Management of non-specific thoracic spine pain: a cross-sectional study among physiotherapists.

BACKGROUND: The thoracic area has mainly been neglected in research compared to the lumbar and cervical regions. No clinical practice guidelines (CPGs) for non-specific thoracic spine pain (TSP) have been compiled. Therefore, it can be argued that the absence of specific CPGs raises questions about the management of non-specific TSP. Hence, this study aimed at determining the management of non-specific TSP among physiotherapists in Italy. METHODS: A web cross-sectional survey investigating physiotherapists' management of non-specific TSP was conducted. The survey instrument was divided into three sections. The first section obtained participants' characteristics. The second section determined participants' agreement with 29 statements regarding the clinical management of non-specific TSP utilising a five-point Likert scale. Participants who partially or completely agreed (scores 4-5) were considered to agree with the statements. A ≥ 70% of agreement with a statement was considered as consensus according to previous literature. The third section asked the participants to indicate how often they adopted several treatments to manage non-specific TSP with a 5-point scale (always - often - sometimes - rarely - never). The frequencies of answers were calculated, and a visual representation through a bar chart was reported. The online version of the survey instrument was delivered through the newsletter of the Italian Association of Physiotherapists and the postgraduate master's degree in Rheumatic and Musculoskeletal Rehabilitation of the University of Genova (Genova, Italy). RESULTS: In total, 424 physiotherapists (mean age (SD): 35.1 years (10.5); 50% female) completed the survey. In the second section, physiotherapists achieved consensus for 22/29 statements. Those statements addressed the importance of psychosocial factors, exercise, education, and manual therapy techniques in managing non-specific TSP. In the third section, 79.7% of participants indicated they would always adopt a multimodal treatment (education, therapeutic exercise, manual therapy), followed by education and information (72.9%), therapeutic exercise (62.0%), soft tissue manual therapy (27.1%), and manual therapy (16.5%). CONCLUSIONS: Study participants considered fundamentally using a multimodal programme based on education, exercise and manual therapy to manage non-specific TSP. This approach aligns with the CPGs for other chronic musculoskeletal pain than non-specific TSP.

Adaptation of the person centered therapeutic relationship patient version (PCTR-PT) to a version for physiotherapists (PCTR-PHYS) and evaluation of its psychometric properties.

BACKGROUND AND PURPOSE: The therapeutic relationship is a central component for developing person-centered care within physiotherapy services. However, it is necessary to understand how this relationship is perceived by both parties involved. The Person Centered Therapeutic Relationship-Patient scale (PCTR-PT) was constructed to identify patients' perceptions. No instruments are currently available to correlate patients' and physiotherapists' perceptions of the therapeutic relationship. This study sought to adapt the PCTR-PT to develop a version for physiotherapists, the Person Centered Therapeutic Relationship Scale for Physiotherapists (PCTR-PHYS) and to determine its psychometric properties. METHODS: A three-stage study was performed: (1) item generation, (2) pretesting of the questionnaire, (3) analysis of psychometric properties. Factor validity and psychometric properties were analyzed by confirmatory factor analysis (CFA). Convergent validity was calculated. Internal consistency was verified using the Cronbach's alpha coefficient. The intraclass correlation coefficient (ICC) was used to examine temporal stability. RESULTS: Thirty-three physiotherapists participated in two rounds of cognitive interviews and 343 participated in the analysis of psychometric properties. The CFA confirmed the four-structure model. Reliability of the tool was confirmed by Cronbach's alpha (α = 0.863) for all four dimensions, as all were above 0.70, ranging from 0.704 (relational bond) and 0.898 (therapeutic communication). Test-retest was performed with 2-week intervals, indicating an appropriate stability for the scale (ICC = 0.908). DISCUSSION: The Person Centered Therapeutic Relationship Scale for Physiotherapists is a useful, valid and applicable instrument to evaluate the person-centered therapeutic relationship during physiotherapy interventions. It will enable the comparison of patients' and physiotherapists' perceptions. To provide person-centered care in physiotherapy services, there is a clear need to incorporate specific resources into clinical practice to evaluate the quality of the therapeutic relationship from the perspective of both the persons being treated and the professionals providing care.

Effects of an Online Education Program on Physical Therapists' Confidence in Weight Management for People With Osteoarthritis: A Randomized Controlled Trial.

