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Background and Objectives: The relevance of red flags in serious spinal pathology (SSP) has evolved throughout the last years. Recently, new considerations have been proposed to expand the consideration of red flags. The purpose of this study was to determine, approve and test a model for the triage and management process of SSPs based on the latest data available in the literature. Materials and Methods: The SSP model was initially built on the basis of a literature review. The model was further determined and approved by an expert panel using a Delphi process. Finally, clinical scenarios were used to test the applicability of the model. Results: After three rounds of the Delphi process, panellists reached a consensus on a final version of the model. The use of clinical scenarios by experts brought about reflexive elements both for the determined model and for the SSPs depicted in the clinical cases. Conclusions: The validation of the model and its implementation in the clinical field could help assess the skills of first-line practitioners managing spinal pain patients. To this end, the development of additional clinical scenarios fitting the determined model should be further considered.
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Dor Lombar , Humanos , Triagem , Técnica Delphi , Coluna VertebralRESUMO
Introduction: The current medical shortage and increasing healthcare needs lead to the overcrowding of primary care services. In an effort to cope with this, task sharing models of care have been implemented between healthcare professionals. Varied terms are used to describe these models. In France, "cooperation protocol" pathways have been established between general practitioners and physiotherapists. Objective: The aim of this narrative review is to define the terms used to describe models of task sharing involving physiotherapists for musculoskeletal care and to describe these models and their impact in order to suggest evolution prospects of French experimentations. Results: Delegation, task shifting, substitution, supplementation and advanced practice terms were found in the literature. A clear distinction is suggested between substitution and supplementation. Advanced practice physiotherapy is internationally defined and recognized. Advanced practice physiotherapy models of care seem to improve care access and quality of care without increasing costs. In France, two cooperation protocols have been implemented between general practitioners and physiotherapists for musculoskeletal disorders. Regarding the obstacles to their deployment, these models could evolve considering the international and formally defined framework of advanced practice physiotherapy. Conclusions: Task sharing models of care involving physiotherapists could be promising strategies to improve access to care for patients with musculoskeletal disorders. Further studies are needed to better define the models, their objectives and to evaluate their impact in the French context.
Introduction: L'engorgement des services de soins primaires et l'augmentation de la demande de soins conduisent à des difficultés croissantes d'accès aux soins de premier recours pour les patients souffrant de troubles musculosquelettiques. Pour y faire face, plusieurs modèles de partage de tâches entre les professionnels de santé sont mis en place. Dans la littérature, différentes notions sont employées pour décrire ces modèles. En France, ces expérimentations peuvent prendre la forme de « protocoles de coopération ¼ établis entre les médecins généralistes et les kinésithérapeutes. Objectif: Cette revue narrative vise à définir les notions employées pour décrire les modèles de partage de tâches impliquant les kinésithérapeutes dans la prise en charge des troubles musculosquelettiques à l'international, puis à décrire ces modèles et leur impact pour aboutir à des perspectives d'évolution des expérimentations françaises. Résultats: Les notions de « délégation ¼, de « transfert ¼, de « substitution ¼, de « supplémentation ¼ et de « pratique avancée ¼ sont employées dans la littérature. À la différence des termes « délégation ¼ et « transfert ¼, une distinction claire est retrouvée entre la substitution et la supplémentation. La pratique avancée en kinésithérapie est quant à elle, définie et reconnue à l'international. Elle permettrait d'améliorer l'accès et la qualité des soins, sans augmentation des coûts. En France, deux protocoles nationaux de coopération entre les médecins généralistes et les kinésithérapeutes existent pour les troubles musculo-squelettiques. En tenant compte des freins à leur déploiement rencontrés sur le terrain, ces modèles gagneraient à être repensés en s'inspirant du cadre international de la pratique avancée en kinésithérapie. Conclusions: Les modèles de partage de tâches impliquant les kinésithérapeutes en soins primaires semblent être des leviers d'amélioration de l'accès aux soins pour les patients souffrant de troubles musculosquelettiques. Davantage d'études permettant de mieux définir les modèles, leurs objectifs et d'en évaluer l'efficacité dans le contexte français restent nécessaires.
