[Job satisfaction and violence in the clinical relationship in Physical Therapists in Spain]. / Satisfacción laboral y violencia en la relación clínica en Fisioterapia en España.

OBJECTIVE: To assess the job satisfaction (JS) of physiotherapists in Spain and their relationship with occupational violence, as with other socio-demographic, health, and occupational factors. DESIGN: A cross-sectional study was conducted. Setting Primary, community, and hospital attention level at public and private care in Spain. PARTICIPANTS: Physiotherapists in Spain who have been working for at least 3months during the last year, and with complete answer to the required variables (n=2,590). MAIN MEASUREMENTS: Information was collected through a questionnaire distributed online. A descriptive quantitative analysis and 3 logistic regression models were performed. In the first model, sociodemographic and violence variables were included as independent variables, in the second, health-related variables, and in the third, occupational variables. RESULTS: The average JS of physiotherapists is 7.26 points, being 8 or more in 46.8% of the cases, with a higher percentage in men". Referring not having suffered psychological violence was related to a higher probability of having JS, even controlling for the rest of the variables studied (OR1=0.485; OR2=0.611; OR3=0.697, respectively for each model). Variables related to health (state of health, symptoms, consumption of tobacco/alcohol/other substances) and to the work environment (working day, work area, autonomy, relationship with superiors/colleagues) were statistically significantly related to JS. CONCLUSIONS: Almost 47% of the respondents had very high JS values. Certain areas of work as well as positive health factors have been linked to very high JS. Psychological violence is the form of violence that, independently of the other factors analysed, leads to lower JS.

Prevalence and associated factors of sexual, psychological, and physical violence among physical therapists in their clinical role in Spain: a national web-based cross-sectional survey.

OBJECTIVES: To determine the extent of career-long and 12-month exposure to sexual, physical, and psychological/verbal violence committed by patients or their companions among physical therapists in Spain. Additionally, to identify the factors associated with such exposure. METHODS: This study employed an observational cross-sectional approach. Initially, a questionnaire was developed and validated using a convenience sample. Subsequently, it was distributed via email to all physical therapists registered in Spain in the first quarter of 2022. Individual risk models were created for each type of violence experienced within the past 12 months. RESULTS: The prevalence of violence encountered by physical therapists throughout their careers was 47.9% for sexual violence, 42.7% for psychological/verbal abuse, and 17.6% for physical abuse. Lower values were observed within the last 12 months (13.4%, 15.8%, and 5.2%, respectively). Statistical risk modeling for each type of violence experienced in the past 12 months indicated that the common precipitating factor for all forms of violence was working with patients with cognitive impairment. Working part-time appeared to be a protective factor. Other factors, such as the practitioners' gender, practice setting, or clinic location showed variations among the diverse types of violence. CONCLUSIONS: The exposure to type II workplace violence within the last 12 months among physical therapists in Spain (Europe) is not so high as in some other world regions. Various individual, clinical, and professional/organizational risk factors have been identified in connection with type II workplace violence. Further research is warranted to compare the violence experienced once the COVID pandemic has subsided.

[Developing a questionnaire about violence(s) suffered by professionals in the field of Physiotherapy.] / Elaboración de un cuestionario sobre violencia(s) sufrida(s) por profesionales del ámbito de la Fisioterapia.

OBJECTIVE: Violence in the health sector is a big problem and it has serious consequences. The prevalence of clinical violence suffered by Spanish physiotherapists is unknown. The objective of this paper was to create and validate a tool in order to detect cases of sexual, physical and psychological and/or verbal violence in the Spanish physiotherapists. METHODS: A questionnaire was elaborated according to the available bibliography. It was analyzed by a group of six physiotherapists in charge of the Union observation and management of violence or from Me-Too Fisio movement. Finally, a pilot test was carried out on a convenience sample of fourteen physiotherapists. RESULTS: The questionnaire obtained includes questions about the facts suffered by the professionals in this discipline, as well as the main data on the profile of the aggressor (sex, age, mental condition…), the contexts where violence is more prevalent (clinical field, size of the population where the center is located…), and the main characteristics of the professional who suffers it (sex, age, professional experience…). Moreover, information about formal and informal strategies used to deal with violence and perception of its impact, will be assessed. CONCLUSIONS: The annual use of this tool will allow the exposure of this group of professionals to be assessed specifically and, also, to assess the evolution over time of each violence separately for providing direction for successful policies and training.