OBJECTIVE: To evaluate effects of an online education program about weight management for osteoarthritis on physical therapists' self-reported confidence in knowledge and skills in weight management and attitudes toward obesity. METHODS: In a 2-group randomized controlled trial, 80 physical therapists (58 female physical therapists) were randomized to education or control groups. The theoretically informed and evidence-informed online self-directed training program covered biopsychosocial elements of obesity and weight management. The primary outcome was self-reported confidence in knowledge in weight management using a customized validated tool (scale 14-70, higher scores indicating higher confidence) assessed at baseline and 6 weeks. Secondary measures included confidence in nutrition care, clinical skills in weight management, and weight stigma. Process measures evaluated participant experience. Differences in change between groups were compared using linear regression models adjusted for baseline scores and stratifying variables (clinical setting; confidence in weight management). Moderation analysis was performed using an interaction approach in a linear regression model and multivariable fractional polynomial interaction approach. RESULTS: A total of 79 participants (99%) completed outcome measures at 6 weeks. The education group demonstrated greater improvement in confidence in knowledge than the control group (adjusted mean difference 22.6 units, 95% confidence interval 19.6, 25.5). Greater improvement in knowledge was associated with lower baseline values (interaction P = 0.002). Secondary outcomes showed greater improvements in confidence in skills and nutrition care and in weight stigma domains favoring the education group. Over 90% of participants would recommend the program to peers. CONCLUSION: An online education program improves physical therapists' short-term confidence in knowledge and skills in weight management for people with osteoarthritis and reduces weight-stigmatized attitudes.

Physiotherapists Both Reproduce and Resist Biomedical Dominance when Working With People With Low Back Pain: A Qualitative Study Towards New Praxis.

Despite recommendations to incorporate physical and psychosocial factors when providing care for people with back pain, research suggests that physiotherapists continue to focus on biological aspects. This study investigated how interpersonal and institutional norms influence this continued enactment of the biological aspects of management. We used theoretically-driven analysis, drawing from Foucauldian notions of power, to analyse 28 ethnographic observations of consultations and seven group discussions with physiotherapists. Analysis suggested that physiotherapy training established expectations of what a physiotherapist 'should' focus on, and institutional circumstances strongly drew the attention of physiotherapists towards biological aspects. Resistance to these forces was possible when, for example, physiotherapists reflected upon their practice, used silences and pauses during consultations, and actively collaborated with patients. These circumstances facilitated use of non-biomedical management approaches. Findings may assist physiotherapists to rework the enduring normative focus on biomedical aspects of care when providing care for patients with back pain.

Physical therapists in integrated palliative care: a qualitative study.

OBJECTIVES: The purpose of this study was to explore the perceptions and experiences of physical therapists (PTs) regarding their role in palliative care (PC) when practising in nations with advanced integration of PC into mainstream healthcare. METHODS: This qualitative study included an electronic demographic survey and semistructured interview. Data analysis included descriptive statistics for demographics and the constant comparative method for interview results. RESULTS: Thirteen PTs from eight nations identified four categories of roles and responsibilities: (1) working with patients and families, (2) being an interdisciplinary team (IDT) member, (3) professional responsibilities beyond direct patient care and (4) factors influencing the role of PTs in PC. Concepts identified were shifting priorities (increased family involvement, emphasis on psychosocial aspects and differences in care philosophy), care across the continuum (accommodating changes in patient status, increasing awareness of PTs' role in varying disease states and working with the IDT) and changing perceptions about PT in PC (perceptions of PTs/others regarding PTs' role in PC and professional responsibilities of the PT in PC). CONCLUSIONS: Based on participant responses, a previously published conceptual framework by Wilson et al in 2017 was updated and included an increased emphasis on patient wishes and dignity, treating breathlessness, patient advocacy within their family and use of technology and networking. Within PC, PTs play a key role on the IDT and can improve quality of life; however, multiple barriers exist to providing PT care within PC. Further advocacy is needed from PTs and professional organisations to integrate these services.

Proximal hamstring tendinopathy; expert physiotherapists' perspectives on diagnosis, management and prevention.

