Effectiveness of pain neuroscience education on somatosensory functioning after surgery for breast cancer: A double-blinded randomized controlled trial.

Pain is one of the most prevalent and long-term adverse effects described by people who have undergone breast cancer surgery. Non-helpful perceptions and thoughts about pain may contribute to the transition of acute to persistent pain. Adding educational interventions to the current physical therapy program in this population may help to improve or prevent persistent pain. Pain neuroscience education (PNE) is a type of educational intervention that addresses the experience of pain in a broader sense by explaining pain not only from a biomedical perspective, but also from a psychological and social perspective. A double-blinded randomized controlled trial (EduCan trial) investigated whether PNE, in addition to a standard physiotherapy program immediately after surgery for breast cancer, was more effective on somatosensory functioning in the short (4 months postoperatively) and long term (18 months postoperatively), than providing a biomedical explanation for pain. Somatosensory functioning was evaluated using a self-reported questionnaire as well as a comprehensive quantitative sensory testing evaluation. The findings of this study revealed that adding six sessions of PNE to a standard physical therapy program (n = 184) did not result in a significantly different course of somatosensory functioning up to 18 months postoperatively as compared to biomedical pain education. These findings provide an interesting basis for future research into who should receive PNE after surgery for breast cancer (e.g., patient profiling or phenotyping) and how we can tailor it to the individual to increase its effectiveness.

The physiotherapy consultation: A qualitative study of the experience of parents of infants with cystic fibrosis in Australia.

BACKGROUND: Physiotherapy is an essential component in the management of cystic fibrosis (CF). OBJECTIVE: To explore how parents of infants with CF experience physiotherapy clinic consultations. METHODS: A qualitative study, informed by hermeneutic phenomenology, utilizing in-depth semi-structured interviews and daily diaries was conducted with 13 parents of infants (aged 0-2 yrs.) receiving physiotherapy care for CF in Australia. RESULTS: Three themes arose from the text. The first was that parents' physiotherapy clinic experience is influenced by the manner in which health professionals communicate to parents about physiotherapy in CF, as well as their own prior experience and knowledge. Secondly, parents receive conflicting messages from the physiotherapy consultation, but perceive the key message to be to prioritize adherence to physiotherapy. The final theme was that parents' expectations of the physiotherapy interaction were often not met, in particular a lack of practical physiotherapy education and training was reported. CONCLUSION: Parents of infants with CF seek an optimistic, practical and hands on approach during physiotherapy consultations. Exploring options for providing physiotherapy input outside of traditional clinic environments may help accommodate individual needs. Investigation into the manner in which physiotherapy education is communicated to parents is warranted in light of the influence on parents' expectations of physiotherapy.

Fisioterapia, Atenção Básica e Interprofissionalidade: reflexões a partir da implementação de um estágio curricular na Comunidade / Physiotherapy, Primary Care and Interprofessionality: Reflections after the Implementation of a Curricular Internship in the Community

Um dos campos de atuação dos profissionais de saúde é a Atenção Básica (AB). A presença de diferentes formações profissionais dentro da AB e a articulação entre esses profissionais é fundamental para a integralidade da assistência prestada à população. As práticas colaborativas e a integralidade do cuidado são habilidades essenciais e comuns a to-dos os profissionais que atuam na AB e na Estratégia de Saúde da Família. Para a Organização Mundial de Saúde (OMS) a Educação Interprofissional em Saúde ocorre quando estudantes e/ou profissionais de duas ou mais áreas aprendem com o outro, sobre o trabalho do outro, e entre si, visando trazer benefícios aos pacientes. Dessa forma, este relato de experiência tem como objetivo relatar a experiência oriunda das atividades de ensino realizadas no estágio acadêmico dos alunos do 7º e 8º períodos do curso de Fisioterapia da Universidade de Ribeirão Preto (UNAERP). As atividades foram desenvolvidas em parceria com as Equipes de Saúde da Família da Unidade Dr. Vinício Plastino, na cidade de Ribeirão Preto, no período de fevereiro de 2018 a dezembro de 2019. Tais atividades são resultantes da implementação de um estágio que tem como foco a atuação do profissional de fisioterapia na AB. Dentro dessa unidade atuaram conjuntamente estudantes dos cursos de Medicina, Farmácia e Fisioterapia. Após o reconhecimen-to do território e da dinâmica da Equipe de Saúde da Família local, o grupo de estagiários iniciou um trabalho de educação em saúde com ações planejadas de forma interprofissional e colaborativa. A partir da percepção das ne-cessidades de saúde da população, foram alinhadas às práticas da disciplina aquelas ações que a equipe realiza no território - cadastramento individual e familiar, territorialização, visita domiciliar e grupos de educação em saúde; acrescidas por aquelas de promoção da saúde específicas da fisioterapia. A experiência no território permitiu: ampliar a vivência dos discentes na ESF, possibilitando a observação e a reflexão sobre o trabalho em equipe nesse contexto; e sensibilizar os acadêmicos para as necessidades em saúde da população e discutir essas necessidades a partir da educação em saúde. Através da vivência, os estudantes da fisioterapia, juntamente com a equipe e alunos de outros cursos da área da saúde puderam redimensionar a importância e a complexidade do trabalho interprofissional na APS e, juntos, desenvolver ou aprimorar habilidades essenciais à sua profissão. (AU)

