Objectives
The objective of this study is to determine orthopaedic consultants' perceptions of an advanced practice physiotherapy (APP) service in paediatrics.
Design
This is a qualitative study that ...use semi‐structured interviews to explore consultant doctors' experiences of an APP paediatric orthopaedic service and its development. Data were transcribed verbatim and subsequently underwent thematic analysis.
Participants
Five orthopaedic consultants in two hospital settings participated, and all of whom had experience of working with paediatric orthopaedic APPs.
Results
Seven themes were derived from the analysis, with all participants in the study identifying factors affecting the development of the service and demonstrating broad support for the APP role, with benefits noted as including improved efficiency of service, expansion of skill mix within the team, positive impressions of the standard of care and improved education and liaison with the families and community practitioners at large.
Conclusions
This paper highlights many of the factors that should be considered when introducing an APP service in an outpatient setting. This study demonstrates consistent cross‐site positive regard in the skill and competency of the APP in paediatric orthopaedics, to enhance orthopaedic services for children.
Background The St Vincent's Working Backs Project (WBP) represents a strategy for the implementation of the UK Faculty of Occupational Medicine guidelines for the management of low back pain (LBP) in ...the workplace (Carter J, Birrell L. Occupational Health Guidelines for the Management of Low Back Pain at Work—Principal Recommendations. London: Faculty of Occupational Medicine, 2000). Aim To evaluate the efficacy of the St Vincent's WBP. Methods Questionnaire survey of staff and managers before and after the WBP intervention together with review of Occupational Health Department (OHD) data. The intervention included changes to LBP management pathways and protocols, combined with a guideline-based health promotion campaign. Outcomes included WBP awareness, LBP-related sickness absenteeism, staff back beliefs, intended management of LBP and manager attitudes towards LBP and it management. Results Following the WBP intervention, 85% (n = 46) of managers and 57% (n = 124) of staff reported having heard of the WBP. LBP-related sickness absenteeism in the previous year had not decreased significantly (95% confidence interval: −0.03 to 0.06). Among staff, a mean improvement of 1.8 had occurred on the Back Beliefs Questionnaire score. More staff (36%) reported that they would try to stay active (P < 0.05) with LBP and would choose to attend the OHD if they required treatment. More managers demonstrated guideline-consistent attitudes. Conclusions Following the WBP, staff and manager attitudes and beliefs towards LBP and its management were more consistent with the LBP guidelines although LBP-related sickness absenteeism did not decrease significantly. Future occupational guideline implementation strategy studies are required which should include a control worksite and rely on pre- and post-intervention organizational data.
The need for a global core competency and capability framework for advanced practice physiotherapy is important due to the rapidly changing nature of health care delivery internationally and the need ...to standardize advanced practice physiotherapy.INTRODUCTIONThe need for a global core competency and capability framework for advanced practice physiotherapy is important due to the rapidly changing nature of health care delivery internationally and the need to standardize advanced practice physiotherapy.To determine the importance of a proposed international core competency and capability framework for advanced practice physiotherapy.OBJECTIVETo determine the importance of a proposed international core competency and capability framework for advanced practice physiotherapy.We conducted a cross-sectional online survey of advanced practice physiotherapists across seven countries. The importance of each competency and capability was rated on a five-point agreement Likert scale. Participants were from the United Kingdom, Ireland, Australia, New Zealand, Canada, Switzerland and Argentina.METHODSWe conducted a cross-sectional online survey of advanced practice physiotherapists across seven countries. The importance of each competency and capability was rated on a five-point agreement Likert scale. Participants were from the United Kingdom, Ireland, Australia, New Zealand, Canada, Switzerland and Argentina.A total of 99 participants completed the survey, comprising 63% (57/90) females and 33% (30/90) males. Sixty percent, 60% (54/90), had over 20 years of experience. The survey participants represented a diverse geographic distribution, with 25% (23/90) from Australia, 25% (23/90) from Canada, 18% (6/90) from New Zealand, and 18% (6/90) from the United Kingdom. Four percent 4% (4/90) from Ireland, and 4% (4/90) from other countries (Switzerland and Argentina). The survey revealed a strong consensus among participants, with all competencies and capabilities ranked as high and considered important to advanced practice.RESULTSA total of 99 participants completed the survey, comprising 63% (57/90) females and 33% (30/90) males. Sixty percent, 60% (54/90), had over 20 years of experience. The survey participants represented a diverse geographic distribution, with 25% (23/90) from Australia, 25% (23/90) from Canada, 18% (6/90) from New Zealand, and 18% (6/90) from the United Kingdom. Four percent 4% (4/90) from Ireland, and 4% (4/90) from other countries (Switzerland and Argentina). The survey revealed a strong consensus among participants, with all competencies and capabilities ranked as high and considered important to advanced practice.This study demonstrates a consensus among advanced practice physiotherapists across seven countries on the importance of a proposed competency and capability framework. The findings highlight the need for a global standard in advanced practice physiotherapy, particularly in light of the rapidly changing healthcare landscape.CONCLUSIONThis study demonstrates a consensus among advanced practice physiotherapists across seven countries on the importance of a proposed competency and capability framework. The findings highlight the need for a global standard in advanced practice physiotherapy, particularly in light of the rapidly changing healthcare landscape.
