The Development of the Canadian Physiotherapy Assessment of Clinical Performance (ACP) 2.0 - Alignment with the 2017 Competency Profile.

Purpose: Clinical education and assessment of students' performance during clinical placements are key components of Canadian entry-to-practice physiotherapy curriculum and important in developing entry-level physiotherapy practitioners. The Canadian Physiotherapy Assessment of Clinical Performance (ACP) is the measure currently used to assess physiotherapy student performance on clinical placements in most of the entry-to-practice physiotherapy programmes across Canada. The release of the 2017 Competency Profile by the National Physiotherapy Advisory Group resulted in a revision of the existing ACP. The purpose of this study is to report the process used to develop a revised version of the ACP based on the 2017 Competency Profile, henceforth called the ACP 2.0. Method: Using a multistage process, we sought input from Canadian clinical education academics, an expert consultant panel, as well as physiotherapists across Canada using a questionnaire, meetings, and an online survey, respectively. Results: Twelve of 15 clinical education academics responded to a questionnaire. The expert consultant panel (n = 12) met three times. There were 144 physiotherapists who initiated the national, online, survey and met the inclusion criteria; 84 completed the survey. In the ACP 2.0, rating scales and comments boxes were grouped, and additional text was added to 12 items for further clarification. The ACP 2.0 came to have 18 items and 9 comment boxes in addition to summative comments, in contrast to the original ACP's 21 items and 9 comment boxes. Conclusions: In November 2020, Canadian clinical education academics reviewed the proposed draft ACP 2.0 and unanimously accepted it for implementation in Canadian physiotherapy university programmes.

Objectif: l'enseignement clinique et l'évaluation du rendement des étudiants pendant les stages cliniques sont des éléments clés du programme canadien d'entrée en pratique de la physiothérapie et sont importants pour former des praticiens de la physiothérapie prêts à entrer en pratique. L'évaluation du rendement clinique de la physiothérapie au Canada (ÉPC) est la mesure actuellement en usage pour évaluer le rendement des étudiants en physiothérapie lors de leur stage clinique dans la plupart des programmes d'entrée en pratique de la physiothérapie au Canada. La publication du Profil des compétences par le Groupe consultatif national en physiothérapie en 2017 a donné lieu à une révision de l'ÉPC. La présente étude vise à rendre compte du processus utilisé pour mettre au point une version révisée de l'ÉPC d'après le Profil des compétences de 2017, désormais appelée l'ÉPC 2.0. Méthodologie: au moyen d'un processus échelonné, les chercheurs ont demandé l'apport d'universitaires canadiens en enseignement clinique, d'un groupe d'experts consultants et de physiothérapeutes des diverses régions du Canada dans le cadre d'un questionnaire, de réunions et d'un sondage en ligne, respectivement. Résultats: au total, 12 des 15 universitaires en enseignement clinique ont répondu à un questionnaire. Le groupe d'experts consultants (n = 12) s'est réuni trois fois. Enfin, 144 physiothérapeutes qui respectaient les critères d'inclusion ont entrepris le sondage national en ligne, et 84 l'ont terminé. Dans l'ÉPC 2.0, les échelles d'évaluation et les encadrés de commentaires ont été regroupés et du texte a été ajouté à 12 des points afin de les clarifier. L'ÉPC 2.0 comporte finalement 18 points et neuf encadrés de commentaires en plus des commentaires sommatifs, par rapport aux 21 points et aux neuf encadrés de commentaires de l'ÉPC original. Conclusions: en novembre 2020, les universitaires en enseignement clinique canadiens ont révisé le projet d'ÉPC 2.0 et en ont adopté la mise en œuvre à l'unanimité au sein des programmes universitaires de physiothérapie du Canada.

How Community-Based Health and Social Care Professionals Support Unpaid Caregivers: Experiences From One Health Authority in Ontario, Canada.

In Ontario, Canada, rising rates of caregiver distress have been the 'canary in the coal mine' for a health system out of balance with the needs of an ageing population. Community-based health and social care professionals are well placed to play an important role in the caregiver support process; however, a gap has remained in the understanding of if and how caregiver support strategies are operationalized or experienced by community service providers (CSPs). The goal of this study was to describe how CSPs interpreted policy and how those interpretations may enable their work in supporting unpaid caregivers. Using a qualitative constructionist design, we interviewed 24 participants and reviewed 92 publicly available documents. Braun and Clarke's method of thematic analysis was used for analysis strategy. Four overarching themes were identified: (1) community care as a priority, (2) sidewalk accountability, (3) creative care planning through partnerships, and (4) challenges to care delivery. We found that the importance of caregivers to the health system was reflected in organizational policy and strategy. There is an opportunity to improve health outcome for caregivers and the population alike through strong leadership and a clear shared vision. Our findings also suggested that social capital was a significant factor in enabling providers in their work, leveraging long-standing relationships, and accumulated local knowledge to implement highly creative care plans.

Mitigating Caregiver Distress in South Western Ontario: Perspectives on Role, Community, and Care.

The former South West Local Health Integration Network (SW LHIN) of Ontario, which is in a predominantly rural region, regularly reports the lowest rates of caregiver distress in the province. Caregivers from rural communities regularly face challenges related to the access, applicability, and availability of supports and services, This qualitative case study describes perspectives of caregiving from the region, and explores how role construction and expectations of caregivers might both mitigate distress and influence service support use. Thematic analysis identified five themes: anticipated care, gendered caring, service support assumptions, confidence in community, and the "line in the sand": care decisions for evolving needs. Using the lens of caregiver identity theory, the findings suggest that these caregivers conceptualize identity as an extension of their primary role, to include caregiving obligations and responsibilities. We also noted a steadfast confidence in community and perceived service support assumptions across the region, with no notable rural-urban divide.

