Group Physical Therapy Programs for Military Members With Musculoskeletal Disorders: A Pragmatic Randomized Controlled Trial.

OBJECTIVE: To compare the effects of personalized, supervised group-based programs (ie, group physical therapy programs) and usual one-on-one physical therapy care (ie, usual physical therapy care) on disability for military personnel suffering from low back pain, rotator cuff-related shoulder pain, patellofemoral pain syndrome, or lateral ankle sprain. Secondary outcomes were pain severity, pain-related fear, health-related quality of life, and patients' satisfaction with their condition and care. DESIGN: Non-inferiority pragmatic randomized clinical trial. METHODS: One hundred twenty military personnel from the Canadian Armed Forces, experiencing 1 of 4 targeted musculoskeletal disorders, were consecutively recruited and randomly assigned to group physical therapy programs or usual physical therapy care. Disability, pain severity, pain-related fear, and health-related quality-of-life outcomes were measured at 6, 12, and 26 weeks after baseline. Satisfaction with treatment was evaluated at the end of the intervention. Intention-to-treat analyses using linear mixed models with random effects were used to compare the effects of interventions. Chi-square tests were used to compare satisfaction. RESULTS: There were no significant Time × Group interactions for any of the primary and secondary outcomes (Time × Group: P>.67). Satisfaction with treatment also did not differ between groups (P>.05). Statistically significant and clinically important improvements were observed in both groups for all outcomes after 12 weeks (Time effect: P<.01), except for health-related quality of life (P = .13). CONCLUSION: Group physical therapy programs were not inferior to usual physical therapy care for managing pain, functional capacity, and patients' satisfaction with care of military personnel presenting with various musculoskeletal disorders. Both interventions led to clinical and statistical improvement in pain and function in the mid and long term. Group physical therapy could be an effective strategy to enhance access to care. J Orthop Sports Phys Ther 2024;54(6):1-10. Epub 26 Mar 2024. doi:10.2519/jospt.2024.12342.

Personalizing rehabilitation for individuals with musculoskeletal impairments: Feasibility of implementation of the Measures Associated to Prognostic (MAPS) tool.

INTRODUCTION: The Measures Associated to PrognoStic (MAPS) tool is a standardized questionnaire that integrates validated prognostic tools to detect the presence of biopsychosocial prognostic factors in patients consulting for musculoskeletal disorders. PURPOSE: The objectives were to assess the: 1) feasibility of implementation of the MAPS tool, 2) clinicians' acceptability of the dashboard, and 3) patients' acceptability of the MAPS tool. METHODS: Twenty physiotherapists and two occupational therapists from seven outpatient musculoskeletal clinics were recruited to implement the MAPS tool during a 3-month timeframe, where new patients completed the questionnaire upon initial assessment. The results were presented to the clinicians via a dashboard. Surveys and semi-structured interviews were conducted to measure feasibility and acceptability. RESULTS: Six out of 11 feasibility criteria (55%) and 21 out of 24 acceptability criteria (88%) reached the a priori threshold for success. The interviews allowed us to identify three main themes to facilitate implementation: 1) limiting the burden, 2) ensuring patients' understanding of the tool's purpose, and 3) integrating the dashboard as a clinical information tool. CONCLUSION: Our quantitative and qualitative results support the feasibility of implementation and acceptability of the MAPS tool pending minor adjustments. Depicting the patients' prognostic profile has the potential to help clinicians optimize their interventions for patients presenting with musculoskeletal disorders.

Low back pain patients' experience and expectations: A qualitative study focusing on physiotherapist and physician care.

BACKGROUND: Low back pain (LBP) is a common and disabling musculoskeletal disorder. LBP experiences and expectations can vary from one person to another and influence their clinical outcomes. Despite the existence of numerous evidence-based treatment recommendations, LBP management in primary care remains challenging. This study aims to investigate the experiences and expectations of patients with LPB in primary care settings. METHODS: A qualitative study with an inductive thematic analysis was conducted. Semi-structured interviews were performed using individuals who had experienced LBP in the past year and had consulted a family physician (FP) or a physiotherapist (PT). RESULTS: Ten participants with LBP were interviewed (5 women, 5 men, mean age 49 ± 17). Five themes were identified: (1) I am always upset because I can't do anything; (2) I waited to consult; I thought it would go away; (3) I want to see what is going on with my LBP; (4) I want to see the person that will provide the right treatment; (5) I need support to get over it. Participants consulted when their pain was severe and disabling. They expected an imaging test to explain the cause of their LBP and placed more importance on the imaging test results than the FP's or PT's evaluation. Their opinions on care selection and being listened to were important for the participants. CONCLUSION: This study has highlighted the importance of the patient's point of view in their care. This consideration is important to ensure a comprehensive and collaborative approach with evidence-based practice care.

Impacts of the COVID-19 pandemic on health and social professionals working with people with disabilities: A qualitative study.