OBJECTIVES: To explore and summarise expert physiotherapists' perceptions on their assessment, management and prevention of proximal hamstring tendinopathy (PHT). METHODS: We conducted semi-structured interviews with expert physiotherapists until data saturation was met (n = 13). Interviews were transcribed verbatim and data were analysed systematically and organised into categories and sub-categories according to study aims. RESULTS: Experts report using a clinical reasoning-based approach, incorporating information from the patient interview and results of clinical load-based provocation tests, in the physical examination to diagnose PHT. Experts manage the condition through education and progressive loading targeting the hamstring unit and kinetic chain, avoiding provocative activities in positions of compression in early-mid stage rehab and a gradated and controlled return to sport. Passive therapies including injection therapies and surgery were believed to have limited utility. Prevention of recurrence primarily involved continuation of hamstring and kinetic chain strengthening programs and management of physical workload. CONCLUSION: Experts rely on a combination of information from the patient interview and a battery of pain provocation tests to diagnose PHT. Education and graded exercise of the hamstring group and synergists, minimising early exposure to hip flexion, were the foundation of management of the condition.

Perceived facilitators and barriers among physical therapists and orthopedic surgeons to pre-operative home-based exercise with one exercise-only in patients eligible for knee replacement: A qualitative interview study nested in the QUADX-1 trial.

AIM: Clinical guidelines recommend non-surgical treatment before surgery is considered in patients eligible for knee replacement. Surgical treatment is provided by orthopedic surgeons and exercise therapy is provided by physical therapists. The aim of this study was to identify perceived facilitators and barriers-among orthopedic surgeons and physical therapists-towards coordinated non-surgical and surgical treatment of patients eligible for knee replacement using pre-operative home-based exercise therapy with one exercise. METHODS: This qualitative study is embedded within the QUADX-1 randomized trial that investigates a model of coordinated non-surgical and surgical treatment for patients eligible for knee replacement. Physical therapists and orthopedic surgeons working with patients with knee osteoarthritis in their daily clinical work were interviewed (one focus group and four single interviews) to explore their perceived facilitators and barriers related to pre-operative home-based exercise therapy with one exercise-only in patients eligible for knee replacement. Interviews were analyzed using thematic analysis. RESULTS: From the thematic analysis three main themes emerged: 1) Physical therapists' dilemma with one home-based exercise, 2) Orthopedic surgeons' dilemma with exercise, and 3) Coordinated non-surgical and surgical care. CONCLUSION: We found that the pre-operative exercise intervention created ambivalence in the professional role of both the physical therapists and orthopedic surgeons. The physical therapists were skeptical towards over-simplified exercise therapy. The orthopedic surgeons were skeptical towards the potential lack of (long-term) effect of exercise therapy in patients eligible for knee replacement. The consequence of these barriers and ambivalence in the professional role is important to consider when planning implementation of the model of coordinated non-surgical and surgical treatment. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02931058.

Síndrome de burnout e engajamento em profissionais de saúde: um estudo transversal / Burnout syndrome and engagement among critical care providers: a cross-sectional study

RESUMO Objetivo: Avaliar a frequência de síndrome de burnout grave em profissionais de terapia intensiva e correlacioná-la com o engajamento com o trabalho. Métodos: Foi distribuído um questionário autoaplicável que incluía o Inventário de Burnout de Maslach, a Escala de Depressão Ansiedade e Estresse e o questionário Gallup. Todas as análises foram estratificadas por local de trabalho (unidade de terapia intensiva ou unidade semi-intensiva) e por grupo profissional (enfermeiros versus médicos versus fisioterapeutas). Resultados: Entre fevereiro de 2017 e junho de 2017, 206 dos 325 profissionais convidados (63,4%) responderam aos questionários. Destes, 55 eram médicos (26,7%), 88 eram fisioterapeutas (42,7%) e 63 eram enfermeiros (30,6%). A frequência de burnout grave foi de 34,3% (27,9 - 41,4%), e não se identificaram diferenças entre os grupos profissionais ou locais de trabalho. A frequência de casos graves ou muito graves de depressão, ansiedade ou estresse foi de 12,9%, 11,4% e 10,5%, respectivamente. O escore mediano (intervalo interquartil) observado pelo questionário Gallup foi 41 (34 - 48), e não se observaram diferenças entre os grupos profissionais ou locais de trabalho. Houve correlação negativa entre burnout e engajamento com o trabalho (r = -0,148; p = 0,035). Conclusão: A frequência de burnout grave foi elevada entre os profissionais de saúde que trabalham na unidade de terapia intensiva e na unidade semi-intensiva. Existe uma correlação negativa entre burnout e engajamento com o trabalho.