A Systematic Review and Meta-Analysis of Exercise Interventions and Use of Exercise Principles to Reduce Fear of Falling in Community-Dwelling Older Adults.

OBJECTIVE: Fear of falling (FOF) contributes to activity restriction and institutionalization among older adults, and exercise interventions are linked to reduction in FOF. Adhering to exercise principles and adapting optimal exercise parameters are fundamental to optimizing the effectiveness of exercise interventions. The purpose of this review was to describe FOF exercise interventions in community-dwelling older adults, evaluate the extent to which these interventions followed the exercise principles and reported exercise parameters, and quantify the effect of these interventions on reducing FOF. METHODS: Randomized controlled trials (RCTs) of FOF exercise interventions in older adults (≥65 years) were identified from 4 databases. The methodological quality of RCTs was assessed using the Physiotherapy Evidence Database scale. A random-effect model was used in the meta-analysis. RESULTS: Seventy-five RCTs were included in this review. With regard to reporting exercise principles, specificity was reported in 92% of trials, progression in 72%, reversibility in 32%, overload in 31%, diminished return in 21%, and initial value in 8%. For exercise parameters, 97% of RCTs reported exercise type; 89%, frequency; and 85%, time. Only 25% reported the intensity. The pooled effect of exercise interventions on FOF among all included studies was a standard mean difference of -0.34 (95% CI = -0.44 to -0.23). CONCLUSION: This study showed a significant small to moderate effect size of exercise interventions in reducing FOF among community-dwelling older adults. Most exercise principles and intensity of exercises were not adequately reported in included trials. IMPACT: These inadequate reports could undermine efforts to examine the optimal dosage for exercise prescription. More attention must be given to designing and reporting components of therapeutic exercise programs to facilitate evidence-based practice.

Moral distress experienced by community service providers of home health and social care in Ontario, Canada.

Moral distress occurs when one knows a morally correct action to take but feels powerless to act the way one believes is right. Moral distress has been studied in many contexts but there remains a gap in our understanding of the phenomenon as it manifests outside of hospital-based settings. The aim of this study was to explore the nature of the moral distress experience among community-based health and social care professionals working with older adults and their caregivers. Using a qualitative constructionist design, we interviewed 24 participants from a single health authority in southwestern Ontario, Canada. Participants were both urban and rurally based. Data were collected in the winter and summer of 2020 and analysed using Braun and Clarke's thematic analysis strategy. Three factors: reluctant clients, human resource shortages and system challenges, contributed to the creation of perceived morally precarious care plans, resulting in symptoms of moral distress. Study participants described frustration, guilt, anger, and grief at not being able to act consistently with their core values and provide the amount and/or quality of care their clients and unpaid caregivers deserved. We consider possible reasons for our finding that community service providers did not always respond to the consequences of moral distress symptoms in a manner similar to those in acute care contexts. Our findings suggest that study participants may have been able to cultivate moral resilience in the face of moral distress through the positive reframing of adversity and therefore maintain their overall sense of moral integrity.

Physiotherapy Students' Performance in Clinical Education: An Analysis of 1 Year of Canadian Cross-Sectional Data.

Purpose: This research examines 1 year of cross-sectional, Canada-wide ratings from clinical instructors using the Canadian Physiotherapy Assessment of Clinical Performance (ACP) and analyzes the performance profiles of physiotherapy students' performance ratings over the course of their entry-to-practice clinical placements. Method: Canadian physiotherapy programmes that use the ACP were invited to submit anonymized, cross-sectional data for placements completed during 2018. Descriptive analyses and summary statistics were completed. Mixed-effects modelling was used to create typical performance profiles for each evaluation criterion in the ACP. Stepwise ordered logistic regression was also completed. Results: Ten programmes contributed data on 3,290 placements. Profiles were generated for each ACP evaluative item by means of mixed-effects modelling; three profiles are presented. In all cases, the predicted typical performance by the end of 24 months of study was approximately the rating corresponding to entry level. Subtle differences among profiles were identified, including the rate at which a student may be predicted to receive a rating of "entry level." Conclusions: This analysis identified that, in 2018, the majority of Canadian physiotherapy students were successful on clinical placements and typically achieved a rating of "entry level" on ACP items at the end of 24 months.

Objectif : étude transversale d'un an des évaluations canadiennes des moniteurs cliniques au moyen de l'Évaluation physiothérapique canadienne de la performance clinique (ÉPC) pour analyser les profils de performance des étudiants en physiothérapie pendant la durée de leurs stages cliniques débutants. Méthodologie : les programmes de physiothérapie canadiens qui font appel à l'ÉPC ont été invités à soumettre des données transversales anonymisées sur les stages effectués en 2018. Les chercheurs ont procédé à des analyses descriptives et des statistiques sommaires. Ils ont utilisé des modèles non linéaires à effets mixtes pour créer des profils de performance types pour chaque critère d'évaluation de l'ÉPC. Ils ont également procédé à la régression logistique séquentielle. Résultats : dix programmes ont fourni des données sur 3 290 stages. Les chercheurs ont produit des profils pour chaque point d'évaluation de l'ÉPC au moyen du modèle non linéaire à effets mixtes et en ont retenu trois. Dans tous les cas, la performance type anticipée à la fin des 24 mois d'étude correspondait environ au classement de premier échelon. Les chercheurs ont constaté des différences discrètes entre les profils, y compris la vitesse à laquelle il est possible d'anticiper qu'un étudiant recevra un classement de premier échelon. Conclusions : cette analyse a déterminé qu'en 2018, la majorité des étudiants en physiothérapie canadiens réussissaient leur stage clinique, et ils obtenaient habituellement une note de premier échelon aux points de l'ÉPC à la fin des 24 mois.