OBJETIVO: La violencia en el sector sanitario es un problema importante y con graves consecuencias. Se desconoce la prevalencia de la violencia en el ámbito clínico sobre los fisioterapeutas en España. El objetivo de este trabajo fue crear y validar una herramienta para detectar casos de violencia sexual, física y psicológica y/o verbal ejercida por pacientes/acompañantes/familiares sobre la población de fisioterapeutas de España. METODOS: A partir de la bibliografía disponible, se elaboró un cuestionario que fue analizado por un grupo de seis fisioterapeutas del Consejo a cargo de la gestión y observación de la violencia sufrida por fisioterapeutas o profesionales destacadas en el movimiento Me Too Fisio. Finalmente, se realizó una prueba piloto en una muestra de conveniencia de catorce fisioterapeutas. RESULTADOS: El cuestionario obtenido incluye preguntas sobre los hechos sufridos por los/las profesionales de esta disciplina, así como los principales datos del perfil de persona agresora (sexo, edad, condición mental, etc.), el contexto en el que la violencia es más prevalente (campo laboral, tamaño del municipio, etc.) y las principales características del/de la profesional que sufre la violencia (sexo, edad, experiencia profesional, etc.). Además se recoge información sobre estrategias formales e informales utilizadas para enfrentar la violencia y la percepción de su impacto. CONCLUSIONES: Una utilización anual de esta herramienta ayudará a valorar la exposición de este grupo de profesionales de forma específica y, también, la evolución en el tiempo de cada violencia por separado, con la finalidad de establecer políticas y programas formativos exitosos.

Effects on venous flow of transcutaneous electrical stimulation, neuromuscular stimulation, and sham stimulation on soleus muscle: A randomized crossover study in healthy subjects.

BACKGROUND: Activation of venous flow has been shown with different types of electrical stimulation. The aim of this study is to compare the hemodynamic effects of transcutaneous electrical nerve stimulation (TENS), neuromuscular electrical stimulation (NMES), and sham stimulation on healthy young people. METHODS: This randomized crossover study was conducted during June 2018 in the Faculty of Physical Therapy of A Coruña (Spain). Twenty-four university students (50% male) received in a randomized order 5 Hz-TENS, NMES, and sham stimulation on soleus muscle. Flow volume (FV) and peak velocity (PV) from popliteal vein were recorded via Doppler ultrasound, and relative changes from baseline were determined. Discomfort among the 3 stimulations was also compared. RESULTS: The differences among the 3 stimulations were assessed using the ANOVA for repeated measured, the Friedman test and the Kendall tau test, according to the type of measurement to be compared. FV (mL/min) and PV (cm/s) increased significantly after NMES (percentual increase 37.2 ± 62.0%, P = .002; 264.4 ± 152.2%, P < .001, respectively) and TENS (226.2 ± 190.3%, P < .001; 202.7 ± 144.6%, P < .001, respectively). These percentual changes from basal level in hemodynamics were statistically different to those after placebo, which was ineffective enhancing hemodynamics. The improvements in FV were statistically higher with TENS than with NMES (P < .001), but there was no statistical difference in PV (P = .531). Despite NMES was applied at a significantly lower amplitude than TENS (P < .001), NMES protocol was the worst tolerated, though the differences in discomfort were not statistically significant. CONCLUSION: Both active electrical protocols but not sham stimulation increased hemodynamics in healthy people. TENS obtained higher flow volume increase from baseline than NMES, considered globally at not only in its on-time.

Is Low-Frequency Electrical Stimulation a Tool for Recovery after a Water Rescue? A Cross-Over Study with Lifeguards.

This study aimed to evaluate the degree to which transcutaneous electrical stimulation (ES) enhanced recovery following a simulated water rescue. Twenty-six lifeguards participated in this study. The rescue consisted of swimming 100 m with fins and rescue-tube: 50 m swim approach and 50 m tow-in a simulated victim. Blood lactate clearance, rated perceived effort (RPE), and muscle contractile properties were evaluated at baseline, after the water rescue, and after ES or passive-recovery control condition (PR) protocol. Tensiomiography, RPE, and blood lactate basal levels indicated equivalence between both groups. There was no change in tensiomiography from pre to post-recovery and no difference between recovery protocols. Overall-RPE, legs-RPE and arms-RPE after ES (mean ± SD; 2.7 ± 1.53, 2.65 ± 1.66, and 2.30 ± 1.84, respectively) were moderately lower than after PR (3.57 ± 2.4, 3.71 ± 2.43, and 3.29 ± 1.79, respectively) (p = 0.016, p = 0.010, p = 0.028, respectively). There was a significantly lower blood lactate level after recovery in ES than in PR (mean ± SD; 4.77 ± 1.86 mmol·L-1 vs. 6.27 ± 3.69 mmol·L-1; p = 0.045). Low-frequency ES immediately after a water rescue is an effective recovery strategy to clear out blood lactate concentration.