ABSTRACT Objective: To evaluate the frequency of severe burnout syndrome among critical care providers and to correlate it with work engagement. Methods: A self-administered survey including the Maslach Burnout Inventory, Depression Anxiety and Stress Scales, and Gallup questionnaire was distributed. All analyses were stratified by setting (intensive care unit or step-down unit) and by professional group (nurses versus physicians versus physiotherapists). Results: Between February 2017 and June 2017, 206 out of 325 invited professionals (63.4%) answered the questionnaires. Of these, 55 were physicians (26.7%), 88 were physiotherapists (42.7%) and 63 were nurses (30.6%). The frequency of severe burnout was 34.3% (27.9 - 41.4%), and no difference was found between professional groups or settings. The frequency of severe or very severe cases of depression, anxiety or stress was 12.9%, 11.4% and 10.5%, respectively. The median (interquartile range) score observed on the Gallup questionnaire was 41 (34 - 48), and no differences were found between professional groups or settings. There was a negative correlation between burnout and work engagement (r = -0.148; p = 0.035). Conclusion: There is a high frequency of severe burnout among critical care providers working in the intensive care unit and step-down unit. There was a negative correlation between burnout and work engagement.

Riesgo ergonómico y estrés laboral de fisioterapeutas del Hospital de Clínicas, Facultad de Ciencias Médicas. Paraguay, 2019 / Ergonomic risk and work stress of physiotherapists at the clinics hospital, Faculty of medical sciences. Paraguay, 2019

Introducción: El riesgo ergonómico y el estrés laboral, además de otros aspectos impactan en la salud del trabajador, el desempeño y productividad dependen del estado de salud. Objetivos: El objetivo de la investigación es determinar el nivel de riesgo ergonómico y estrés laboral de los fisioterapeutas que ejercen funciones en el Hospital de Clínicas de la Facultad de Ciencias Médicas. Materiales y métodos: Estudio observacional, descriptivo de corte transversal, con una muestra de 49 fisioterapeutas del Hospital de Clínicas, no probabilístico por conveniencia. Resultados: de 49 profesionales, 32 son mujeres y 17 varones. El promedio de edad 36,7 ± 9,8. El promedio de la antigüedad dentro de la institución, 8 años. El 67% de los fisioterapeutas presenta nivel 4, riesgo alto y el 33% presenta un nivel 5, riesgo muy alto. En relación al nivel de estrés el 78% presenta nivel bajo. Conclusión: El riesgo ergonómico hallado se encuentra entre alto y muy alto, requiriendo una intervención inmediata para evitar lesiones musculo esqueléticas y la posterior discapacidad física para el ejercicio profesional.

Introduction: Ergonomic risk and work stress, in addition to other aspects impact on worker health, performance and productivity depend on the state of health. Objectives: The objective of this study is to determine the level of ergonomic risk and occupational stress of the physiotherapists who works at Clinicas Hospital. Materials and methods: Observational, descriptive cross-sectional study, with a sample of 49 physiotherapists, not probabilistic for convenience. Results: of 49 professionals, 32 are women and 17 are men. The average age 36.7 ± 9.8. The average of years working at the institution is 8 years. 67% of physical therapists have level 4, high risk and 33% have level 5, very high risk. Regarding the stress level, 78% have a low level. Conclusion: The ergonomic risk found is between high and very high, requiring immediate intervention to avoid musculoskeletal injuries and subsequent physical disability for professional skills.

Comparing expert opinion within the care team regarding postoperative rehabilitation protocol following rotator cuff repair.