Better patient outcomes and more efficient healthcare could be achieved by predicting post hip fracture function at an early stage. This study aimed to identify independent predictors of mobility ...outcome one week post hip fracture surgery.
All hip fracture inpatients (n=77) were included in this 6 month prospective observational cohort study. Predictor variables were obtained on the first postoperative day and included premorbid function using the New Mobility Score (NMS). Mobility outcome measures one week postoperatively included the Cumulated Ambulatory Score (CAS). Data were analysed with SPSS using binary multiple logistic regression analysis
Patients who fell outdoors (OR 3.848; 95% CI, 1.053-14.061), had no delay to surgery (OR 5.472; 95% CI, 1.073-27.907) and had high pre-fracture function (OR3.366; 95% CI, 1.042-10.879) were predicted to achieve independent mobility (CAS = 6) one week postoperatively.
Fall location, time to surgery and baseline function predict independent mobility one week after hip fracture, and can be used for early rehabilitation stratification. The NMS and CAS are recommended as standardised hip fracture clinical measures. Orthogeriatric and physiotherapy service initiatives may improve early functional outcome.
Randomised controlled trials (RCTs) are described as the gold standard of investigative clinical research. Evidence based practice is critical to the physiotherapy profession, and it is therefore ...important to explore the research underpinning practice by examining published RCTs.
The main aims of this review were to profile the quantity and quality of RCTs published in the journal Physiotherapy over the past 50 years.
Physiotherapy journal, hand searched (1967 to 1987) and electronically (1988 to 2017).
Studies identified as RCTs.
Quality assessed via PEDRO criteria.
120 RCTs were identified from January 1967 to January 2017. The frequency of RCTs published has increased steadily and the UK was the most common source of RCTs, but the prevalence of non-UK based trials is increasing. The quality of RCTs improved steadily over the decades, with a mean PEDro score of 6.9 in the most recent decade (2017 to 2008), indicative of ‘high quality’. The mean number of trial participants was 60 and the most commonly evaluated area was musculoskeletal physiotherapy.
RCTs were not evaluated against CONSORT criteria.
Frequency of publication of RCTs in the journal Physiotherapy has increased over this time, mirroring trends in the wider medical literature. This highlights the predominance of some areas of research such as musculoskeletal and exercise-based research while other prominent areas such as neurology appear to be less researched.
The aim of this study was to explore the feasibility and the efficacy of a physiotherapy-led exercise program in changing the health status of a sample of patients with chronic hepatitis C.
A ...single-blind randomized controlled trial was conducted in a sample of patients with iatrogenically acquired hepatitis C in Ireland. Twenty-two participants were recruited and randomly assigned to exercise (n = 10) and control (n = 12) groups. Both groups received a generic exercise advice leaflet, and the exercise group attended 12 exercise sessions for 6 wks. A battery of physical performance measures and patient-reported outcome measures were assessed at baseline and 6 wks, with 1-yr follow-up of the self-reported measures.
Significant group by time interactions during the 6-wk period were found for pain (F(1,20) = 5.15, P = 0.034), grip strength (F(1,20) = 5.94, P = 0.024), aerobic capacity (F(1,20) = 5.73, P = 0.024), and depression (F(1,20) = 6.16, P = 0.022), with the exercise group showing greater positive change. The exercise group also had superior gains in the 36-Item Short-Form Health Survey vitality and social function scores (P < 0.05). The short-term gains were not sustained at 1 yr.