BACKGROUND: Since the beginning of the COVID-19 pandemic, protection and isolation measures established by the Canadian and Quebec governments have directly affected the work of health and social professionals (HSPs). These measures have added pressure on HSPs, complexified their work and added tasks to their already busy workload. However, few studies have explored in depth the impacts of the pandemic on HSPs working with people with disabilities. OBJECTIVE: The objective of this study was to qualitatively explore the experiences of HSPs working among people with disabilities in the province of Quebec, Canada, during the COVID-19 pandemic (January and February 2021), including the impact on their work, the relationships with their colleagues, and on their immediate social and familial environment. METHODS: HSPs participated in a semi-structured interview. A mixed thematic analysis approach, combining inductive and deductive coding, was carried out using N'Vivo 12. RESULTS: Fifty-five HSPs participated in the interviews (mean [SD] age, 42 [9]). They mostly identified as women (91% ). Three main themes representing the impacts of the pandemic were identified, including 1) Health and Well-being; 2) Family and social networks including the subthemes; 2.1) Fear of being a vector of contamination for their loved ones; 2.2) Work-family balance; 2.3) Social Network, and finally 3) Work, highlighting, including 3.1) Workload and adaptative strategies developed; 3.2) Relationship with colleagues; 3.3) Perceived support received at work, and 3.4) Services offered to patients. CONCLUSIONS: These findings highlight the importance of closely tracking and supporting the well-being of HSPs.

"I Had to Know About It, I Had to Find It, I Had to Know How to Access it": Experiences of Access to Rehabilitation Services Among People Living with Long COVID.

Purpose: The aim of this qualitative study is to understand the need for, access to, and quality of rehabilitation services for people living with Long COVID. Little is known about the experiences of people living with Long COVID accessing rehabilitation services. Therefore, we explored health concerns leading people living with Long COVID to seek help to address functional concerns and their experiences with accessing and participating in rehabilitation. Method: Interpretive description guided exploration of participants' experiences with Long COVID rehabilitation in Alberta, Canada. Semi-structured interviews were completed with 56 participants recruited from: three publicly funded Long COVID clinics, a specialized private physiotherapy clinic, a telephone-based rehabilitation advice line, and a Workers' Compensation Board-funded Long COVID rehabilitation program. Recruitment through mass media coverage allowed us to include people who did not access rehabilitation services. Data analysis was informed by Braun and Clarke's reflexive thematic analysis. Results: Four themes were identified: (1) the burden of searching for guidance to address challenges with functioning and disability; (2) supportive relationships promote engagement in rehabilitation; (3) conditions for participation in safe rehabilitation; and (4) looking forward - provision of appropriate interventions at the right time. Conclusions: Our findings highlight the experiences of accessing rehabilitation services for people living with Long COVID. Results suggest approaches to Long COVID rehabilitation should be accessible, multi-disciplinary, flexible, and person-centred.

Objectif: étude qualitative pour comprendre les besoins en services de réadaptation des personnes qui vivent avec la COVID longue, l'accès à ces services et leur qualité. On sait peu de choses sur les expériences des personnes qui vivent avec la COVID longue et accèdent à des services de réadaptation. C'est pourquoi les auteurs ont exploré les inquiétudes qui incitent ces personnes à demander de l'aide pour répondre à leurs problèmes fonctionnels et les expériences qu'elles ont vécues en matière d'accès à la réadaptation et de participation aux services qui y sont associés. Méthodologie: exploration guidée de la description interprétative des expériences des participants qui suivent une réadaptation à cause de la COVID longue en Alberta, au Canada. Les chercheurs ont procédé à des entrevues semi-structurées auprès de 56 participants recrutés dans trois cliniques de COVID longue financées par le gouvernement, une clinique de physiothérapie spécialisée privée, une ligne téléphonique de conseils en réadaptation et un programme de réadaptation après la COVID longue remboursé par la commission des accidents de travail. Le recrutement dans les médias de masse a permis d'inclure des personnes qui n'avaient pas accédé aux services de réadaptation. L'examen des données reposait sur l'analyse thématique réflexive de Braun et Clarke. Résultats: les chercheurs ont relevé quatre thèmes : 1) le fardeau de la recherche de conseils pour répondre aux problèmes de fonctionnement et d'incapacité; 2) les relations de soutien qui favorisent la participation à la réadaptation; 3) les conditions nécessaires pour participer à une réadaptation sécuritaire et 4) pour l'avenir, la prestation d'interventions appropriées au bon moment. Conclusions: les constatations des auteurs font ressortir les expériences d'accès aux services de réadaptation chez les personnes qui vivent avec la COVID longue. Selon les résultats, les approches de réadaptation après la COVID longue devraient être accessibles, multidisciplinaires, flexibles et axées sur l'individu.

Identifying competencies for an advanced practice physiotherapy role within an interprofessional chronic pain clinic.

BACKGROUND: Advanced practice physiotherapy (APP) models of care have shown success in access, safety, satisfaction, and care quality for musculoskeletal pain conditions in various settings. Yet, there is a gap in defining competencies for physiotherapists to be the initial point of contact for people with chronic pain. This study aims to identify and agree upon the competencies necessary for a physiotherapist to fulfill the role of an APP in an interprofessional chronic pain clinic. METHODS: Three focus groups were conducted using a Nominal Group Technique and a modified Delphi process. Consensus on the competency, defined as agreement by ≥ 75% of participants, was sought. RESULTS: Twenty-three experts (17 healthcare providers and six individuals with chronic pain) participated in the focus group discussions. Twenty completed the follow-up Delphi surveys. Ten essential competencies for an APP role in interprofessional chronic pain clinics were identified and achieved consensus: 1) use an evidence-based approach to practice; 2) communicate effectively with the patient; 3) perform a comprehensive assessment; 4) determine pain-related diagnoses; 5) develop therapeutic relationships; 6) provide appropriate care; 7) support patients through transitions in care; 8) collaborate with members of the interprofessional team; 9) advocate for the needs of the patients; and 10) use a reflective approach to practice. CONCLUSION: This study identified ten competencies essential for physiotherapists to fulfill an APP role within interprofessional chronic pain clinics. These competencies serve as a foundation for informing a training program and future research evaluating the effectiveness of the APP model in this setting.