Clinical Instructors' Perceptions of Internationally Educated Physical Therapists' Readiness to Practise during Supervised Clinical Internships in a Bridging Programme.

Purpose: The purpose of this study was to describe clinical instructors' (CIs) comments on the Canadian Physiotherapy Assessment of Clinical Performance (ACP) that reflect areas of strength and areas requiring improvement among internationally educated physical therapists (IEPTs) during supervised clinical internships in a bridging programme. Method: We reviewed the assessment records of 100 IEPTs' clinical performance during two internships each for three successive cohorts of learners in a Canadian bridging programme. We extracted the CIs' text from 385 comment sections of the ACP completed during these internships and analyzed them using qualitative content analysis. Results: The iterative deductive coding process resulted in 36 subcategories: 14 for areas of strength and 22 for areas requiring improvement. We merged the 36 subcategories to produce nine categories: four areas of strength (subjective assessment, treatment, patient confidentiality, and professionalism) and five areas for improvement (objective assessment, clinical reasoning, establishment of treatment goals, communication, confidence, and time management). We then grouped these categories into two broad themes: professional practice and professional conduct. Conclusions: The CIs commended the IEPTs for their clinical competence in subjective assessment, treatment, patient confidentiality, and professionalism. The areas requiring improvement typically required more complex clinical decision-making skills, which may have been challenging for these IEPTs to demonstrate as competently during a short internship.

Objectif : décrire les commentaires des moniteurs cliniques (MC) dans l'évaluation clinique de la performance (ÉCP) en physiothérapie au Canada, qui reflètent les points forts et les points à améliorer chez les physiothérapeutes formés à l'étranger (PTFÉ) pendant les stages cliniques supervisés d'un programme de transition. Méthodologie : les chercheurs ont analysé les dossiers d'évaluation de la performance clinique de 100 PTFÉ faisant partie de trois cohortes successives d'un programme de transition canadien, qui ont toutes participé à deux stages. Ils ont extrait les textes de 385 sections de commentaires des MC dans l'ÉCP remplie lors de ces stages et ont procédé à une analyse qualitative du contenu. Résultats : le processus itératif de codage déductif s'est traduit par 36 sous-catégories : 14 dans les points forts et 22 dans les points à améliorer. Les chercheurs ont fusionné les 36 sous-catégories en neuf points : quatre points forts (évaluation subjective, traitement, confidentialité des patients et professionnalisme) et cinq points à améliorer (évaluation objective, raisonnement clinique, établissement des objectifs thérapeutiques, communication, confiance et gestion du temps). Ils ont ensuite regroupé ces catégories en deux grands thèmes : pratique professionnelle et conduite professionnelle. Conclusion : Les MC ont félicité les PTFÉ pour leur compétence clinique dans l'évaluation subjective, le traitement, la confidentialité des patients et le professionnalisme. Les points à améliorer exigent habituellement des aptitudes décisionnelles cliniques plus complexes, à l'égard desquelles les PTFÉ ont peut-être eu plus de difficulté à démontrer leur compétence dans le cadre d'un court stage.

Improving Cultural Knowledge to Facilitate Cultural Adaptation of Pain Management in a Culturally and Linguistically Diverse Community.

Purpose: Health care disparities exist for people from culturally and linguistically diverse (CALD) communities. Addressing the cultural competence of health care providers could limit these disparities. The aim of this study was to improve cultural knowledge of and humility regarding pain in a CALD community. Method: This interpretive description qualitative study used focus group discussions (FGDs) to generate ideas about how South Asian culture could influence how health care providers manage pain. A total of 14 people with pain and of South Asian background (6 women and 8 men, aged 28-70 y) participated. Two investigators independently analyzed the data. This process involved repeatedly reading the transcripts, then manually sorting the key messages into categories. The investigators compared their categorizations and resolved differences through discussion. Next, similar categories and concepts were grouped into ideas (potential themes). These ideas, along with supporting categories and verbatim quotes, were presented to the full research team for feedback. After compiling the feedback, the ideas formed the thematic representation of the data. Results: The data from the FGDs revealed how pain management could be culturally adapted. The FGDs generated four themes about South Asian cultural perspectives that could influence the pain management experience for people living with pain: (1) cultural and linguistic impediments to communication, (2) understanding of pain in terms of the extent to which it interferes with function and work, (3) nurturing or personal attention as a marker of good care, and (4) value attributed to traditional ideas of illness and treatment. Conclusion: This study demonstrates how engaging with CALD people living with pain can lead to improved cultural knowledge and humility that can form the basis for adapting pain management. Through this process, it is more likely that a meaningful and client-centred pain management plan can be developed.