One of the fields of action of health professionals is Primary Health Care (PHC). The presence of different professional formations within PHC and the articulation between these professionals is fundamental for the integrality of the assistance provided to the population. Collaborative practices and comprehensive care are essential skills common to all professionals working in PHC and the Family Health Strategy. For the World Health Organization (WHO), Interprofessional Health Learning occurs when students and/or professionals from two or more areas learn from each other, about the work of the other, and from each other, aiming to bring benefits to patients. Thus, this expe-rience report aims to report the experience arising from teaching activities carried out in the academic internship of students from the 7th and 8th terms of the Physiotherapy course at Universidade de Ribeirão Preto (UNAERP). The activities were developed in partnership with the Family Health Team of Unit Dr. Vinício Plastino, in Ribeirão Preto, from February 2018 to December 2019. Such activities result from the implementation of an internship that focuses on the professional's performance of physiotherapy at PHC. Within this unit, students from the Medicine, Pharmacy, and Physiotherapy courses worked together. After recognizing the territory and the dynamics of the local Family Health Team, the group of interns started a health education work with actions planned in an interprofessional and collaborative way. Based on the perception of the population's health needs, those actions that the team performs in the territory were aligned to the discipline practices - individual and family registration, territorialization, home visits, and health education groups; added by those of health promotion specific to physical therapy. The experience in the territory allowed: expanding the students' experience in the FHS, enabling observa-tion and reflection on teamwork in this context; and sensitizing academics to the health needs of the population and discussing these needs through health education. Through experience, physiotherapy students, along with the team and students from other courses in the health area, could resize the importance and complexity of interprofessional work in PHC and, together, develop or improve skills essential to their profession. (AU)

Técnicas fisioterapéuticas de entrenamiento muscular inspiratorio y Buteyko en niños con asma bronquial / Inspiratory and Buteyko muscular training physiotherapeutic techniques in children with bronchial asthma

El asma bronquial es una enfermedad respiratoria crónica que genera elevados índices de discapacidad, sobre todo en la población infantil. La aplicación de fisioterapia respiratoria constituye un coadyuvante en los esquemas terapéuticos de la enfermedad; en este sentido el entrenamiento muscular inspiratorio y el método Buteyko constituyen técnicas respiratorias que han sido reportadas como útiles en el tratamiento del asma bronquial. La presente investigación tuvo como objetivo describir las ventajas que ofrecen ambos métodos como esquemas terapéuticos de niños con asma bronquial. Como principales resultados se describen una serie de estudios que muestran las ventajas de la implementación de estos métodos para mejorar distintos componentes de la patogenia y manifestaciones clínicas del asma bronquial. Estos estudios muestran que la aplicación indistinta de uno o ambos métodos mejora diversos aspectos entre los que sobresalen mejorar volúmenes y capacidades pulmonares, función pulmonar, fuerza muscular ventilatoria y la mecánica respiratoria. Adicionalmente, mejoran algunos elementos relacionados con la mecánica respiratoria como es el uso de la respiración bucal. Se concluye que la realización de la fisioterapia respiratoria en niños con asma bronquial constituye una alternativa viable y eficaz en el mejoramiento de varios parámetros relacionados con esta enfermedad. Diversos estudios demuestran que la aplicación de estas técnicas respiratorias mejora la capacidad respiratoria, el tono y trofismo de músculos respiratorios y la mecánica respiratoria. Los resultados positivos evidencian la necesidad de aumentar la implementación del entrenamiento muscular inspiratorio y el método Buteyko como esquema terapéutico en niños con asma bronquial en unidades de atención pública y privada(AU)

