Pelvic Health Content in Canadian Entry-To-Practice Physiotherapy Programs: An Online Survey.

Purpose: Pelvic health physiotherapy is an emerging and sensitive area of practice that offers effective conservative treatment for pelvic health conditions. Canadian entry-to-practice curriculum guidelines accord programs considerable flexibility regarding incorporating pelvic health content, which may lead to differences between programs and diverse levels of competence among new graduates. The purpose of this study was to determine the nature and extent to which pelvic health content is incorporated in entry-to-practice physiotherapy programs in Canada. Method: We conducted a descriptive cross-sectional e-survey of representatives from Canadian entry-to-practice physiotherapy programs. Results: Ten out of 15 Canadian programs participated. Programs incorporated pelvic health content throughout the required curriculum (n = 9) and in optional courses (n = 6). All participating programs covered musculoskeletal-related conditions, urinary incontinence, and pelvic pain conditions, and included anatomy and physiology, clinical reasoning, subjective assessment and pelvic floor muscle training topics. Three programs trained students in internal pelvic floor techniques in elective courses. All programs covered cisgender women populations, however, transgender populations were seldom covered. Conclusions: This study provides an understanding of pelvic health curricular content that can serve as a first step towards standardizing and improving entry-level pelvic health training in Canada.

Objectif: la physiothérapie pelvienne est un domaine de pratique émergent et sensible qui propose des traitements conservateurs efficaces pour les affections pelviennes. Les directives canadiennes sur le cursus d'entrée en pratique prévoient une grande souplesse quant à l'intégration de la matière sur la santé pelvienne, qui peut se solder par des différences entre les programmes et les divers niveaux de compétence chez les nouveaux diplômés. La présente étude visait à déterminer la nature et l'importance du contenu en santé pelvienne intégré aux programmes d'entrée en pratique en physiothérapie au Canada. Méthodologie: les chercheurs ont effectué un sondage descriptif transversal en ligne auprès de représentants des programmes d'entrée en pratique en physiothérapie au Canada. Résultats: dix des 15 programmes canadiens ont participé. Ils intégraient le contenu sur la santé pelvienne tout au long du cursus obligatoire (n = 9) et dans des cours à option. Tous les programmes participants traitaient des affections musculosquelettiques, de l'incontinence urinaire et des douleurs pelviennes et incluaient l'anatomie et la physiologie, le raisonnement clinique, l'évaluation subjective et l'entraînement musculaire du plancher pelvien. Trois programmes formaient les étudiants aux techniques internes du plancher pelvien dans le cadre de cours à option. Tous les programmes couvraient les populations de femmes cisgenres, mais les populations transgenres y étaient rarement intégrées. Conclusions: la présente étude permet de comprendre le cursus en santé pelvienne et peut représenter une première étape vers la standardisation et l'amélioration de la formation en santé pelvienne à l'entrée en pratique au Canada.

Methodological approaches for identifying competencies for the physiotherapy profession: a scoping review.

Physiotherapy competencies inform the education and regulation of the profession. Many different methods appear to be used to identify competencies and there is no consensus on optimal methods to identify competencies. The purpose of this review is to synthesize the methodological approaches used to identify competencies for the physiotherapy profession and summarize the nature of those competencies. We searched MEDLINE, EMBASE, CINAHL, and the grey literature from inception to June 2020. Two independent reviewers screened for empirical peer-reviewed articles that aimed to identify professional physiotherapy competencies. General study characteristics, competency characteristics (e.g., target practice area), and methodological characteristics (e.g., study population, data collection and analysis method for each methodological step) were extracted. Descriptive statistics and narrative synthesis were performed. Of the 9529 references screened, 38 articles describing 35 studies published between 1980 and 2020 were included. Orthopaedics (20.0%) was the most commonly targeted area of practice. Studies used one to eight methodological steps whose objective was to generate (16 studies), validate (18 studies), assign value (21 studies), refine (10 studies), or triangulate (3 studies) competencies, or to address multiple objectives (10 studies). The most commonly used methods were surveys to assign value (n = 20, 95%), and group techniques to refine competencies (n = 7, 70%). Physiotherapists with experience in the area of competence was the most commonly consulted stakeholder group (80% of studies). This review can provide methodological guidance to stakeholders such as educators and regulators that aim to identify professional competencies in the future. Supplementary Information: The online version contains supplementary material available at 10.1007/s44217-022-00008-9.