Objectif : les membres de communautés linguistiques et culturelles diversifiées (CLCD) font face à des disparités en matière de soins. Si les dispensateurs de soins acquéraient des compétences culturelles, il serait possible d'atténuer ces disparités. La présente étude visait à améliorer les connaissances et l'humilité culturelle au sujet de la douleur dans les CLCD. Méthodologie : étude qualitative descriptive et interprétative faisant appel à des entrevues de groupe pour générer des idées sur la manière dont la culture sud-asiatique peut influencer les modes de gestion de la douleur par les dispensateurs de soins. Au total, 14 personnes d'origine sud-asiatique qui souffrent de douleur y ont participé (six femmes et huit hommes de 28 à 70 ans). Deux chercheurs ont analysé les données de manière indépendante. Ce processus incluait la lecture répétée des comptes rendus, puis la catégorisation manuelle des principaux messages. Les chercheurs ont comparé les catégories et résolu leurs différends par des discussions. Ils ont ensuite regroupé les catégories et les concepts semblables en idées (thèmes potentiels). Les idées, de même que les catégories et les citations textuelles qui les appuyaient, ont ensuite été présentées à l'ensemble de l'équipe de recherche pour qu'elle y réagisse. Une fois les réactions compilées, les idées ont formé la représentation thématique des données. Résultats : les données tirées des entrevues de groupe ont révélé des manières d'adapter la gestion de la douleur à la culture. Les entrevues ont produit quatre thèmes sur les points de vue de la culture sud-asiatique qui pourraient influer sur l'expérience de gestion de la douleur des personnes qui vivent avec la douleur : 1) les obstacles culturels et linguistiques à la communication, 2) la compréhension de l'importance de l'entrave que représente la douleur pour le fonctionnement et le travail, 3) l'accompagnement ou l'attention personnelle comme marqueur de bons soins et 4) la valeur attribuée aux idées traditionnelles de la maladie et du traitement. Conclusion : la présente étude démontre que le fait d'engager un dialogue avec des personnes de CLCD qui vivent avec la douleur peut améliorer les connaissances et l'humilité culturelles sur lesquelles reposeront les mesures d'adaptation. Grâce à ce processus, il est plus probable d'établir un plan concret de gestion de la douleur, axé sur le client.

"I've found it's very meaningful work": Perspectives of physiotherapists providing palliative care in Ontario.

OBJECTIVES: This study aimed to describe insights from interviews about the experience of physiotherapists providing palliative care in Ontario and their perceptions of the role and value of physiotherapists' involvement in palliative care. METHODS: We conducted interviews with physiotherapists in Ontario, Canada (n = 14), and received emailed submissions from two others (one physiotherapist and one physiotherapy student) with current or recent practice experience in palliative care. We conducted inductive thematic analysis of the interview data and emailed submissions. RESULTS: Participants' reflections were categorized into three major themes: perceived value of the contribution of physiotherapists in palliative care; the experience of providing physiotherapy in palliative care; and reflections on the palliative care system. Participants described their role in palliative care as diverse, driven by patient goals and focused on the experience of patients and families. Participants perceived a high value in collaborative networks for supporting them to fulfill their role in palliative care settings. Participants also recommended efforts to increase awareness of the potential for physiotherapists to contribute to palliative care. CONCLUSIONS: The findings confirm those of research in other jurisdictions and extend our understanding of the value and meaningfulness of physiotherapy in palliative care, to patients, families, and physiotherapists themselves.

Clinical Performance Scores of Internationally Educated Physical Therapists during Clinical Education in a Bridging Programme.

Purpose: We describe the numerical ratings assigned by clinical instructors to the performance of internationally educated physical therapists (IEPTs) during their clinical internships while enrolled in a bridging programme. Method: We conducted a secondary analysis of the quantitative data for IEPT learners attending the Ontario Internationally Educated Physical Therapist Bridging Program using the Canadian Physiotherapy Assessment of Clinical Performance (ACP) tool. We extracted the scores from each IEPT's ACP form at the midterm and final evaluations for two internships and conducted a descriptive analysis. Results: We obtained 318 data sets for 61 IEPTs. By the final point of the second internship, (1) items about communication pertaining to ethical professional relationships, conducting oneself within legal and ethical requirements, and respecting the individuality and autonomy of the client had high mean ratings; (2) most items rated achieved advanced intermediate performance and many indicated entry-level performance; and (3) most IEPTs (84%) either had high scores throughout or improved from lower scores to at least advanced intermediate performance. Conclusions: Items relating to professional conduct and effective communication in professional relationships were relatively high among the IEPTs. By the end of the second internship, most IEPTs in this bridging programme had improved their clinical performance toward or up to the entry-level standard for Canadian physiotherapists.

Objectif : décrire les cotes numériques que les moniteurs cliniques attribuent au rendement des physiothérapeutes formés à l'étranger (PFÉ) pendant les stages cliniques de leur programme de transition. Méthodologie : les chercheurs ont procédé à une analyse secondaire des données quantitatives des apprenants PFÉ qui participent au programme ontarien de transition des PFÉ. Pour ce faire, ils ont utilisé l'outil d'évaluation du rendement clinique (ÉRC) en physiothérapie au Canada. Ils ont extrait les cotes de chaque formulaire d'ÉRC des PFÉ à l'évaluation de mi-session et à l'évaluation finale de deux stages et réalisé une analyse descriptive. Résultats : les chercheurs ont obtenu 318 ensembles de données sur 61 PFÉ. À la fin du deuxième stage, a) les points sur la communication relative aux relations professionnelles éthiques, le comportement respectueux des exigences légales et éthiques et le respect de l'individualité et de l'autonomie du client ont obtenu des cotes élevées; b) la plupart des points cotés ont obtenu un rendement intermédiaire avancé, et bon nombre, un rendement de physiothérapeute débutant et c) la plupart des PFÉ (84 %) ont obtenu des cotes élevées tout au long de leurs stages ou sont passés de scores faibles à un rendement au moins intermédiaire avancé. Conclusion : les points relatifs au comportement professionnel et à des communications efficaces étaient relativement élevés chez les PFÉ. À la fin de leur deuxième stage, la plupart des PFÉ de ce programme de transition avaient amélioré leur rendement clinique pour qu'il avoisine ou atteigne la norme exigée des physiothérapeutes canadiens débutants.

