How do Employees with Chronic Musculoskeletal Disorders Experience the Management of Their Condition in the Workplace? A Metasynthesis.

This metasynthesis contributes to an understanding of the experiences, perceptions, and attitudes of employees on managing chronic musculoskeletal disorders (CMSDs) at work. Many studies in this field are concerned with prevention or return-to-work (RTW) programmes. However, the purpose of this review was to synthesise evidence that only focuses on the employees' management of their CMSDs at work. The SPIDER framework was used to structure the question "How do employees with CMSDs experience the management of their condition in the workplace"? The literature search focused on articles published between 2011 and 2021, and the search was conducted using the following databases: MEDLINE, SCOPUS, CINAHL, AMED, PsycINFO. The review identified nine articles that explored employees' experiences of managing CMSDs at work. Thematic synthesis was used to create analytic themes which provided a more in-depth discussion of these experiences. The identified themes were: 'employees actively seek ways to manage their conditions', 'influence of work environment on employees with CMSDs' and 'optimising the relationship between employees and managers. This metasynthesis suggests that the ability to negotiate workplace support and manage CMSDs at work is influenced by the cultural and social environment of the organisation. Effective communication, care and trust between the employee is needed. The review also illustrated the need for healthcare professionals to provide support to employees at work.

The concept of integration in mixed methods research: a step-by-step guide using an example study in physiotherapy.

BACKGROUND: Integration is a unique attribute of Mixed Methods Research (MMR). However, some MMR studies, published in the field of physiotherapy and other allied health professions, have illustrated a lack of understanding of the concept of integration. AIMS: The purpose of this paper is to provide guidance for integrating elements of mixed methods research in order to effectively support evidence-based practice in health. METHODS: The concept of integration of findings is explained with reference to the author's recent PhD study, which used a mixed methods exploratory sequential design. This article describes how the author used a narrative joint display to integrate findings from both the qualitative and survey phases of the study. Then, a step-by-step approach is introduced to guide the interpretation and integration of the findings. RESULTS: This four-step approach demonstrates integration of the two different datasets: Creating a joint display, linking activity, establishing relationships, and interpreting and reporting. Tables and Figures are used to support detailed description and illustration of the integration process. DISCUSSION: A joint display provides a visual representation of how the qualitative and quantitative findings in a MMR study can be integrated. In this way, interpretation of the data drawn from this process extend beyond the individual findings of each study component to facilitate a greater understanding of complex health care issues.

Management of Chronic Musculoskeletal Disorders in the Workplace from the Perspective of Older Employees: A Mixed Methods Research Study.

(1) Background: This mixed methods research (MMR) study explored older employees' experiences of chronic musculoskeletal disorders (CMSDs) in relation to their employment, their perspectives on managing these conditions in the workplace and the strategies used to facilitate and maintain their roles and responsibilities. The services offered to them were also identified. (2) Methods: A mixed methods exploratory sequential design was implemented. In the first qualitative phase, 16 semi-structured interviews gathered in-depth information from older employees. The findings informed the development of an online questionnaire in the survey phase, which was administered to older employees (N = 107). Both sets of findings were then integrated using a narrative joint display. (3) Results: The phenomena of presenteeism and leaveism were important components of employees' strategies for managing their condition. The integrated findings highlighted the roles of employers, managers and social support in encouraging disclosure and supporting the management of CMSDs. The results also emphasised how self-management and professional health services are crucial for sustaining employability. (4) Conclusions: Current challenges call for employers to identify effective ways to support the ageing workforce and invest in training opportunities for managers and collaborative opportunities with healthcare professionals and other stakeholders. A flexible, empathetic and resourceful work environment is optimal for supporting sustained employability for an ageing workforce.

The experience of carers of children with cerebral palsy living in rural areas of Ghana who have received no rehabilitation services: A qualitative study.

AIM: This study aims to explore the experiences of carers of children with cerebral palsy living in rural areas of Ghana who have received no rehabilitation services. BACKGROUND: Cerebral palsy is the most common chronic disability from childhood, which needs lifelong rehabilitation. Most of the population living in rural communities in Ghana have virtually no form of rehabilitation services for their chronic disabling conditions. Caring for children with disability are known to be challenging especially when coupled with environmental challenges in rural communities. RESULTS: Purposive and snowball techniques were used to recruit 12 carers, age 22 to 68 years, of children with cerebral palsy aged 7 to 15 years. Two main themes, developing personal beliefs to support the caregiving role and the demands that shape the experience of caring, emerged from six subthemes and 25 theme clusters of the narratives of the carers. The essential structure of the phenomenon demonstrated the complex interaction of personal and environmental factors in harmony with the actual demands to influence the experiences of participants positively or negatively. Positively, carers achieved coping, committed to caring, hoped for the future, and accepted the condition. However, negatively, carers described the triggering factors of feeling of despair and sorrow as frustration and lack of understanding of the condition, felt stigmatized, and perceived the child was going through pain and suffering. CONCLUSIONS: Carers derived strength from their religious and spiritual beliefs to balance the demands of caregiving. Findings could be used as basis for developing interventions to support carers and inform new strategies for rehabilitation service and sensitization of community members about inclusion of children with disabilities.