INTRODUCTION: There is no established consensus regarding the optimal rehabilitation protocol following rotator cuff repair, including duration of immobilization, timing to initiate range of motion and resistance exercises, and the importance of supervised, formal therapy. The purpose of this study was to determine agreement in opinion regarding rotator cuff rehabilitation between orthopedic surgeons and physical therapists (PTs). METHODS: A 50-question survey was created on a secure data capture system and distributed via e-mail to members of professional organization affiliations. Surgeon participants were recruited from the American Shoulder and Elbow Surgeons, and PTs were recruited from the American Society of Shoulder and Elbow Therapists and the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. Survey responses were analyzed for interprofessional differences in majority opinion and distribution of answer choices. RESULTS: A total of 167 surgeons and 667 PTs responded to the survey. Of the 39 questions evaluated, surgeons and PTs reached intraprofessional majority agreement in 26 (67%) and 28 (72%) statements, respectively, with agreements matching in 17 instances and differing in 4. The 2 groups had different answer preferences in 32 questions (82%). PTs were more likely to support shorter immobilization intervals (P < .001), earlier strengthening (P < .001), and more frequent home exercises (P = .002), whereas surgeons endorsed more conservative weight-bearing restrictions (P < .001), time-based phase transitions (P < .001), and web-based technological platforms for rehabilitation (P < .001). CONCLUSION: Our findings show that although significant discrepancy of opinion exists within professions, greater differences in preferences exist between surgeons and PTs regarding rotator cuff repair rehabilitation.

Neonatal pain: characterization of the physiotherapist's perception in the neonatal intensive care unit / Dor neonatal: caracterização da percepção do fisioterapeuta na unidade de terapia intensiva neonatal

ABSTRACT Objective: To describe the perception of physiotherapists in neonatal units regarding pain, the use of measurement scales and strategies that minimize pain. Methods: Interviews were conducted with physiotherapists in hospitals with neonatal units between 2013 and 2015 in Rio de Janeiro. The questions concerned the knowledge of the feeling of pain, from its recognition to its care or treatment. The description of the results was done by comparing public and private hospitals (Fisher''s Exact exact Testtest), considering p<0.05 as significant. Results: 27 hospitals were visited. All the professionals interviewed (n=27) stated that the newborns feel pain, with facial expression being the most cited and known sign for pain. 26% of physiotherapists believe that newborns experience pain at the same magnitude as adults. Among the scales, the Neonatal Infant Pain Scale (NIPS) was the most well known, but only 37% of the units had routine pain assessment protocols. IV cannulation and blood collection were the most mentioned procedures as a cause of pain and there was no difference between public and private hospitals. Conclusions: There is a gap in the knowledge about neonatal pain and how to evaluate it among the participating physiotherapists, with no systematization of care routines involving this assessment.

RESUMO Objetivo: Descrever a percepção dos fisioterapeutas de unidades neonatais sobre a dor, a utilização de escalas de mensuração e estratégias que a minimizem. Métodos: Entrevistas foram realizadas com chefes ou rotinas de fisioterapia em hospitais com unidades neonatais entre 2013 e 2015, no Rio de Janeiro. As perguntas versaram sobre o conhecimento da sensação dolorosa, desde seu reconhecimento até seu cuidado ou tratamento. Foi realizada a descrição dos resultados, comparando-se os dados dos hospitais públicos com os privados (teste exato de Fisher), considerando-se p<0,05 como significante. Resultados: Vinte e sete hospitais foram visitados. Todos os profissionais entrevistados (n=27) afirmaram que os recém-nascidos sentem dor, sendo a expressão facial o sinal de dor mais conhecido. Do total de fisioterapeutas entrevistados, 26% acreditam que os neonatos sentem dor na mesma magnitude que o adulto. Entre as escalas, a Neonatal Infant Pain Scale (NIPS) era a mais conhecida, e apenas 37% das unidades possuíam protocolos de avaliação da dor na rotina. As coletas e as punções foram os procedimentos mais mencionados como causa de dor, e não houve diferença entre os hospitais públicos e privados. Conclusões: Constatou-se uma lacuna no conhecimento sobre dor neonatal e como avaliá-la entre os fisioterapeutas participantes, com ausência de sistematização de rotinas assistenciais que envolvam essa aferição.

Outpatient Physical Therapist Attitudes Toward and Behaviors in Cardiovascular Disease Screening: A National Survey.