Imaging use for low back pain by Ontario primary care clinicians: protocol for a mixed methods study - the Back ON study.

BACKGROUND: At any one time, one in every five Canadians has low back pain (LBP), and LBP is one of the most common health problems in primary care. Guidelines recommend that imaging not be routinely performed in patients presenting with LBP without signs or symptoms indicating a potential pathological cause. Yet imaging rates remain high for many patients who present without such indications. Inappropriate imaging can lead to inappropriate treatments, results in worse health outcomes and causes harm from unnecessary radiation. There is a need to understand the extent of, and factors contributing to, inappropriate imaging for LBP, and to develop effective strategies that target modifiable barriers and facilitators. The primary study objectives are to determine: 1) The rate of, and factors associated with, inappropriate lumbar spine imaging (x-ray, CT scan and MRI) for people with non-specific LBP presenting to primary care clinicians in Ontario; 2) The barriers and facilitators to reduce inappropriate imaging for LBP in primary care settings. METHODS: The project will comprise an inception cohort study and a concurrent qualitative study. For the cohort study, we will recruit 175 primary care clinicians (50 each from physiotherapy and chiropractic; 75 from family medicine), and 3750 patients with a new episode of LBP who present to these clinicians. Clinicians will collect data in the clinic, and each participant will be tracked for 12 months using Ontario health administrative and self-reported data to measure diagnostic imaging use and other health outcomes. We will assess characteristics of the clinicians, patients and encounters to identify variables associated with inappropriate imaging. In the qualitative study we will conduct in-depth interviews with primary care clinicians and patients. DISCUSSION: This will be the first Canadian study to accurately document the extent of the overuse of imaging for LBP, and the first worldwide to include data from the main healthcare professions offering primary care for people with LBP. This study will provide robust information about rates of inappropriate imaging for LBP, along with factors associated with, and an understanding of, potential reasons for inappropriate imaging.

Knowledge about risk factors for falls and practice about fall prevention in older adults among physiotherapists in Nigeria.

BACKGROUND AND OBJECTIVE: Falling is a major health concern that has contributed significantly to older people's injury and loss of life worldwide, warranting the development of fall-prevention strategies, the success of which has been attributed to the levels of knowledge and practice about fall prevention among physiotherapists and other health professionals. The objective of this study was to determine the self-reported levels of knowledge on risk factors of fall and practices about fall prevention in older adults among physiotherapists in Nigeria. METHODS: Physiotherapists (N = 237) recruited from the six geopolitical zones of Nigeria completed a three-part structured questionnaire that asked questions about risk factors for fall and common practices for fall prevention using a 5-point-rated Likert scale. Data were analysed using descriptive analysis, chi-square, and Kruskal-Wallis tests. RESULTS: Among physiotherapists in Nigeria, 89% rated their level of knowledge about preventing falls among older adults as high, and 64% of them rated their level of practice on this topic as high. Among the individual items that measured knowledge, 40% of the participants reported a moderate level of knowledge about multiple medications as a risk factor for falls. Fifty percent of the participants reported a low level of practice of referral to other health care professionals, whereas 40% and 41% reported a moderate level of practice on documenting risk factors and treatment plans, respectively. There was no association between age, gender, or years of practice with levels of knowledge or practice. CONCLUSION: This study suggests that physiotherapists in Nigeria have adequate knowledge and practice for fall prevention in older adults. However, there are potential gaps in knowledge of risk factors, documentation, and referrals to other professions that may be addressed through developing context-specific fall-prevention clinical guidelines for practice in Nigeria.

Let's Talk about the Talk: Exploring the Experience of Discussing Student Performance at the Mid- and Final Points of the Clinical Internship.

Purpose: The purpose of this study was to explore the experiences of physiotherapy students and clinical instructors (CIs) when discussing student clinical performance at the mid- and final points of clinical internships. The objectives were to identify why performance assessment discussions are valuable, explore the role of each participant throughout the discussion, identify the challenges associated with these discussions, and explore the effect of the standardized assessment tool on the discussion. Methods: This study used a qualitative descriptive design, consisting of student and CI focus groups in the Greater Toronto Area from January to June 2016. Results: All participants (N=29) recognized the importance of having face-to-face performance assessment discussions in a quiet and private space. Students and CIs agreed that the Canadian Physiotherapy Assessment of Clinical Performance helped to structure and focus the discussions. Valuable discussions occurred when students were open minded and self-reflected on their performance and when CIs were honest and used their expertise to guide learning. Other key features included mutual preparedness, two-way feedback that was constructive and tangible, and a goal-setting process. Students described the emotional component of these discussions as being challenging, and CIs found it difficult when a student took a more passive role in the discussion. Conclusions: Our findings indicate that valuable discussions can provide meaningful feedback, strengthen the student-CI relationship, and engage the learner in an ongoing and cumulative learning process that contributes to professional development.