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Clínicos Gerais , Doenças Musculoesqueléticas , Fisioterapeutas , Humanos , Atenção à Saúde , Doenças Musculoesqueléticas/terapia , Modalidades de Fisioterapia , Atenção Primária à SaúdeRESUMO
BACKGROUND: Unaccompanied refugee minors (URMs) are a population at risk of mental health problems and a population with whom the therapeutic alliance can be difficult to set up. The therapeutic alliance's quality can impact the result and effectiveness of psychotherapeutic interventions. The aim of the present study was to gather URMs' points of view about mental health services and mental health professionals (MHP) in the host country. A summary of interviews conducted with URMs will allow a better understanding of their perception and expectations. METHODS: Seven databases were searched with English and French keywords. In the end, nine studies were selected. RESULTS: The review of the interviews shows that URMs do not have a clear perception of MHP - it seems difficult for them to trust MHP, but also to understand the value of sharing past painful experiences to reduce current symptoms. They can have a negative perception of mental health and consider that this is not a priority. URMs prefer to focus on day-to-day problems, do activity-based interventions and do group sessions to value social interactions. CONCLUSIONS: Clinical and methodological implications are discussed. The development of an instrument to evaluate therapeutic care for URMs could be interesting for future research and for clinicians.
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Serviços de Saúde Mental , Refugiados , Humanos , Saúde Mental , Menores de Idade/psicologia , Percepção , Refugiados/psicologiaRESUMO
INTRODUCTION: The objectives of this work were: 1) to develop and validate a questionnaire to understand several dimensions of the use of CAM practitioners in France and 2) to evaluate the test-retest reliability of each of its items. PURPOSE OF RESEARCH: Development and validation (face validity): A questionnaire was created and then analyzed by 7 experts, including 3 social scientists. Before finalization, the questionnaire was tested on a sample of 43 individuals via cognitive interviews. Test-retest reliability: 322 individuals completed the questionnaire twice (at least 9 days apart). The reliability of the 107 categorical variables that compose the questionnaire was assessed by unweighted Gwet's AC1 coefficient. RESULTS: A short and clear questionnaire, suitable for collecting the targeted information, was methodically developed. In total, excluding descriptive items characterizing the population, the questionnaire includes 114 items, 107 of which are closed and 7 open. 107 of these items are conditional. The average filling time was less than 3 minutes. Of the 107 categorical items, 1 item was associated with moderate test-retest reliability, 9 items with good reliability and 97 with very good reliability. CONCLUSION: A reliable and valid questionnaire to evaluate the use of CAM practitioners in France is available. It may allow the collection of data necessary to assess the public health issue that this phenomenon represents.
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INTRODUCTION: The objectives of this work were: 1) to develop and validate a questionnaire to understand several dimensions of the use of CAM practitioners in France and 2) to evaluate the test-retest reliability of each of its items.Purpose of research: Development and validation (face validity): A questionnaire was created and then analyzed by 7 experts, including 3 social scientists. Before finalization, the questionnaire was tested on a sample of 43 individuals via cognitive interviews. Test-retest reliability: 322 individuals completed the questionnaire twice (at least 9 days apart). The reliability of the 107 categorical variables that compose the questionnaire was assessed by unweighted Gwet's AC1 coefficient. RESULTS: A short and clear questionnaire, suitable for collecting the targeted information, was methodically developed. In total, excluding descriptive items characterizing the population, the questionnaire includes 114 items, 107 of which are closed and 7 open. 107 of these items are conditional. The average filling time was less than 3 minutes. Of the 107 categorical items, 1 item was associated with moderate test-retest reliability, 9 items with good reliability and 97 with very good reliability. CONCLUSION: A reliable and valid questionnaire to evaluate the use of CAM practitioners in France is available. It may allow the collection of data necessary to assess the public health issue that this phenomenon represents.