BACKGROUND: Screening the cardiovascular system is an important and necessary component of the physical therapist examination to ensure patient safety, appropriate referral, and timely medical management of cardiovascular disease (CVD) and risk factors. The most basic screening includes a measurement of resting blood pressure (BP) and heart rate (HR). Previous work demonstrated that rates of BP and HR screening and perceptions toward screening by physical therapists are inadequate. OBJECTIVE: The purpose was to assess the current attitudes and behaviors of physical therapists in the United States regarding the screening of patients for CVD or risk factors in outpatient orthopedic practice. DESIGN: This was a cross-sectional, online survey study. METHODS: Data were collected from an anonymous adaptive online survey delivered via an email list. RESULTS: A total of 1812 surveys were included in this analysis. A majority of respondents (n = 931; 51.38%) reported that at least half of their current caseload included patients either with diagnosed CVD or at moderate or greater risk of a future occurrence. A total of 14.8% of respondents measured BP and HR on the initial examination for each new patient. The most commonly self-reported barriers to screening were lack of time (37.44%) and lack of perceived importance (35.62%). The most commonly self-reported facilitators of routine screening were perceived importance (79.48%) and clinic policy (38.43%). Clinicians who managed caseloads with the highest CVD risk were the most likely to screen. LIMITATIONS: Although the sampling population included was large and representative of the profession, only members of the American Physical Therapy Association Orthopaedic Section were included in this survey. CONCLUSIONS: Despite the high prevalence of patients either diagnosed with or at risk for CVD, few physical therapists consistently included BP and HR on the initial examination. The results of this survey suggest that efforts to improve understanding of the importance of screening and modifications of clinic policy could be effective strategies for improving rates of HR and BP screening.

Physical Therapist-Led Exercise Assessment and Counseling in Integrative Cancer Care: Effects on Patient Self-reported Symptoms and Quality of Life.

BACKGROUND: Exercise - contributes to improved treatment-related outcomes. We reviewed characteristics of cancer patients referred for physical therapist-led exercise counseling at a comprehensive cancer center and its effects on self-reported symptoms and quality of life. METHODS: Patients presenting for outpatient exercise counseling from February 2016 to May 2017 completed the Edmonton Symptom Assessment Scale (ESAS; 0-10 scale, 10 most severe) pre-encounter/post-encounter and Patient-Reported Outcomes Measurement Information System (PROMIS10) global health assessment pre-encounter. Counseling included assessment and education. ESAS individual items and subscales of physical distress (PHS), psychological distress, and global distress (GDS) were analyzed. We used paired t-tests to compare (1) ESAS symptoms pre-encounter/post-encounter and (2) ESAS and PROMIS10 scores at baseline (pre-encounter) and first follow-up. RESULTS: Of 350 participants, most were female (77.7%), Caucasian (66.3%), and had breast cancer (43%). Baseline (pre-encounter) symptom scores (frequency; mean) included poor sleep (68.2%; 3.5), poor well-being (67.4%; 3.2), and fatigue (64.7%; 3.1). Comparing pre-encounter/postencounter ESAS outcomes, we observed statistically and clinically significant reduction in GDS (-3.32; SD = 6.52; P < .001). On follow-up, statistically and clinically significant improvements were observed for fatigue (-1.22; P = .01), GDS (-4.81; P = .01), PHS (-3.1; P = .03) and PROMIS10 global health, mental health, and physical health scores (all P <.05). CONCLUSION: Patients presenting for exercise counseling had a low to moderate symptom burden and experienced significant improvement in GDS. Longitudinal evaluation revealed improvement in global health and fatigue. Additional research is needed to learn more about patient selection and timing of exercise counseling.

Evidence, education and multi-disciplinary integration are needed to embed exercise into lung cancer clinical care: A qualitative study involving physiotherapists.

AIMS: To explore physiotherapists perceptions regarding barriers and enablers to embedding exercise into routine lung cancer clinical care. DESIGN: Qualitative study (content analysis). Eight physiotherapists working in the area of lung cancer at five hospitals participated. The focus group was conducted, transcribed verbatim and independently crosschecked. Thematic analysis was utilized. RESULTS: The data generated four major themes: evidence justifying exercise; staffing and services; maximising the efficacy of interventions; and hospital culture. Physiotherapists perceived that barriers included lack of evidence, lack of physiotherapy time and funding, inconsistencies in patient access to outpatient exercise programs, lack of clear referral pathways, limited knowledge about exercise by the wider multi-disciplinary team, and poor culture of physical activity in the inpatient setting. Recommendations included developing a stronger evidence-base, establishing set patient pathways into exercise programs, re-allocating physiotherapy services to high-risk patients, and integrating/involving the multi-disciplinary team particularly through education and communication. CONCLUSION: This study has identified barriers to, and potential strategies for, the embedding of exercise into lung cancer clinical practice. Evidence, education and multi-disciplinary integration are viewed by physiotherapists as critical for success. A targeted gradual approach, by applying these strategies at defined stages across the lung cancer pathway, is recommended to facilitate future practice change.