Physical activity experiences in children post-liver transplant: Developing a foundation for rehabilitation interventions.

Physical Activity (PA) plays an important role in the physical and psychosocial health of children and is beneficial in the treatment and prevention of comorbidities associated with transplantation. Despite this, PA participation in pediatric liver transplant recipients remains low compared to healthy peers. This qualitative-focused mixed-methods study explored the PA experiences and parental perception of these experiences, including perceived facilitators and barriers to PA in children post-liver transplant. Eighteen participants (9 children [median age 10.8 years] and 9 parents) took part in semi-structured interviews and completed the PedsQL Multidimensional Fatigue Scale and PAQ. Most children reported they were physically active (PAQ median 3.08 [IQR] 2.60-3.51), participating in PA for its enjoyment, regardless of their level of motor proficiency. Levels of fatigue (median 65.28 [IQR] 56.25-90.97) were higher than healthy norms and impacted PA participation in some children. Children and parents perceived PA as central to post-transplant recovery and valued its social and mental health benefits; however, parents struggled with ongoing uncertainty and perceived physical vulnerability of their child. This study indicates the need for continuing PA support and education and provides valuable information for family-centered interventions to increase PA and improve health outcomes in children post-transplant.

Learning Experiences and Strategies of Parents of Young Children with Developmental Disabilities: Implications for Rehabilitation Professionals.

AIM: To better understand the learning experiences of parents of children with developmental disabilities and the strategies they develop to support their caregiving role. METHODS: A qualitative secondary analysis of in-depth interviews with parents of children with developmental disability was conducted to better understand parents' learning experiences and the strategies they developed to use this learning in supporting their children. A foundational thematic analysis process was used to identify the main themes, and the interpretive process was influenced by adult education theories. RESULTS: Findings suggest that participants are highly motivated to learn by a need to understand, to do, and to belong. They also demonstrated varying levels of cognitive, affective, and psychomotor learning. Learning style preferences are evident in participants' narratives and in their self-reported learning strategies. CONCLUSIONS: Conceptualizing parents, as adult learners, can be helpful in designing clinical interactions and education initiatives. Knowledge of adult learning principles may enable pediatric therapists to better meet the needs of parents and fulfill their information sharing responsibilities.

Using different methods to communicate: how adults with severe acquired communication difficulties make decisions about the communication methods they use and how they experience them.

PURPOSE: This study aimed to explore how adults with severe acquired communication difficulties experience and make decisions about the communication methods they use. The primary objectives were to explore their perceptions of different communication methods, how they choose communication methods to use in different situations and with different communication partners, and what facilitates their decision-making. METHOD: A qualitative phenomenological approach was used. Data collection methods were face-to-face video-recorded interviews using each participant's choice of communication method and e-mail interviews. The methodological challenges of involving participants with severe acquired communication disorders in research were addressed in the study design. Seven participants, all men, were recruited from a long-term care setting in a rehabilitation hospital. The data analysis process was guided by Colaizzi's (1978) analytic framework. RESULTS: Four main themes were identified: communicating in the digital age ­ e-mail and social media, encountering frustrations in using communication technologies, role and identity changes and the influences of communication technology and seeking a functional interaction using communication technologies. CONCLUSION: Adults with acquired communication difficulties find digital communication, such as e-mail and social media, and mainstream technologies, such as iPads, beneficial in communicating with others. Current communication technologies present a number of challenges for adults with disabilities and are limited in their communicative functions to support desired interactions. The implications for AAC technology development and speech and language therapy service delivery are addressed.

An Evaluation of a Pilot Protected Mealtime Program in a Canadian Hospital.

The study evaluated the impact of a pilot "protected mealtime" program on meal experience and care of hospitalized acute care patients. A 4-month pilot protected mealtime program was implemented on a 35-bed acute, older adult ward. A pre- and post-observational audit was implemented to examine interruptions during lunch, food intake, hand hygiene, and positioning practices on the ward. A staff questionnaire was administered to gain the opinions of health care team members about the protected mealtime program. The observational audit showed a significant decrease in the number of total interruptions (Z = -2.496, P = 0.013, r = -0.42). Hand hygiene practices improved and no effect was found on mealtime patient positioning at mealtimes. Staff questionnaire responses indicated positive changes to the patients' mealtime experiences. The protected mealtime program appeared to improve patient mealtime experiences and patient care. Enabling patients to eat their meals uninterrupted will assist in ensuring that patients in hospital are adequately nourished.