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Terapias Complementares/normas , Psicometria/normas , Inquéritos e Questionários/normas , Terapias Complementares/métodos , França , Humanos , Psicometria/métodos , Reprodutibilidade dos TestesRESUMO
BACKGROUND: In 2010, the World Health Organization published benchmarks for training in osteopathy in which osteopathic visceral techniques are included. The purpose of this study was to identify and critically appraise the scientific literature concerning the reliability of diagnosis and the clinical efficacy of techniques used in visceral osteopathy. METHODS: Databases MEDLINE, OSTMED.DR, the Cochrane Library, Osteopathic Research Web, Google Scholar, Journal of American Osteopathic Association (JAOA) website, International Journal of Osteopathic Medicine (IJOM) website, and the catalog of Académie d'ostéopathie de France website were searched through December 2017. Only inter-rater reliability studies including at least two raters or the intra-rater reliability studies including at least two assessments by the same rater were included. For efficacy studies, only randomized-controlled-trials (RCT) or crossover studies on unhealthy subjects (any condition, duration and outcome) were included. Risk of bias was determined using a modified version of the quality appraisal tool for studies of diagnostic reliability (QAREL) in reliability studies. For the efficacy studies, the Cochrane risk of bias tool was used to assess their methodological design. Two authors performed data extraction and analysis. RESULTS: Eight reliability studies and six efficacy studies were included. The analysis of reliability studies shows that the diagnostic techniques used in visceral osteopathy are unreliable. Regarding efficacy studies, the least biased study shows no significant difference for the main outcome. The main risks of bias found in the included studies were due to the absence of blinding of the examiners, an unsuitable statistical method or an absence of primary study outcome. CONCLUSIONS: The results of the systematic review lead us to conclude that well-conducted and sound evidence on the reliability and the efficacy of techniques in visceral osteopathy is absent. TRIAL REGISTRATION: The review is registered PROSPERO 12th of December 2016. Registration number is CRD4201605286 .
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Medicina Osteopática/normas , Bases de Dados Bibliográficas , Humanos , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/terapia , Medicina Osteopática/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
Unaccompanied refugee minors (URMs) are a population at risk for developing mental problems, post-traumatic stress disorder, anxiety, and/or depression. Therapists working with URMs often have to overcome language and cultural barriers, while taking into account these young people's specific needs. A growing literature describes a wide range of interventions designed to reduce psychopathologies and improve well-being. We summarized the different interventions used with URMs to get an overview of techniques used for reducing psychopathologies and difficulties of URMs and to give recommendations to help professionals. We searched eight databases for articles and books, imposing no restrictions on publication date or geographical region, and using English and French keywords. We included all studies (RCTs, case series, case study) that assessed an intervention with one or more URMs. Seventeen studies, reported in papers or book chapters, met the criteria for inclusion in our analysis. Only one RCT has been conducted with URMs but because of small sample size we cannot conclude on its efficacy. Other studies are case series or case studies and because of their study design, we cannot conclude whether one intervention is superior to others. Further research, with higher level of evidence, is needed to determine which types of intervention are most effective when working with URMs.
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Menores de Idade/psicologia , Processos Psicoterapêuticos , Refugiados/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Adolescente , HumanosRESUMO
OBJECTIVES: To analyze a clip from the program ? Acupuncture, osteopathy, hypnosis: do complementary medicines have superpowers ? about acupuncture as an anesthetic for surgical procedures in China. To propose a rational explanation for the phenomena observed. To describe the processes leading a public service broadcasting channel to offer this type of content at prime time and the potential consequences in terms of public health. METHOD: Analysis using critical thinking attitudes and skills, along with a bibliographical search of Medline, Google Scholar and Cochrane Library databases. RESULTS: The information delivered in the television clip is ambiguous. It does not allow the viewer to form an informed opinion on the relevance of acupuncture as an anesthetic for surgical procedures. It is reasonable to assume that the clip shows surgery performed with undisclosed epidural anesthesia coupled with mild intravenous anesthesia, sometimes performed in other countries. What needs to be highlighted here is the overestimation of acupuncture added to the protocol. The media tend to exaggerate the risks and expected effects of the treatments they report on, which can lead patients to turn to unproven therapies. CONCLUSION: Broadcasting such a clip at prime time underlines the urgent need for the public and all health professionals to be trained in sorting and critically analyzing health information.