Physical activity and advanced cancer: The views of chartered physiotherapists in Ireland.

OBJECTIVES: To investigate Irish chartered physiotherapists' views on physical activity for patients with advanced cancer. METHODS: A mixed methods study design was used. Eligibility criteria included Irish physiotherapists treating patients with advanced cancer. An online survey instrument was created, which included: (1) A quantitative section that explored physiotherapists' views on the role of physical activity for patients with advanced cancer; and (2) A qualitative section that explored physiotherapists' prescription of physical activity for two patient case studies. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using content analysis. RESULTS: A total of 38 physiotherapists completed the study. In all, 94% (n = 36) of physiotherapists agreed with the statement "being physically active is important for patients with advanced cancer" and 80% (n = 30) stated a need for further information on prescribing physical activity to patients with advanced cancer. A content analysis of case study responses demonstrated physiotherapists have a number of concerns regarding the prescription of physical activity to patients with bone metastasis. Concerns center on patients' increased fracture risk, the presence of osteoporosis and the risk of falls in this patient group. CONCLUSION: The majority of physiotherapists perceived physical activity to be of benefit for patients living with advanced cancer. There is a need for more education and training around the prescription of physical activity programs to advanced cancer populations. Physiotherapists' responses suggest patients with advanced cancer have limited exposure to factors that may prompt increased physical activity levels post diagnosis.

User Preferences for Mobile Health Interventions: A Survey among Intermittent Claudication Patients and Their Physical Therapists.

BACKGROUND: Smartphone apps provide novel ways for triggering lifestyle change by coupling objective measurements of health behavior with tailored feedback. Little is known about end-user preferences regarding the content of mobile health (mHealth) interventions. The aim of this study was to assess smartphone use and preferences regarding app content among intermittent claudication patients and their treating physical therapists. METHODS: A cross-sectional survey was sent via an internal email system to 1,514 physical therapists specialized in treating patients with intermittent claudication. They were asked to complete one questionnaire themselves and administer a second to their intermittent claudication patients currently under treatment. Data on participant characteristics and smartphone use were collected from all respondents. The preferred app components were obtained from participants owning a smartphone. Binary logistic regression analysis was used to explore the adjusted association between age and attained educational level, and smartphone use. RESULTS: The response rate of therapists was 40.8% (617/1,514), and a total of 488 patients completed the survey. After excluding incomplete forms, a total of 615 physical therapist forms and 483 patient forms were analyzed. Overall, 40.6% of patients and 95% of therapists owned a smartphone. Higher educational level was associated with smartphone ownership (adjusted odds ratio = 2.46, 95% confidence interval (CI) = 1.41-4.27, P = 0.001). Compared to patients aged ≥75 years, lower age was associated with higher odds of owning a smartphone (adjusted odds ratios for patients aged ≤54 years = 21.27, 95% CI = 6.82-66.30, P < 0.001; aged 55-64 years = 4.76, 95% CI = 2.52-9.00, P < 0.001; and aged 65-74 years = 2.58, 95% CI = 1.54-4.33, P < 0.001). The most preferred app components for intermittent claudication patients in possession of a smartphone included monitoring treadmill-measured walking distances (71%), global positioning system tracking of walks (50%), and daily physical activity monitoring (49%). Physical therapists were most interested in global positioning system tracking of walks (89%), daily physical activity monitoring (82%), keeping track of treadmill-measured walking distance (79%), help with smoking cessation (65%). CONCLUSIONS: Smartphone ownership is associated with younger age and a higher educational level in patients with intermittent claudication. This study provides a framework of end-user preferences regarding desired features to guide the development of an app to potentiate health outcomes of intermittent claudication treatment.

Experience of using non-invasive ventilation as an adjunct to airway clearance techniques in adults with cystic fibrosis-A qualitative study.