Mirror visual feedback for phantom pain: international experience on modalities and adverse effects discussed by an expert panel: a delphi study.

BACKGROUND: Mirror visual feedback (mirror therapy) is practiced worldwide in very different ways to alleviate phantom pain; no study has compared these variations yet or researched the associated risk and harm. OBJECTIVES: To establish use and justification of a generally accepted mirror visual feedback treatment plan after amputation; to explore the occurrence and handling of adverse effects; and to increase knowledge about contributing factors. METHODS: Experiential knowledge of 13 experienced practitioners from 6 countries and 5 professions was explored with a 3-round Delphi technique. RESULTS: Experience with the use of 5 different treatment plans was described, of which 1 has never been mentioned in the literature: an intense 1-off plan in which the illusion was carefully set up before the patient was left to the experience with no interference, resolving pain as well as adverse effects. In the 4 known treatment plans, the expectations of response time varied, which influenced the definition of responders/nonresponders; the set-ups, control, and use of material reflected the professional background of the practitioners. Contraindications also were defined according to the professional confidence to deal with the adverse effects. Adverse effects were reported, including emotional reactions, pain increase, sensory changes, freezing of the phantom limb, dizziness, and sweating. The attitude toward, and the handling of, adverse effects varied in patients as in practitioners according to their professional background. A tool to fine tune the experience was reported with covering of the limb during therapy. Full consensus was reached on several treatment modalities. CONCLUSION: Analysis of the results suggests that the different treatment plans suit different patients and practitioners. Matching these could enhance effectiveness and compliance. Knowledge about adverse effects needs to inform treatment decisions. These findings triggered the development of a mirror visual feedback gateway to guide patients to the treatment plan for their needs, and to collect data from the practitioners to enhance neuroscientific understanding and inform practice.

Perceptions of parents of children with cerebral palsy about the relevance of, and adherence to, exercise programs: a qualitative study.

PURPOSE: The purpose of this study was to explore how parents of children with cerebral palsy, attending mainstream primary schools, perceive the relevance of, and adherence with, exercise programs. METHODS: A qualitative research with constructivist approach was used. Semi-structured interviews were conducted with parents. Open-ended questions related to their role in supporting the child's recommended exercise program. A thematic analysis approach was used to generate three main themes. FINDINGS: The themes were: exercise program management and delivery, perceived feelings and personal responses, and external impact and support. CONCLUSION: Exercise programs, to be implemented by families at home and support workers in school, are often characterized as prescriptive and focused on the child's impairment. These need to be integrated into a more holistic approach that considers family and child preferences. If this is to be achieved, parents' perspectives must play a legitimate part in evaluating the effectiveness of practice.

Bringing Masters' level skills to the clinical setting: what is the experience like for graduates of the Master of Science in manual therapy programme?

INTRODUCTION: The nursing profession has been influential in conducting research to investigate the effect of continuing education programs on clinical practice. This research has indicated positive gains in competencies and behaviors, such as, becoming more research positive and dynamic as practitioners. There is, however, a dearth of studies investigating the clinical impact of Masters degrees in the physiotherapy profession. PURPOSE: The purpose of this study was to explore physiotherapists' experiences of change and/or development in their clinical practice after successfully completing a Masters in manual therapy degree. STUDY DESIGN AND METHODOLOGY: An exploratory qualitative, specifically phenomenological, approach was used. Semi-structured telephone interviews were conducted with seven Masters degree graduates, audio-taped, and transcribed. A foundational thematic analysis approach was used to analyze the data. FINDINGS: Four main themes were identified: (1) precision thinking--an ability to integrate new skills and knowledge, so that care was patient-centered and based on available research evidence. (2) Clinical outputs--development of "ingenuity" in delivering efficient clinical practice. (3) Professional outputs--assuming an enhanced professional role (role model, education resource, and lifelong learner) in the workplace and acknowledging personal development. (4) Expectations--reviewing the relevance of pre-course expectations. CONCLUSIONS: This study provided evidence for the applicability to practice of the knowledge and skills gained in Masters education and suggested that the participants experienced substantial positive change across a broad spectrum of professional and personal issues.

Recent experiences and challenges of military physiotherapists deployed to afghanistan: a qualitative study.