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Analgesia por Acupuntura , Procedimentos Cirúrgicos Cardíacos , França , Humanos , TelevisãoRESUMO
BACKGROUND: Physiotherapists working in collaboration with family physicians in French multidisciplinary primary healthcare clinics are now able to manage acute low back pain patients as first-contact practitioners in advanced practice roles. This includes medical act delegation such as making a medical diagnosis and prescribing medication. The aim of this study is to explore patients' experience and perceptions when attending a first-contact physiotherapist (FCP) in an advanced practice collaborative primary care model for acute low back pain (LBP). METHODS: A qualitative study using semi-structured interviews was conducted. Patients that consulted a FCP for acute LBP care in new collaborative model were included. Interviews were transcribed verbatim and inductive thematic analysis was performed to generate themes related to patients' experience and perceptions. RESULTS: Ten patients were interviewed (3 women, 7 men; mean age 36.5 ± 9.63 years). All LBP participants experienced important level of pain and disability. Four overarching themes related to patients' experience with the new FCP model were formalized: 1) "Going to see a physiotherapist who specializes in painful movements, well that makes sense to me", 2) "Physiotherapist offered to give me exercises to do at home to relieve the back pain", 3) "I went there feeling confident", 4) "The physiotherapist can do more than just send you to see more appropriate people". Participants highlighted the need to receive timely and high-quality care and were receptive with being autonomously managed by a FCP. Overall, patients' experiences with FCP model of care were positive. Participants were highly confident in the FCP's ability to perform delegated medical tasks including making a medical diagnosis and prescribing oral medication such as analgesic drugs. Patients felt that a greater expansion of FCPs' scope of practice was needed to improve the model. CONCLUSION: Findings from this study can inform the implementation of FCP in countries where patients are not typically granted FCP by underlining that patients are favourable towards the advance practice model as such models support timely and high-quality care. Further research is needed to better determine the future advance practice physiotherapists' scope of practice in French primary and secondary care settings.
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Dor Lombar , Médicos , Masculino , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Dor Lombar/terapia , Dor Lombar/diagnóstico , Confiança , Modalidades de Fisioterapia , Atenção Primária à SaúdeRESUMO
Background: A new advanced practice model of care enables French physiotherapists to perform medical acts for low back pain (LBP) patients as first-contact physiotherapists (FCPs). Objective: The aim of this study is to determine the self-perceived competency of FCPs and to further explore factors underpinning this feeling. Methods: A mixed-methods explanatory sequential design was conducted. A survey was used to self-assess the perceived competency of FCPs in performing medical tasks. Semi-structured interviews were then performed to explore determining factors of perceived competency. Inductive thematic analysis was performed. Results: Nine FCPs answered the survey and were interviewed (mean age 40.1, standard deviation [SD]: ±10.0). FCPs felt very competent with making medical diagnosis (3.44/4, SD: ±0.53), analgesic prescription (3.11, SD: ±0.78) and referring onward to physiotherapy (3.78, SD: ±0.55). They did not feel competent with nonsteroidal anti-inflammatory drug prescription (2.78, SD: ±0.67) and issuing sick leave certificate (2.67, SD: ±1.0). The main identified influencing factors were previous FCPs' experience, training, knowledge, collaboration with family physicians, high responsibility and risk management associated with decision-making. Conclusion: French FCPs appeared to have the necessary skills to directly manage LBP patients without medical referral. Future training focusing on analgesic prescription and issuing sick leave certificate is however needed.