Identifying competencies for integrated knowledge translation: a Delphi study.

BACKGROUND: Considerable progress has been made to advance the field of knowledge translation to address the knowledge-to-action gap in health care; however, there remains a growing concern that misalignments persist between research being conducted and the issues faced by knowledge users, such as clinicians and health policy makers, who make decisions in the health care context. Integrated knowledge translation (IKT) is a collaborative research model that has shown promise in addressing these concerns. It takes advantage of the unique and shared competencies amongst researchers and knowledge users to ensure relevance of the research process and its outcomes. To date, core competencies have already been identified to facilitate training in knowledge translation more generally but they have yet to be prioritized for IKT more specifically. The primary aim of this study was to recruit a group of researchers and knowledge users to identify and prioritize core competencies for researchers and knowledge users to engage with IKT. METHODS: We recruited health care knowledge users (KUs) and researchers with experience and knowledge of IKT for a quantitative, cross-sectional study. We employed a modified Delphi approach consisting of three e-survey rounds to establish consensus on competencies important to IKT for KUs and researchers based on mean rating of importance and agreement between participants. RESULTS: Nineteen (73%) of the initial 26 participants were researchers (response rate = 41% in the first round; retention in subsequent rounds > 80%). Participants identified a total of 46 competencies important for IKT (18 competencies for KUs, 28 competencies for researchers) under 3 broad domains. Technical research skills were deemed extremely important for researchers, while both groups require teamwork and knowledge translation skills. CONCLUSIONS: This study provides important insight into distinct and overlapping IKT competencies for KUs and researchers. Future work could focus on how these can be further negotiated and contextualized for a wide range of IKT contexts, projects and teams. Greater attention could also be paid to establishing competencies of the entire team to support the research co-production process.

Telehealth e-mentoring in postgraduate musculoskeletal physiotherapy education: A mixed methods case study.

BACKGROUND: Educational standards of advanced musculoskeletal physiotherapy include mentored clinical practice. Whilst traditionally delivered face-to-face, telehealth e-mentoring affords a distinctive andragogy to facilitate mentee development. OBJECTIVE: To understand the experiences and outcomes of stakeholders participating in musculoskeletal physiotherapy telehealth e-mentoring. DESIGN: A case study design with sequential mixed methods (quantitative patient outcome data and qualitative interviews and a focus group) of a 20-week e-mentored telehealth physiotherapy service. METHODS: Data collection comprised 1) Patient experiences and measures of musculoskeletal health 2) Mentee semi-structured interviews 3) Mentor focus group. Data analysis included descriptive statistics (median and IQR) and the Framework Method for qualitative and quantitative data respectively. An exploratory bidirectional approach supported data integration across all participants. RESULTS: Participants included patients (n = 90), mentees (n = 10) and mentors (n = 6). Patients reported improvements (>MCID) in MSK-HQ and Patient Specific Functional Scale, with high scores for Consultation and Relational Empathy and Patient Enablement Instruments. Main themes were a) social learning b) advanced professional practice c) learner experience and d) limitations of telehealth for mentees, and for mentors a) preparedness b) journey of development and c) challenges. Participant data integration resulted in 4 main themes 1) energising/positive experience 2) communications skills valued 3) perceptions of telehealth 4) upskilling required. CONCLUSIONS: Telehealth e-mentoring is a valuable alternative to face-to-face mentored physiotherapy practice to support development in advanced musculoskeletal physiotherapy practice. Findings indicate that technical and professional skills are required, high levels of communication skills were valued, there is a need for reconceptualisation of musculoskeletal physiotherapeutic interventions.

A narrative review on cervical interventions in adults with chronic whiplash-associated disorder.