Objectif : la présente étude visait à explorer les expériences d'étudiants en physiothérapie et de moniteurs cliniques (MC) lors des discussions sur le rendement clinique des étudiants au milieu et à la fin de leur stage clinique. Les objectifs consistaient à déterminer l'intérêt des discussions sur l'évaluation de rendement, à explorer le rôle de chaque participant à la discussion, à cerner les défis associés à ces discussions et à explorer l'effet de l'outil d'évaluation normalisé sur la discussion. Méthodologie : la présente étude faisait appel à une méthodologie descriptive qualitative, composée de groupes de travail d'étudiants et de MC du Grand Toronto entre janvier et juin 2016. Résultats : tous les participants (n=29) ont convenu de l'importance des discussions d'évaluation du rendement en tête à tête, dans un lieu calme et privé. Les étudiants et les MC conviennent également que l'évaluation de rendement clinique de l'Association canadienne de physiothérapie contribuait à structurer et à orienter les discussions. Des discussions intéressantes avaient lieu lorsque les étudiants étaient ouverts et prêts à tenir une autoréflexion sur leur rendement et lorsque les MC étaient honnêtes et utilisaient leurs compétences pour orienter l'apprentissage. Parmi les autres caractéristiques clés, soulignons une préparation mutuelle, des commentaires bidirectionnels constructifs et tangibles et un processus d'établissement d'objectifs. Les étudiants trouvaient les aspects émotifs de ces discussions exigeants, alors que les MC éprouvaient de la difficulté lorsqu'un étudiant adoptait un rôle plus passif dans la discussion. Conclusions : selon nos observations, des discussions intéressantes peuvent favoriser des commentaires significatifs, renforcer la relation entre l'étudiant et le MC et faire participer l'étudiant à un processus d'apprentissage continu et cumulatif qui contribue à son perfectionnement professionnel.

Photovoice and Persons With Physical Disabilities: A Scoping Review of the Literature.

Photovoice is a group analysis method often affiliated with participatory action research (PAR). It has become increasingly popular in qualitative research with people with physical disabilities. This article details the results of a study that sought to understand the scope of the literature related to how photovoice is conducted with people with physical disabilities. We performed a scoping review related to use of photovoice in physical disabilities research. We identified 20 articles that featured diverse participants with physical disabilities and demonstrated a range of approaches to data collection, analysis, and dissemination. Nearly all of the articles identified used photovoice to study physical accessibility/navigation of space. Although a majority of selected articles purported to use PAR approaches, many articles demonstrated research that may not be as participatory as presumed. Based on the findings, we provide suggestions for photovoice studies that will ensure full and meaningful participation of members involved.

Demographic Characteristics of Applicants to, and Students of, Ontario Physiotherapy Education Programs, 2004-2014: Trends in Gender, Geographical Location, Aboriginal Identity, and Immigrant Status.

Purpose: The authors analyzed the demographics of potential future physiotherapists to determine whether they were representative of the Canadian population. The specific objectives were to examine selected demographic variables from all applicants to and students in Ontario English-language Master of Physical Therapy programmes in admission cycles 2004-2014, inclusive, and to analyze the results as compared with Canadian population data. Method: Anonymized applicant records (n=14,135) were obtained for admission cycles 2004-2014, inclusive. Variables examined for applicants and students included their gender, geographical location from Canadian and international regions, Aboriginal identity, and immigrant status. A descriptive analysis of counts and proportions was conducted for all variables. Results: The majority of applicants were women (70%), from southern Ontario (73%), and Canadian born (82%). Aboriginal and rural applicants made up small proportions of the applicant pool (1% and 12%, respectively). The number of applicants from British Columbia was proportionally high relative to those from other Canadian provinces. Conclusion: Although Ontario's physiotherapy education programmes remain female dominated, the demographics of applicants and students are otherwise mostly representative of the diverse Canadian population, although very low in the number of Aboriginal peoples. Further research is needed to understand the diversity and composition of the Canadian physiotherapy workforce.

Objectif : analyser les données démographiques des potentiels futurs physiothérapeutes afin de déterminer s'ils sont représentatifs de la population canadienne. L'objectif principal était d'examiner certaines variables démographiques de tous les candidats et étudiants aux programmes de maîtrise en physiothérapie de langue anglaise de l'Ontario des cycles d'admission de 2004 à 2014 inclusivement et d'analyser les résultats comparativement aux données sur la population canadienne. Méthodes : les dossiers de candidature anonymes (n=14 135) ont été obtenus pour les cycles d'admission de 2004 à 2014 inclusivement. Les variables examinées incluaient le sexe, la région de provenance au Canada ou à l'étranger, l'identité autochtone et le statut d'immigrant. Une analyse descriptive des comptes et des proportions a été effectuée pour toutes les variables. Résultats : la majorité des candidats étaient des femmes (70 %), venaient du sud de l'Ontario (73 %) et étaient nés au Canada (82 %). Les candidats autochtones et des régions rurales représentaient de petites proportions du bassin de candidats (1 % et 12 %, respectivement). Proportionnellement parlant, le nombre de candidats provenant de la Colombie-Britannique était élevé comparativement aux autres provinces canadiennes. Conclusion : bien que les programmes universitaires en physiothérapie de l'Ontario comportent une majorité de femmes, les données démographiques des candidats et des étudiants sont autrement assez représentatives de la diversité de la population canadienne, exception faite du très faible nombre d'autochtones. D'autres recherches sont nécessaires pour comprendre la diversité et la composition de la main-d'œuvre en physiothérapie au Canada.

Exploring Record Keeping, Clinical Reasoning, and Practice Context: Peer Assessment Findings from the Perspective of Situational Competence.

