side bending and the effects of repeated movements. CONCLUSIONS: Three out of 4 clinicians newly trained in the system showed moderate reliability. The reliability was slight when the fourth therapist was included. Refinement of the operational definitions and criteria for determining lumbar capsular patterns are needed. One day of training is probably not adequate for all therapists, especially for those biased towards specific low back pain syndromes.

Adult↗
PubMed2005

The MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care: a psychometric analysis.

STUDY DESIGN: Psychometric evaluation of a cross-sectional survey. OBJECTIVES: To determine the validity of measures obtained from the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care (MRPS) to differentiate between patient satisfaction with internal and external factors. BACKGROUND: Self-report measures that sample a variety of items provide clinicians with an array of information that may assist in assessing patient satisfaction. An important measurement characteristic of these instruments is the ability to discriminate between different factors that may influence patient reports of satisfaction with care, ie, discriminant validity. In previous work, exploratory factor analysis suggested that the MRPS questionnaire has a 2-factor structure: "internal," relating to the patient-therapist interaction, and "external," describing nontherapist issues such as admissions and clinic environment. METHODS AND MEASURES: One thousand four hundred forty-nine adult patients completed the MRPS questionnaire upon finishing their course of outpatient physical therapy treatment. Discriminant validity of the 2-factor model was assessed using confirmatory factor analysis. The measures from the 2 factors were then evaluated for reliability by calculating the standard error of measurement (SEM), and for concurrent validity by correlating the mean score of the factors and individual items to global measures of satisfaction. RESULTS: Confirmatory factor analysis supported a good to excellent model fit for the internal factor (7 items) and external factor (3 items). The SEM for the 2 factors was 0.19 and 0.24, indicating a low degree of measurement error. Both factors had high significant correlation with global measures of satisfaction (internal, r = 0.83 and 0.80; external, r = 0.71 and 0.71). All individual items within the 2 factors had significant correlations with global measures ranging from r = 0.33 to 0.80. CONCLUSIONS: Our findings provide evidence of discriminant and concurrent validity of the 2-factor solution for the MRPS questionnaire for the sample that was tested. This 2-factor solution yields measures that are relatively free of error and may discriminate between internal and external factors influencing patient satisfaction. Patients who complete their course of physical therapy report that the professional interaction between the therapist and patient, especially the meaningful exchange of relevant information, is critical for patient satisfaction with care. The generalizability of our data to patients who do not complete their physical therapy care or who are receiving care in other health care environments is unknown.

Cross-Sectional Studies↗
PubMed2005

Historical perspectives of autonomy within the medical profession: considerations for 21st century physical therapy practice.

As a part of the American Physical Therapy Association's (APTA) vision statement, by the year 2020, physical therapists "will hold all privileges of autonomous practice." This vision statement and the ideals held within it are elemental to the direction of our continued growth as a profession. Many members and nonmembers, however, appear confused and perhaps even intimidated by the concept of autonomous practice. This paper will review and discuss the processes used by other health care professions to gain autonomy within the US health care system. In particular, the processes used by physicians, which were extremely effective and have been used as a template by many other health professions, including physical therapy. Further discussion will focus on the physical therapy profession, emphasizing the parallels with medicine and considering many issues relevant to the goal of autonomous practice. By understanding the past and considering the present, readers will develop an appreciation of (1) the foundation for autonomous practice in health care, (2) the vision of the APTA and why the profession is well positioned to achieve this vision, and (3) the factors we need to consider to hold (and maintain) all privileges of autonomous practice.

Delivery of Health Care↗
PubMed2005

Thrust joint manipulation clinical education opportunities for professional degree physical therapy students.

STUDY DESIGN: Descriptive survey. OBJECTIVE: Describe the availability of thrust joint manipulation clinical educational opportunities for physical therapy professional degree students. BACKGROUND: In the United States, most of the faculty teaching manual therapy content in physical therapy programs believe that the best way for their students to develop thrust joint manipulation skills is to receive additional training during clinical education experiences. There are no data that describe the availability of such training opportunities. METHODS AND MEASURES: Seventy-three physical therapy programs that include thrust joint manipulation in their curricula were divided into 5 geographic regions. Of these programs, 27% (total, n = 20) were randomly selected per region to participate. Program academic coordinators of clinical education (ACCEs) identified their clinical instructors working in outpatient orthopaedic settings. ACCEs and clinical instructors were surveyed regarding thrust joint manipulation clinical education opportunities for students. RESULTS: Survey return rates were 100% for ACCEs and 67.4% for clinical instructors. Of ACCEs, 70% were unsure which sites employed clinical instructors trained in thrust joint manipulation and 85% did not consider whether thrust joint manipulation training was provided when scheduling the experience. The ACCEs who did consider availability cited lack of qualified instructors as the number-one barrier to finding sites that offered thrust joint manipulation. Of clinical instructors, 30% provide thrust joint manipulation training including lecture/theory, technique demonstration, practice on "normals," and direct patient care supervision. Clinical instructors who did not teach thrust joint manipulation cited reasons that included the belief that it is not an entry-level skill (57%), lack of qualified staff (53%), liability concerns (46%), and students not being academically prepared (41%). CONCLUSIONS: Results suggest that the availability and scope of thrust joint manipulation clinical educational opportunities are limited, vary considerably, and are not considered when selecting clinical education sites for students. Potential obstacles to offering thrust joint manipulation training were identified, which suggested the need for resources, including clinical education curricula and philosophical guidelines for clinical instructors.

Curriculum↗
PubMed2005

Management of a patient with an isolated greater tuberosity fracture and rotator cuff tear.

STUDY DESIGN: Case report. BACKGROUND: Patients with hyperflexion/hyperabduction injury to the glenohumeral joint are at risk for isolated greater tuberosity fractures, which are often undiagnosed or misdiagnosed. In this case report, we describe the clinical decision-making process that led to the diagnosis of an isolated greater tuberosity fracture and subsequent rotator cuff tear. CASE DESCRIPTION: The patient was a 45-year-old male who sustained a shoulder injury as the result of a fall while skiing. After the initiation of physical therapy, he was diagnosed with an isolated greater tuberosity fracture. Little is known regarding the optimal management and overall prognosis of this type of fracture. Conservative nonoperative management and postoperative physical therapy management are discussed. OUTCOMES: With conservative nonoperative management, the patient was unable to regain high-level functional shoulder use. Suspicion of continued pathology of the greater tuberosity dictated further diagnostic imaging, which led to surgical intervention. Upon completion of postoperative rehabilitation, he was able to resume full recreational activities. DISCUSSION: It is recommended that sound clinical decision-making dictate the management and ongoing evaluation of traumatic shoulder injuries, especially when managing a patient with an injury for which optimal treatment and prognosis is not well established.

Athletic Injuries↗