Introduction: Whiplash injuries are common in society, but clinical interventions are inconclusive on the most effective treatment. Research and reviews have been completed with the goal of determining clinical interventions that are effective for whiplash injuries and disorders, but literature has not recently been summarised on best practices for cervical spine interventions for adults with chronic whiplash. Purpose: The objective of this narrative review is to update and expand on previous works, to provide recommendations for clinical interventions and future research in the area of cervical spine rehabilitation for adults with chronic whiplash-associated disorder. Method: The Arskey and O'Malley methodology was used for this narrative review. CINHAL, EMBASE, Medline, PsychInfo, Scopus, Web of Science, as well as grey literature, were searched from 2003 to April 2017. Two reviewers screened titles and abstracts for relevance to the review, and content analysis summarised the study findings. A total of 14 citations were included in the final review. Findings: Exercise-based interventions targeted at the cervical spine appear most beneficial for adults with chronic whiplash-associated disorder (WAD). Invasive interventions still require more rigorous studies to deem their effectiveness for this population. Conclusion: Further research is required to investigate and determine clinically relevant results for cervical spine intervention in patients with chronic WAD.

Exploring the teaching and learning of clinical reasoning, risks, and benefits of cervical spine manipulation.

The aim of this study was to examine how risks and benefits of cervical spine manipulation (CSM) were framed and discussed in the context of mentorship and their impact on the perception of safe practice of CSM in clinical physiotherapy settings. A multi-method qualitative approach was employed, including a document analysis of established educational guidelines, observations of mentoring sessions, and individual face-to-face interviews with five mentees in the process of learning CSM, and four mentors with Orthopedic Manual Physical Therapy (OMPT) certification. Results demonstrated that participants' clinical decision-making processes to perform CSM were primarily oriented to the mitigation of risk. Achieving proficiency in the "science" of clinical reasoning and the "art" of "feel" related to mastering technical skills were viewed as means to mitigating risk and enhancing confidence to use CSM safely in clinical practice. While the "art" of technical skill mastery was of high importance to mentees and considered important to developing competency in performing CSM, it was discussed as distinct from their clinical reasoning processes. Thus, promoting a more balanced and integrated use of the "art" and "science" of safe practice for CSM in OMPT training may result in greater confidence and judicious use of CSM by physiotherapists.

Gluteus Medius and Minimus Muscle Structure, Strength, and Function in Healthy Adults: Brief Report.

Purpose: This article describes gluteus medius and minimus muscle thickness and hip abductor strength and function in healthy adults and explores the relationships between muscle thickness and function. Methods: Gluteus medius and minimus muscle thickness (B-mode ultrasound), isometric hip abductor strength (Biodex dynamometer), and lower extremity function (timed Trendelenburg test, Five-Times-Sit-to-Stand Test [FTSST], and lateral step-down test) were measured in healthy adults using a cross-sectional study design. Results: A total of 22 subjects were included: 10 men and 12 women, mean age 25.2 (SD 3.1) years, mean BMI 22.9 (SD 3.5) kilograms per metre squared. Muscle thickness of the gluteals was a mean 3.88 (SD 0.13) centimetres, and mean hip abductor peak torque was 111 (SD 43) newton-metres. FTSST mean time was 5.3 (SD 0.2) seconds, and median scores were 2.0 points for lateral step-down and 90 seconds for timed Trendelenburg. No significant relationships were found between gluteal muscle thickness and functional tests (rs=-0.28 to 0.37, ps=0.09-0.80) or strength (r=-0.24, p=0.28). Conclusion: Although hip abductors are key pelvic stabilizers for functional movements, gluteal muscle thickness was not associated with strength or function. This may be a result of agonist muscle activity, leading to an inability to isolate the gluteals, and to the ceiling effects of the functional tests.