Purpose: The College of Physiotherapists of Ontario developed its peer practice assessment (PA) process on the basis of the statutory requirements for quality assurance. We previously reported outcomes from physiotherapists who had two PAs. The aims of the current research were to identify areas of sub-optimal performance on the assessments and explore any associations with the physiotherapists' practice context. Methods: We examined scores from the PAs of all physiotherapists who had two unrelated PAs between 2004 and 2012 (n=117), and we examined assessment reports for those who had specific patterns of sub-optimal outcomes (n=22). We conducted qualitative content analysis on the assessment reports to identify areas deemed to need improvement and the contexts in which the physiotherapists practised. Comparisons of proportions were carried out using Fisher's exact test. Results: The most common area of sub-optimal scores was record keeping, followed by clinical reasoning as assessed by means of chart-stimulated recall. Record-keeping deficits were related to either clinical care or administrative requirements (e.g., documenting patient consent in the manner required by law). At the second PA, record-keeping deficits were predominantly administrative. Physiotherapists with sub-optimal outcomes disproportionately worked in private practice contexts (p=0.026). Conclusions: Ontario physiotherapists generally maintain high-quality practice. Regulatory bodies may consider developing support strategies for meeting professional standards that take practice context into account.

Objectif : le processus d'évaluation par les pairs de l'Ordre des physiothérapeutes de l'Ontario est fondé sur les exigences prescrites en matière d'assurance-qualité. Dans une étude antérieure, les auteurs ont fait état des résultats de physiothérapeutes évalués à deux reprises. Dans la présente, ils cherchaient à déterminer les domaines dans lesquels des lacunes ont été observées et d'éventuels liens avec le milieu de pratique. Méthodologie : les auteurs ont examiné les notes de tous les physiothérapeutes évalués deux fois entre 2004 et 2012 (n=117) ainsi que les rapports d'évaluation de ceux qui affichaient des lacunes particulières (n=22). Ils ont effectué une analyse qualitative du contenu des rapports d'évaluation afin de déterminer les domaines à améliorer et le milieu de pratique. Ils ont comparé les proportions à l'aide de la méthode exacte de Fisher. Résultats : le domaine dans lequel les lacunes étaient le plus observées est la tenue de dossiers, suivi par le raisonnement clinique, évalué par rappel stimulé des dossiers. Spécifiquement, les lacunes relativement à la tenue des dossiers étaient liées aux soins cliniques ou aux exigences administratives (p. ex., consignation du consentement du patient conformément à la loi). Lors de la deuxième évaluation, les lacunes relativement à la tenue de dossiers étaient principalement d'ordre administratif. Un nombre disproportionné de physiothérapeutes ayant présenté des lacunes exerçait en milieu privé (p=0,026). Conclusion : les physiothérapeutes de l'Ontario maintiennent généralement une pratique de qualité. Les organismes de réglementation pourraient envisager de formuler des stratégies visant à favoriser le respect des normes professionnelles qui tiennent compte du milieu de pratique.

Evidence of Reliability, Validity, and Practicality for the Canadian Physiotherapy Assessment of Clinical Performance.

Purpose: To investigate the internal consistency, construct validity, and practicality of the Canadian Physiotherapy Assessment of Clinical Performance (ACP), a descriptive measure used by physiotherapy students and their clinical instructors (CIs) at the mid- and endpoints of an internship to describe the students' behaviours as observed in the clinical education setting relative to what might be expected of an entry-level physiotherapist. Methods: This multi-centre study piloted the ACP in 10 university physiotherapy (PT) programmes. Both CIs and students undertaking clinical internships completed the ACP and the current tool, the Physical Therapist Clinical Performance Instrument (PT-CPI; Version 1997). Results: CIs assessing PT students' performance during internships representing a variety of areas of practice completed the ACP at the midpoint (n=132) and the endpoint (n=126) of the internship. The end-of-internship sample consisted of 55 junior, 30 intermediate, and 41 senior students. The ACP demonstrated strong internal consistency: Alpha coefficients for each role ranged from 0.94 to 0.99. Aligned items on the ACP and PT-CPI were significantly correlated (r=0.51-0.84). Senior PT students performed significantly better than intermediate students, who, in turn, performed better than junior students (p<0.0001). Effect sizes for midpoint to final scores on the ACP ranged from medium to large (0.40-0.74). Participants were satisfied with the online education module that provided instruction on how to use and interpret the ACP, as indicated by satisfaction scores and qualitative comments. Conclusions: The ACP is a reliable, valid, and practical measure to assess and describe the PT students' behaviours as observed during clinical education relative to what is expected of an entry-level physiotherapist.

Objectif : Examiner la cohérence interne, la validité de construit et l'utilité pratique de l'évaluation de la performance clinique (EPC) en physiothérapie au Canada, une mesure employée par les étudiants en physiothérapie et leurs instructeurs cliniques en milieu et en fin de stage clinique pour décrire les comportements des étudiants par rapport à ce qu'il y a lieu d'être attendu d'un physiothérapeute débutant. Méthodes : Cette étude multicentrique évaluait la mise à l'essai de l'EPC dans 10 programmes universitaires. Les instructeurs cliniques et les étudiants en stage clinique ont réalisé leurs évaluations à l'aide de l'EPC et de l'outil actuel, le PT-CPI (version 1997). Résultats : Des instructeurs cliniques représentant différents champs de pratique ont complété l'ECP en milieu (n=132) et en fin (n=126) de stage. L'échantillon de fin de stage était composé de 55 étudiants débutants, 30 étudiants intermédiaires et 41 étudiants avancés. L'ECP a démontré un haut degré de cohérence interne, soit des coefficients alpha de 0,94 à 0,99 pour chaque rôle. Une corrélation significative a été observée entre les éléments correspondants de l'ECP et du PT-CPI (r=0.51­0.84). Les étudiants avancés ont obtenu des résultats significativement meilleurs que les étudiants intermédiaires qui ont à leur tour obtenu des résultats significativement meilleurs que les étudiants débutants (p<0.0001). Les différences constatées entre les notes de l'ECP en milieu et en fin de stage révèlent une taille d'effet moyenne à forte (0,40 à 0,74). Les notes de satisfaction et les commentaires qualitatifs indiquent que les participants étaient satisfaits du module de formation en ligne qui expliquait comment utiliser et interpréter l'ACP. Conclusions : L'ECP est une mesure fiable, valide et pratique pour évaluer et décrire les comportements des étudiants observés en formation clinique par rapport à ce qu'il y a lieu d'attendre d'un physiothérapeute débutant.