PURPOSE: Military physiotherapists in the Canadian Forces meet the unique rehabilitation needs of military personnel. Recently, the physiotherapy officer role has evolved in response to the Canadian Forces' involvement in the combat theatre of operations of Afghanistan, and this has created new and unique challenges and demands. The purpose of this study was to describe the experiences and challenges of military physiotherapists deployed to Afghanistan. METHODS: A qualitative research design guided by descriptive phenomenology involved recruitment of key informants and in-depth interviews as the data collection method. The interviews were transcribed verbatim and the data analyzed using a foundational thematic analysis approach. Strategies of peer review and member checking were incorporated into the study design. RESULTS: Six military physiotherapists were interviewed. They described rewarding experiences that were stressful yet highly career-satisfying. Main challenges revolved around heavy workloads, an expanded scope of practice as sole-charge practitioners, and the consequences and criticality of their clinical decisions. CONCLUSIONS: Our findings suggest that enhanced pre-deployment training and the implementation of a stronger support network will improve the capabilities of military physiotherapists deployed to difficult theatres of operations. This type of systematic and comprehensive research is needed to assist the Canadian Forces in proactively preparing and supporting physiotherapists deployed on future missions.

Moral distress in physical therapy practice.

The purpose of this article is to discuss the theoretical concept of moral distress in the context of current physical therapy practice and ethics knowledge and differentiate it from emotional distress and burnout. Moral distress, largely discussed in nursing, is a theoretical concept that has the potential to elucidate the experiences of physical therapists delivering direct care to patients in complex health care situations and to contribute to physical therapy ethics knowledge and education. It focuses attention on the role of moral agent and the ethical dimensions of practice, offers a basis for dialogue among health professionals, and promotes analysis of the impact of the organizational environment on practice. The article concludes by suggesting how an understanding of the concept of moral distress might inform existing physical therapy ethical decision-making models and future research directions by which the experience of moral distress in physical therapy might be explored.

Non-entropic and reversible long-range deformation of an encapsulating bioelastomer.

Encapsulation is a widespread biological process particularly in the formation of protective egg cases of oviparous animals. The egg capsule wall of the channelled whelk Busycon canaliculum is an effective shock absorber with high reversible extensibility and a stiffness that changes significantly during extension. Here we show that post-stretch recovery in egg capsules is not driven by entropic forces as it is in rubber. Indeed, at fixed strain, force decreases linearly with increasing temperature, whereas in rubber elasticity the force increases. Instead, capsule wall recovery is associated with the internal energy arising from the facile and reversible structural alpha-helix <--> beta-sheet transition of egg capsule proteins during extension. This behaviour is extraordinary in the magnitude of energy dissipated and speed of recovery and is reminiscent of strain-induced crystallization in some polymeric fibres and of superelastic deformations associated with diffusionless phase transitions in shape-memory alloys.

Employment after spinal cord injury: the impact of government policies in Canada.

The British Columbia Paraplegic Association (BCPA) sought a research partnership to evaluate where its activities should be focused. A survey of members with disabilities of the BCPA included questions on employment and identified three priorities related to employment. These were the need for assistance in finding appropriate work, the impact of policies of government and insurance agencies, and attitudes of employers. This paper examines the social and political environment related to employment following spinal cord injury in British Columbia, Canada. There is no coherent set of goals underlying government employment and income programs in Canada. Incremental development of particular employment and income programs during the 20th century led to a patchwork of policies and programs, which deal with people differently according to the cause of their disability. Federal and provincial governments have attempted to educate employers and reduce barriers to employment of those with disabilities by focusing on anti-discrimination legislation and individual rights (e.g. the Employment Equity Act and the Canadian Human Rights Act). However, people with disabilities face non-accommodating environments, inadequate income support, lack of opportunities and little political influence which stem from an unfair distribution of societal resources, not from discrimination. Joint efforts of the BCPA and other disability organizations are likely to have the most impact on legislative changes.

Community participation after spinal cord injury.

OBJECTIVES: To describe participation among a community-based sample of adults with spinal cord injury (SCI) and to explore the relationship between participation and life satisfaction. DESIGN: Survey. SETTING: Community. PARTICIPANTS: A sample of 357 people (response rate, 44%) with SCI recruited through the British Columbia Paraplegic Association. The mean age +/- standard deviation was 46.0+/-14.7 years, mean time since SCI was 13.0+/-11.0 years, and 68% of the respondents were men. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Descriptive survey data on community participation specifically related to social involvement, physical activity and relationship with others, transportation, and community access. Life satisfaction and happiness assessed using the Satisfaction With Life Scale and Happiness Scale. RESULTS: No limitations to participation were experienced by 18.5% of the respondents. Satisfaction with transportation was associated with owning one's own vehicle (P<.001). There was overall satisfaction with access to community buildings (mean score range, 6.9-8.5; where 10 is most satisfied). Being physically active was important to a majority and 75% were currently engaged in physical activity. Those living alone were less satisfied (mean, 7.3+/-2.7; where 10 is most satisfied) with the support they received than those living with others (8.5+/-1.7). Respondents were generally happy (5.0+/-1.4) and satisfied with life (18.6+/-7.6). CONCLUSIONS: This study provides a rich description of the multifaceted nature of participation and its association with life satisfaction as identified by people with SCI living in the community.