Objectif : décrire l'épaisseur du muscle moyen glutéal et du muscle petit glutéal, la force et la fonction de l'abducteur de la hanche chez des adultes en santé et explorer les liens entre l'épaisseur et la fonction des muscles. Méthodologie : les chercheurs ont mesuré l'épaisseur du muscle moyen glutéal et du muscle petit glutéal (échographie en mode B), la force de l'abduction isométrique de la hanche (dynanomètre Biodex) et la fonction des jambes (test de Trendelenburg chronométré, test fonctionnel assis-debout de cinq répétitions [FTSST] et tests de descente latérale des marches) chez des adultes en santé dans le cadre d'une étude transversale. Résultats : au total, 22 sujets ont participé, soit 10 hommes et 12 femmes d'un âge moyen de 25,2 ans (ÉT 3,1 ans), d'un IMC moyen de 22,9 kg/m2 (ÉT 3,5 kg/m2). L'épaisseur moyenne des muscles glutéaux était de 3,88 cm (ÉT 0,13 cm), et la puissance de pointe moyenne de l'abducteur de la hanche, de 111 newton-mètres (ÉT 43 Nm). La durée moyenne du FTSST était de 5,3 secondes (ÉT 0,2 s), tandis que le score médian du test de descente latérale des marches était de 2,0 points, et celui du test de Trendelenburg chronométré, de 90 secondes. Il n'y avait pas de relation significative entre l'épaisseur des muscles glutéaux et les tests fonctionnels (r=−0,28 à +0,37, p=0,09 à 0,80) ou la force (r=−0,24, p=0,28). Conclusion : même si les abducteurs de la hanche sont des stabilisateurs essentiels du bassin lors des mouvements fonctionnels, l'épaisseur des muscles glutéaux ne s'associait ni à la force ni à la fonction. Ce peut être à cause de l'activité des muscles agonistes qui empêche d'isoler les muscles glutéaux, de même que des effets plafonds des tests fonctionnels.

Validity of a new assessment rubric for a short-answer test of clinical reasoning.

BACKGROUND: The validity of high-stakes decisions derived from assessment results is of primary concern to candidates and certifying institutions in the health professions. In the field of orthopaedic manual physical therapy (OMPT), there is a dearth of documented validity evidence to support the certification process particularly for short-answer tests. To address this need, we examined the internal structure of the Case History Assessment Tool (CHAT); this is a new assessment rubric developed to appraise written responses to a short-answer test of clinical reasoning in post-graduate OMPT certification in Canada. METHODS: Fourteen physical therapy students (novices) and 16 physical therapists (PT) with minimal and substantial OMPT training respectively completed a mock examination. Four pairs of examiners (n = 8) participated in appraising written responses using the CHAT. We conducted separate generalizability studies (G studies) for all participants and also by level of OMPT training. Internal consistency was calculated for test questions with more than 2 assessment items. Decision studies were also conducted to determine optimal application of the CHAT for OMPT certification. RESULTS: The overall reliability of CHAT scores was found to be moderate; however, reliability estimates for the novice group suggest that the scale was incapable of accommodating for scores of novices. Internal consistency estimates indicate item redundancies for several test questions which will require further investigation. CONCLUSION: Future validity studies should consider discriminating the clinical reasoning competence of OMPT trainees strictly at the post-graduate level. Although rater variance was low, the large variance attributed to error sources not incorporated in our G studies warrant further investigations into other threats to validity. Future examination of examiner stringency is also warranted.

Establishing assessment criteria for clinical reasoning in orthopedic manual physical therapy: a consensus-building study.

OBJECTIVES: Clinical reasoning (CR) represents one of the core components of clinical competence in Orthopaedic Manual Physical Therapy (OMPT). While education standards have been developed to guide curricular design, assessment of CR has not yet been standardized. Without theory-informed and rigorously developed measures, the certification of OMPTs lacks credibility and is less defensible. The purpose of this study was to use a theory-informed approach to generate assessment criteria for developing new assessment tools to evaluate CR in OMPT. METHODS: A list of assessment criteria was generated based on international education standards and multiple theoretical perspectives. A modified Delphi method was used to gain expert consensus on the importance of these assessment criteria for the assessment of CR in OMPT. The OMPTs from 22 countries with experience in assessing CR were invited to participate in three rounds of online questionnaires to rate their level of agreement with these criteria. Responses were tabulated to analyze degree of consensus and internal consistency. RESULTS: Representatives from almost half of the OMPT member organizations (MO) participated in three rounds of the Delphi. High levels of agreement were found among respondents regarding the importance and feasibility of most assessment criteria. There was high internal consistency among items within the proposed item subgroupings. DISCUSSION: A list of assessment criteria has been established that will serve as a framework for developing new assessment tools for CR assessment in OMPT. These criteria will be important for guiding the design of certification processes in OMPT as well as other episodes of CR assessment throughout OMPT training.

Ordering diagnostic imaging: a survey of ontario physiotherapists' opinions on an expanded scope of practice.