Knowledge and Use of, and Attitudes toward, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in Practice: A Survey of Ontario Physiotherapists.

Purpose: To investigate Ontario physiotherapists' knowledge and use of, and attitudes toward, non-steroidal anti-inflammatory drugs (NSAIDs) to identify whether there is a need for physiotherapists to receive education specific to NSAIDs. Method: An existing survey instrument was modified and tested by five Ontario physiotherapists. The final version was distributed electronically to approximately 4,400 Ontario Physiotherapy Association members as a self-administered online questionnaire. Results: A total of 294 physiotherapists responded to the survey (response rate=6.7%). Respondents demonstrated variability in their knowledge of NSAID contraindications, side effects, and drug interactions. Most respondents (62.6%) were incorrect or unsure about where and how to obtain most NSAIDs, and most demonstrated incorrect or uncertain knowledge of the relevant legislation. Despite this lack of knowledge, 50% of respondents recommend NSAIDs to their patients. Conclusions: Many Ontario physiotherapists who participated in this survey recommend NSAIDs to their patients despite having a variable understanding of the legislation and medication-related factors. A lack of thorough knowledge of risks and contraindications has implications for patient safety. Physiotherapists who incorporate medications into their practice should access comprehensive information on appropriate NSAID use and should inform themselves about legislative restrictions to ensure that associated treatment is provided in a manner that is evidence based, safe, and in keeping with regulatory boundaries.

Objectif : enquêter sur les connaissances et l'usage de médicaments anti-inflammatoires non stéroïdiens par les physiothérapeutes de l'Ontario, ainsi que leurs opinions à l'égard de ceux-ci, afin de déterminer si les physiothérapeutes devraient recevoir une formation spécifique sur les anti-inflammatoires. Méthodes : un instrument de sondage existant a été modifié et mis à l'essai par cinq physiothérapeutes ontariens. La version finale a été distribuée électroniquement à environ 4 400 membres de la Ontario Physiotherapy Association. Résultats : 294 physiothérapeutes ont répondu au sondage (taux de réponse=6,7%). Un niveau de connaissance variable a été observé chez les répondants quant aux contre-indications, aux effets secondaires et aux interactions médicamenteuses des anti-inflammatoires. La majorité des répondants (62,6%) avaient une connaissance erronée ou incertaine du mode d'obtention de la plupart des anti-inflammatoires, et la plupart avaient une connaissance erronée ou incertaine des lois régissant leur usage. Malgré ce manque de connaissance, 50% des répondants recommandent des anti-inflammatoires à leurs patients. Conclusions : les physiothérapeutes ontariens qui ont participé au sondage sont nombreux à recommander des anti-inflammatoires à leurs patients malgré un niveau de connaissance variable des lois applicables et de certains facteurs liés aux médicaments. Un manque de connaissance des risques et des contre-indications a des répercussions sur la sécurité des patients. Les physiothérapeutes qui intègrent la médicamentation dans leur pratique devraient se renseigner en profondeur sur l'usage des anti-inflammatoires et les restrictions législatives afin de s'assurer que le traitement associé est dispensé en toute sécurité et conformément aux données probantes et aux lois.

A robot-based behavioural task to quantify impairments in rapid motor decisions and actions after stroke.

BACKGROUND: Stroke can affect our ability to perform daily activities, although it can be difficult to identify the underlying functional impairment(s). Recent theories highlight the importance of sensory feedback in selecting future motor actions. This selection process can involve multiple processes to achieve a behavioural goal, including selective attention, feature/object recognition, and movement inhibition. These functions are often impaired after stroke, but existing clinical measures tend to explore these processes in isolation and without time constraints. We sought to characterize patterns of post-stroke impairments in a dynamic situation where individuals must identify and select spatial targets rapidly in a motor task engaging both arms. Impairments in generating rapid motor decisions and actions could guide functional rehabilitation targets, and identify potential of individuals to perform daily activities such as driving. METHODS: Subjects were assessed in a robotic exoskeleton. Subjects used virtual paddles attached to their hands to hit away 200 virtual target objects falling towards them while avoiding 100 virtual distractors. The inclusion of distractor objects required subjects to rapidly assess objects located across the workspace and make motor decisions about which objects to hit. RESULTS: As many as 78 % of the 157 subjects with subacute stroke had impairments in individual global, spatial, temporal, or hand-specific task parameters relative to the 95 % performance bounds for 309 non-disabled control subjects. Subjects with stroke and neglect (Behavioural Inattention Test score <130; n = 28) were more often impaired in task parameters than other subjects with stroke. Approximately half of subjects with stroke hit proportionally more distractor objects than 95 % of controls, suggesting they had difficulty in attending to and selecting appropriate objects. This impairment was observed for affected and unaffected limbs including some whose motor performance was comparable to controls. The proportion of distractors hit also significantly correlated with the Montreal Cognitive Assessment scores for subjects with stroke (r s < = - 0.48, P < 10-9). CONCLUSIONS: A simple robot-based task identified that many subjects with stroke have impairments in the rapid selection and generation of motor responses to task specific spatial goals in the workspace.