BACKGROUND: Adults with cystic fibrosis (CF) suffer from abnormally thick mucus that is difficult to clear from the airways. Different airway clearance techniques (ACTs) can be used to clear secretions and non-invasive ventilation (NIV) can be used as an adjunct to these techniques. ACTs are ideally introduced at the time of diagnosis and thereafter modified throughout the patient's lifespan and disease progress. PURPOSE: The research aim was to describe adult patients' views and experiences with using NIV as an adjunct to ACT. METHOD: Eighteen adults with CF were interviewed about their experiences with using NIV during ACT. Semi-structured interviews were conducted and analyzed in accordance with qualitative content analysis. RESULTS: The results gave rise to the overall theme 'Becoming Friends with NIV' and six associated categories: 1) getting a sense of control and feedback; 2) getting support; 3) dealing with doubt; 4) finding the rhythm; 5) feeling the effects; and 6) finding their own motivation. The findings represent a learning process for adults during the implementation stages of NIV; the physiotherapist was found to play a key role in this process. CONCLUSION: 'Becoming Friends with NIV' involves a learning process for adults with CF. To facilitate this learning process, different aspects should be taken into account so as to promote independence and self-management, which in turn allows the patient to experience the treatment as meaningful. The findings are relevant to physiotherapists working with adults and NIV, as improved insight into and understanding of the relationship may have a positive influence on the outcome and success of NIV usage.

Determining the impact of a new physiotherapist-led primary care model for back pain: protocol for a pilot cluster randomized controlled trial.

BACKGROUND: Back pain is a leading contributor to disability, healthcare costs, and lost work. Family physicians are the most common first point of contact in the healthcare system for people with back pain, but physiotherapists (PTs) may be able to support the primary care team through evidence-based primary care. A cluster randomized trial is needed to determine the clinical, health system, and societal impact of a primary care model that integrates physiotherapists at the first visit for people with back pain. Prior to conducting a future fully powered cluster randomized trial, we need to demonstrate feasibility of the methods. Therefore, the purpose of this pilot study will be to: 1) Determine feasibility of patient recruitment, assessment procedures, and retention. 2) Determine the feasibility of training and implementation of a new PT-led primary care model for low back pain (LBP) 3) Explore the perspectives of patients and healthcare providers (HCPs) related to their experiences and attitudes towards the new service delivery model, barriers/facilitators to implementation, perceived satisfaction, perceived value, and impact on clinic processes and patient outcomes. METHODS: This pilot cluster randomized controlled trial will enroll four sites and randomize them to implement a new PT-led primary care model for back pain or a usual physician-led primary care model. All adults booking a primary care visit for back pain will be invited to participate. Feasibility outcomes will include: recruitment and retention rates, completeness of assessment data, PT training participation and confidence after training, and PT treatment fidelity. Secondary outcomes will include the clinical, health system, cost, and process outcomes planned for the future fully powered cluster trial. Results will be analyzed and reported descriptively and qualitatively. To explore perspectives of both HCPs and patients, we will conduct semi-structured qualitative interviews with patients and focus groups with HCPs from participants in the PT-led primary care sites. DISCUSSION: If this pilot demonstrates feasibility, a fully powered trial will provide evidence that has the potential to transform primary care for back pain. The full trial will inform future service design, whether these models should be more widely implemented, and training agendas. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03320148 . Submitted for registration on 17 September 2017.

"In the physio we trust": A qualitative study on patients' preferences for physiotherapy.

BACKGROUND: Patients' preferences should be integrated in evidence-based practice. This study aimed to explore patients' preferences for physiotherapy treatment and participation in decision making. METHODS: A qualitative study set in an urban physiotherapy clinic in Gothenburg, Sweden. Individual, semi-structured interviews were conducted with 20 individuals who sought physiotherapy for musculoskeletal disorders. The interviews were recorded, transcribed, and analyzed with qualitative content analysis. RESULTS: An overarching theme, embracing six categories, was conceptualized: Trust in the physiotherapist fosters active engagement in therapy. The participants preferred active treatment strategies such as exercise and advice for self-management, allowing them to actively engage in their therapy. Some preferred passive treatments. Key influencers on treatment preferences were previous experiences and media. All participants wanted to be involved in the clinical decision making, but to varying extents. Some expressed a preference for an active role and wanting to share decisions while others were content with a passive role. Expectations for a professional management were reflected in trust and confidence in physiotherapists' skills and competence, expectations for good outcomes, and believing that treatment methods should be evidence-based. CONCLUSION: Trust in the physiotherapist's competence, as well as a desire to participate in clinical decision making, fosters active engagement in physiotherapy.