PURPOSE: To explore Ontario physiotherapists' opinions on their ability to order diagnostic imaging (DI). METHODS: An online questionnaire was sent to all registered members of the College of Physiotherapists of Ontario. Descriptive statistics were calculated using response frequencies. Practice characteristics were compared using χ(2) tests and Wilcoxon rank-sum tests. RESULTS: Of 1,574 respondents (21% response rate), 42% practised in orthopaedics and 53% in the public sector. Most physiotherapists were interested in ordering DI (72% MRI/diagnostic ultrasound, 78% X-rays/computed tomography scans). Respondents with an orthopaedic caseload of 50% or more (p<0.001) and those in the private sector (p<0.001) were more interested in ordering DI. Respondents preferred a DI course that combined face-to-face and Web-based components and one that was specific to their area of practice. Most respondents perceived minimal barriers to the uptake of ordering DI, and most agreed that support from other health care professionals would facilitate uptake. CONCLUSION: The majority of Ontario physiotherapists are interested in ordering DI. For successful implementation of a health care change, such as physiotherapists' ability to order DI, educational needs and barriers to and facilitators of the uptake of the authorized activity should be considered.

Objet: Connaître l'opinion des physiothérapeutes de l'Ontario sur leur capacité d'ordonner des imageries diagnostiques (ID). Méthodes: Un questionnaire en ligne a été envoyé à tous les membres enregistrés de l'Ordre des physiothérapeutes de l'Ontario. Des statistiques descriptives ont été calculées selon les fréquences des réponses obtenues. Les caractéristiques de la pratique ont été comparées au moyen de tests du chi carré et de tests de Wilcoxon. Résultats: Parmi les 1 574 répondants (taux de réponse de 21%), 42% pratiquent l'orthopédie et 53% travaillent dans le secteur public. La majorité des physiothérapeutes se sont dits intéressés à ordonner des ID (72% étaient intéressés par l'imagerie par résonance magnétique ou l'ultrasonoscopie et 78%, par les radiographies ou la tomodensitométrie). Les répondants dont la charge de travail était composée à plus de 50% de cas d'orthopédie (p<0.001) et ceux qui travaillent dans le secteur public (p<0.001) sont plus intéressés que les autres répondants. Les répondants ont indiqué qu'ils préfèrent un cours d'imagerie diagnostique qui combine de l'enseignement en personne et des éléments d'apprentissage en ligne et qui soit spécialisé dans leur domaine de pratique. La majorité des répondants perçoivent des obstacles minimaux au fait de prendre en charge la prescription d'ID et ont convenu qu'un soutien d'autres professionnels de la santé faciliterait cette prise en charge. Conclusion: La majorité des physiothérapeutes de l'Ontario se sont dits intéressés à ordonner des ID. Pour assurer la réussite de la mise en œuvre d'un changement dans le domaine de la santé, tel que la capacité des physiothérapeutes à ordonner de l'ID, il faut prendre en considération les besoins liés à la sensibilisation ainsi que les obstacles et les éléments encourageant la prise en charge de l'activité autorisée.

Sensibility of a new instrument to assess clinical reasoning in post-graduate orthopaedic manual physical therapy education.

Sound application of clinical reasoning (CR) by the physical therapist is critical to achieving optimal patient outcomes. As such, it is important for institutions granting certification in orthopaedic manual physical therapy (OMPT) to ensure that the assessment of CR is sufficiently robust. At present, the dearth of validated instruments to assess CR in OMPT presents a serious challenge to certifying institutions. Moreover, the lack of documentation of the development process for instruments that measure CR pose additional challenges. The purpose of this study is to evaluate the sensibility of a newly developed instrument for assessing written responses to a test of CR in OMPT; a 'pilot' phase that examines instrument feasibility and acceptability. Using a sequential mixed-methods approach, Canadian OMPT examiners were recruited to first review and use the instrument. Participants completed a sensibility questionnaire followed by semi-structured interviews, the latter of which were used to elaborate on questionnaire responses regarding feasibility and acceptability. Eleven examiners completed the questionnaire and interviews. Questionnaire results met previously established sensibility criteria, while interview data revealed participants' (dis)comfort with exerting their own judgment and with the rating scale. Quantitative and qualitative data provided valuable insight regarding content validity and issues related to efficiency in assessing CR competence; all of which will ultimately inform further psychometric testing. While results suggest that the new instrument for assessing clinical reasoning in the Canadian certification context is sensible, future research should explore how rater judgment can be utilized effectively and the mental workload associated with appraising clinical reasoning.