This pilot study shows the feasibility of exercise in hepatitis C management, improving physical fitness, psychologic function, and quality-of-life without worsening symptoms in the short term.
Background
Since 2011, advanced practice physiotherapists (APPs) have triaged the care of patients awaiting orthopaedic and rheumatology consultant/specialist doctor appointments in Ireland. APP ...services have evolved across the major hospitals (n = 16) and, after 5 years, profiling and evaluation of APP services was warranted. The present study profiled the national musculoskeletal APP services, focusing on service, clinician and patient outcome factors.
Methods
An online survey of physiotherapists in the allocated APP posts (n = 25) explored: service organization; clinician profile and experience of the advanced role; and patient wait times and outcome measures. Descriptive statistics were used to analyse hospital‐ and clinician‐specific data, and a content analysis was performed to explore APP experiences.
Results
A 68% (n = 17) response from 13 sites was achieved, whereby 20 whole‐time APP posts existed in services led by 91 consultant doctors. Co‐location of APP and consultant clinics at 11 sites facilitated joint medical–APP processes, with between‐site differences in autonomy to screen referral letters, and arrange investigations, injections and surgery. Although 83% had postgraduate qualifications, APPs also availed themselves of informal role‐specific training. Positive APP experiences related to learning opportunities and clinical support networks but experiences were consultant dependent, with further service developments and formal training required to manage workloads. APPs reported reduced wait times and most commonly chose to capture function/disability in future evaluations.
Conclusions
Variances existed in the organizational design and operating of APP services. Although highly experienced and qualified, APPs welcomed additional formal training and support, due to the complex, more medical nature of APP roles. Further formal evaluation, capturing patient outcomes, is proposed.
Background: Hip fracture is experienced by almost 3,500 older people in Ireland annually. The Irish Hip Fracture Database (IHFD), which drives clinical improvements in acute hospitals, aims to allow ...recording of longer-term outcomes. Feasible and robust methods of data collection need to be identified to inform this activity. The aim of this systematic review is to identify, describe and appraise studies that have collected long-term outcomes after hip fracture in Ireland in the last 15 years and to generate pooled estimates of outcomes if appropriate. Methods: A search of electronic databases (MEDLINE, Embase, Scopus, Web of Science and CINAHL) and grey literature sources will be conducted for journal articles, conference abstracts, academic theses, and reports. Search terms related to hip fracture and Ireland will be included for most sources. The search will be supplemented by email contact with relevant professionals. Observational and interventional studies published between 2005 and 2021 will be included if outcome data were collected in the Republic of Ireland in patients with hip fracture. Outcomes of interest will include data collected after discharge from an inpatient setting or at a fixed time-point greater than 30 days after fracture, hospital admission or surgery. Information relating to study characteristics, description of researchers, data collection methods, patient characteristics and long-term outcomes will be extracted from each study and summarised in tables. Studies will be assessed for risk of bias by two review authors. Where outcomes are sufficiently homogeneous, meta-analyses of estimates will be conducted. Conclusion: Results from this study will inform the planning of further qualitative research to explore barriers and facilitators of long-term outcome collection in Ireland. It will form the basis of education and training for future data collectors in this setting.
Background. Little is known about the experience of carers of children with disabilities in Uganda, where child disability constitutes 31.4% of all disabilities. This study examined the experiences, ...beliefs, and attitudes of parents/ main carers of children with disabilities, and the challenges they face, in order to optimize rehabilitation strategies for the child and their family. Methods. Qualitative data were collected from ten semi - structured interviews with eight main carers children receiving rehabilitation in rural Uganda. Results. Three main themes were identified: (1) experiences, (2) beliefs, and (3) attitudes of the parents/ main carers. Carers experienced emotional stress and many life changes as the burden of care fell primarily on them. A lack of knowledge and information about disability amongst carers, resulted in alternative beliefs about treatment. Social stigma towards disability remains an issue within Ugandan society. Conclusions. Family centered rehabilitation should be incorporated into rehabilitation programmes to decrease burden of care upon the main carer. Health care practitioners are in a strong position to educate families about causation, diagnosis, and prognosis of a child's condition, but such services should be improved through community education about disability and facilitated with the development of parental support groups.
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