Bayesian Methods in the Field of Rehabilitation.

Bayesian techniques, as an alternative method of statistical analysis in rehabilitation studies, have some advantages such as handling small sample sizes, allowing incorporation of previous experience of the researchers or clinicians, being suitable for different kinds of studies, and managing highly complex models. These characteristics are important in rehabilitation research. In the present article, the Bayesian approach is displayed through three examples in previously analyzed data with traditional or frequentist methods. The studies used as examples have small sample sizes and show that the Bayesian procedures enhance the statistical information of the results. The Bayesian credibility interval includes the true value of the corresponding parameter diminishing uncertainty about the treatment effect. In addition, the Bayes factor value quantifies the evidence provided by the data in favor of the alternative hypothesis as opposed to the null hypothesis. Bayesian inference could be an interesting and adaptable alternative statistical method for physical medicine and rehabilitation applications.

Effects of transcutaneous electrical nerve stimulation via peroneal nerve or soleus muscle on venous flow: A randomized cross-over study in healthy subjects.

BACKGROUND: Transcutaneous electrical nerve stimulation (TENS) is used to prevent venous stasis and thromboembolism. However, best electrostimulation parameters have yet to be established. The aim of the study was to compare the hemodynamic effects and the participants' relative discomfort of 3 TENS sequences at the maximum tolerated intensity stimulus. METHODS: Twenty-four healthy university students (50% male) participated in a cross-over, randomized study. Each participant received 2 TENS sequences on peroneal nerve at 1 and 5 Hz, and the third one on soleus muscle at 5 Hz. Popliteal flow volume (FV) and peak velocity (PV) were measured using Doppler ultrasound and the relative change from basal values was recorded. Discomfort questionnaires -visual analogue scale (VAS) and verbal rating scale (VRS)- were also administered to compare sensations among the three applications. RESULTS: All interventions produced significant hemodynamic responses compared to baseline. Both 5 Hz applications obtained higher FV increments than 1 Hz TENS (P < .001). The muscle application resulted in the lowest PV increment (P < .001). TENS at 5 Hz on nerve location was the worst tolerated, with higher values in VRS (P = .056) and VAS (P = .11), although not significant. CONCLUSION: TENS at 5 Hz on soleus site may be the most appropriate protocol for enhancing venous return.

[Healthcare consumption due to musculoskeletal pain in fishery sector workers]. / Consumo de recursos sanitarios debido al dolor musculoesquelético en trabajadores del sector primario.

OBJECTIVE: To determine the frequency and factors associated with medicine consumption and consultations with family physicians due to musculoskeletal pain in fishery workers. METHODS: We performed a cross-sectional study (n = 929). The variables analyzed consisted of sociodemographic factors, the frequency of musculoskeletal pain, healthcare resource consumption, back pain disability (Roland-Morris) and health-related quality of life (SF-36). RESULTS: A total of 98.7% of the sample were women, with a mean age of 50.6 years. Musculoskeletal pain was reported by 66.5%, 43% were taking medication, and 64% had consulted their family physician due to musculoskeletal pain. The factors associated with medication intake in the logistic regression analysis were the number of years worked in the sector, hip-knee pain, bodily pain and physical functioning. The variables associated with physician visits were the presence of hip-knee pain, neck-back-shoulder pain, bodily pain, and social functioning. CONCLUSIONS: The variables most closely associated with resource utilization were hip-knee pain and the physical dimension of health-related quality of life, especially bodily pain.

The effect of alternating and biphasic currents on humans' wound healing: a literature review.

Although different types of currents, including bidirectional currents, have been used to promote healing, there is neither a summary about their effects nor consensus on best parameters to be used. The aim of this article is to provide an overview of current evidence on the effectiveness of bidirectional electrical stimulation on wound healing in accordance with the parameters used. Relevant articles were selected following a search of Medline, Cochrane, Embase, CINAHL, and PEDro for English, Spanish, Portuguese, Italian, or French articles published between 1980 and 2011. Ten trials and four case-series were found that deal with pressure ulcers, diabetic ulcers, venous ulcers, skin flaps, and amputation. Eight trials were of low-quality. Five of ten controlled trials found a statistically significant difference on wound healing, and another four trials found positive trends. Both of the two skin flap trials, one of two diabetic trials, and two of five pressure ulcer trials found a significant difference in bidirectional stimulated groups. Both TENS and NMES types of currents were used, but many parameters were not specified. In general, bidirectional currents appear to increase wound healing rates and reduce size of wounds, above all in skin flaps. However, there is a lack of well-designed studies on biphasic and alternating stimulation, and there is a need for improvement in description of parameters and in uniformity of nomenclature.