An online community of practice to support evidence-based physiotherapy practice in manual therapy.

INTRODUCTION: The purpose of this study was to explore how a community of practice promoted the creation and sharing of new knowledge in evidence-based manual therapy using Wenger's constructs of mutual engagement, joint enterprise, and shared repertoire as a theoretical framework. METHODS: We used a qualitative approach to analyze the discussion board contributions of the 19 physiotherapists who participated in the 10-week online continuing education course in evidence-based practice (EBP) in manual therapy. The course was founded on community of practice, constructivism, social, and situated learning principles. RESULTS: The 1436 postings on 9 active discussion boards revealed that the community of practice was a social learning environment that supported strong participation and mutual engagement. Design features such as consistent facilitation, weekly guiding questions, and collaborative assignments promoted the creation and sharing of knowledge. Participants applied research evidence to the contexts in which they worked through reflective comparison of what they were reading to its applicability in their everyday practice. Participants' shared goals contributed to the common ground established in developing collective knowledge about different study designs, how to answer research questions, and the difficulties of conducting sound research. DISCUSSION: An online longitudinal community of practice utilized as a continuing education approach to deliver an online course based on constructivist and social learning principles allowed geographically dispersed physiotherapists to be mutually engaged in a joint enterprise in evidence-based manual therapy. Advantages included opportunity for reflection, modeling, and collaboration. Future studies should examine the impact of participation on clinical practice.

Attitudes toward Adults with Intellectual Disability: A Survey of Ontario Occupational and Physical Therapy Students.

PURPOSE: To examine attitudes of students in Ontario master's degree programmes in occupational therapy (MScOT) and physical therapy (MScPT) toward adults with intellectual disability (ID). METHODS: A quantitative cross-sectional survey study was conducted. An electronic questionnaire was distributed to 1,255 MScOT/PT students at five Ontario universities via email, using a modified Dillman approach. Descriptive statistics were used to describe experiences, attitudes, willingness, and preparedness. RESULTS: Overall response rate was 17.9%. A total of 96.0% of respondents felt "quite" or "very willing" to deliver rehabilitation to adults with ID; however, 50.7% of respondents felt "not at all prepared" or "a little prepared" to interact with this population in a clinical setting. Of those who felt unprepared, 75.4% reported it to be due to inadequate knowledge. In addition, Ontario MScOT/PT students have neutral attitudes toward adults with ID. CONCLUSIONS: While many MScOT/PT students are willing to deliver rehabilitation to adults with ID, a large proportion do not feel adequately prepared to interact with this population in a clinical setting. These findings could inform future research and curricular reform in the rehabilitation professions so that future clinicians are better prepared to provide support for this population.

Objectif : Analyser les attitudes des étudiants des programmes de maîtrise en ergothérapie (MScOT) et en physiothérapie (MScPT) face aux adultes qui ont une déficience intellectuelle (DI). Méthodes : Dans le cadre d'une étude transversale quantitative, on a distribué par courriel un questionnaire électronique à 1 255 étudiants à la MScOT/PT de cinq universités de l'Ontario en suivant une stratégie Dillman modifiée. On a utilisé des statistiques descriptives pour décrire les expériences, les attitudes, la volonté et la préparation. Résultats : Le taux de réponse global s'est établi à 17,9 %. Au total, 96,0 % des répondants se sentaient « assez ¼ ou « très disposés ¼ à fournir des services de réadaptation aux adultes ayant une DI, mais 50,7 % des répondants ne se sentaient « pas préparés du tout ¼ ou « un peu préparés ¼ à interagir avec cette population en contexte clinique. Parmi ceux qui ne se sentaient pas préparés, 75,4 % ont déclaré que c'était attribuable à un manque de connaissances. En outre, les étudiants à la MScOT/PT de l'Ontario ont des attitudes neutres à l'égard des adultes qui ont une DI. Conclusions : Même si beaucoup d'étudiants à la MScOT/PT sont prêts à fournir des services de réadaptation aux adultes qui ont une DI, un pourcentage important d'entre eux ne se sent pas bien préparé pour interagir avec cette population en contexte clinique. Ces constatations pourraient éclairer des recherches futures et une réforme du cursus des professions de la réadaptation afin que les futurs cliniciens soient mieux préparés à aider cette population.

Virtually present: the perceived impact of remote facilitation on small group learning.

BACKGROUND: The engagement of facilitators located remotely for small group learning has received little research attention. However, this approach could increase the pool of experts for small group learning, thus addressing challenges to sustainability faced by in-person models of small group facilitation. AIM: The objective of this study was to describe the experiences and perceptions of students regarding the use of remote facilitation for small group learning in a health education setting. METHODS: This qualitative study involved three focus groups (n = 16) composed of students in the advanced neuromusculoskeletal teaching unit in the University of Toronto, Department of Physical Therapy. Focus groups were audio-taped and transcribed verbatim, and data were analyzed thematically. RESULTS: Three main influences emerged related to the experiences of students regarding the use of remote facilitation for small group learning in a health education setting: technology (including audio and visual), facilitator (including quality of facilitation and facilitator expertise), and group dynamics (including ground rules, roles and responsibilities, and learning style). Each of these influences acted independently and interdependently to shape participants' perceptions. CONCLUSION: This study prompts a widening of the concept of distance learning to also include distance teaching, which may have wide applicability to health profession programs.

Continuing education for advanced manual and manipulative physiotherapists in Canada: a survey of perceived needs.

PURPOSE: Our purpose was to determine advanced manual and manipulative physiotherapists' (AMPTs') current use and awareness of continuing education (CE) opportunities; to establish their perceived CE needs by identifying facilitators and barriers to participation; and to explore the association of demographics with CE needs. METHODS: A questionnaire was e-mailed to 456 registered members of the Canadian Academy of Manipulative Physiotherapy. Data analyses using frequencies and percentages of total responses and t-tests for group comparisons were performed. RESULTS: One hundred thirty-three (29.2%) participants responded. Most lived in an urban region and worked predominantly in direct patient care. More respondents reported engaging in informal CE than in formal CE. Hands-on or practical workshops were the preferred CE format. Common barriers to CE included professional commitments and cost and time of travel; facilitators included interest in the topic and increasing knowledge and competency. AMPTs with less physical therapy experience found cost to be a greater barrier and were more interested in mentorship programs and CE as a means to obtain credentials. CONCLUSIONS: AMPTs' preferred CE formats are inconsistent with the CE opportunities in which they participate. CE initiatives for AMPTs should include hands-on training and should account for time and cost to make CE opportunities more readily available to them.

Internet Use among Community-Based Rehabilitation Workers in Bosnia and Herzegovina: A Cross-Sectional Survey.

PURPOSE: The Internet may be one way to support and improve rehabilitation practice and service delivery in low- and middle-income countries (LMICs) such as Bosnia and Herzegovina. Little information exists on use of the Internet to enhance the practice and professional development of community-based rehabilitation (CBR) workers in LMICs. The purpose of this study was to assess the patterns of and barriers to Internet use by CBR workers in Bosnia and Herzegovina. METHODS: Participants were CBR workers (physiotherapists, physiatrists, and technicians) from Bosnia and Herzegovina who attended a conference or workshop in 2005. A cross-sectional questionnaire was administered in the local language to assess Internet use. Descriptive results were summarized in tables. Bivariate and multiple logistic regressions were used to assess factors associated with Internet use. RESULTS: A total of 33% of respondents had never used the Internet. Common barriers to Internet use included "not enough time" (24%), "no access" (23%), and "lack of skill" (18%). Participants with higher levels of education had greater odds of using the Internet than physiotherapy school graduates (odds ratio=7.6, p=0.016) and had greater odds of using the Internet to obtain medical, rehabilitation, or health information (odds ratio=5.8, p=0.028). CONCLUSIONS: Improving CBR workers' access to the Internet and their proficiency in using it may enable them to obtain valuable rehabilitation-related information and enhance communication among CBR workers, potentially translating into improved rehabilitation services for people with disabilities in LMICs.