Bronchial asthma is a chronic respiratory disease that generates high rates of disability, especially in children. The application of respiratory physiotherapy constitutes an adjunct in the therapeutic schemes of the disease; in this sense, inspiratory muscle training and the Buteyko method constitute respiratory techniques that have been reported as useful in the treatment of bronchial asthma. The present investigation aimed to describe the advantages offered by both methods as therapeutic regimens for children with bronchial asthma. The main results are a series of studies that show the advantages of the implementation of these methods to improve different components of the etiopathogenesis and clinical manifestations of bronchial asthma. These studies show that the indistinct application of one or both methods improves different aspects, among which the improvement of lung volumes and capacities, lung function, ventilatory muscle strength and respiratory mechanics stand out. Additionally, they improve some elements related to respiratory mechanics such as the use of mouth breathing. It is concluded that the performance of respiratory physiotherapy in children with bronchial asthma constitutes a viable and effective alternative in the improvement of various parameters related to this disease. Several studies show that the use of these respiratory techniques improves respiratory capacity, tone and trophism of respiratory muscles, and respiratory mechanics. The positive results demonstrate the need to increase the implementation of inspiratory muscle training and the Buteyko method as a therapeutic scheme in children with bronchial asthma in public and private care units(AU)

Screening for Yellow Flags in Orthopaedic Physical Therapy: A Clinical Framework.

BACKGROUND: Psychological factors influence or are associated with physical function, pain, and health care costs among individuals with musculoskeletal pain conditions. Recent clinical practice guidelines recommend screening for psychological factors (also referred to as "yellow flags") in physical therapy practice to help understand prognosis and inform shared decision making for treatment. CLINICAL QUESTION: Despite the urgings of clinical practice guidelines and evidence of the influence of psychological factors on clinical outcomes, screening for yellow flags is uncommon in clinical practice. Clinicians may feel uncertain about how to integrate screening tools into clinical practice, and how screening results might inform decision making and care coordination. KEY RESULTS: We outline a 3-step framework for routine yellow flag screening in physical therapy practice: (1) establish a standard first-line screening instrument and process, (2) interpret the results to inform shared decision making, and (3) monitor treatment progress. Four case examples illustrate how yellow flag screening can help clinicians and patients decide whether the patient might benefit most from standard physical therapy, psychologically informed physical therapy, psychologically informed physical therapy with referral to another health care provider, or immediate referral. CLINICAL APPLICATION: Consider incorporating a standard yellow flag screening process into usual musculoskeletal health care. We present a framework to guide yellow flag screening in practice (1) to help inform treatment pathway selection and (2) to enhance interdisciplinary communication. J Orthop Sports Phys Ther 2021;51(9):459-469. doi:10.2519/jospt.2021.10570.

A Survey of Pediatric Competencies in Entry-Level Physical Therapy Programs in Australia.

PURPOSE: To describe perspectives of pediatric physical therapy clinical facilitators on contemporary curricula for Australian entry-level physical therapy programs. METHODS: Physical therapy clinical facilitators completed an online survey based on the Academy of Pediatric Physical Therapy of the APTA essential competencies. RESULTS: Conditions including cerebral palsy, cystic fibrosis, and prematurity were highly rated by most participants to include in an entry-level program. Exercise prescription, goal-directed training, and group-based physical therapy were the highest rated interventions. Outcome measures considered important to include were the Alberta Infant Motor Scale and Goal Attainment Scale. Students should demonstrate knowledge and skills using relevant frameworks and have practical opportunities to interact with children. CONCLUSION: Pediatric clinical facilitators perceived that theoretical knowledge on frameworks, human development, movement skills, pediatric conditions, exercise prescription, and outcome measurement as well as face-to-face experiences with children are important to include in Australian entry-level physical therapy programs.

EduCan trial: study protocol for a randomised controlled trial on the effectiveness of pain neuroscience education after breast cancer surgery on pain, physical, emotional and work-related functioning.

INTRODUCTION: Over the past decades, awareness on the importance of educational interventions in cancer pain management has increased. However, education is often restricted to biomedical pain management instructions. A more modern educational approach, also known as pain neuroscience education (PNE), explains pain from a biopsychosocial perspective. We hypothesise that this more comprehensive educational approach in the early treatment phase of breast cancer will lead to more beneficial effects for cancer pain management. Therefore, the aim of the present study is to investigate the effectiveness of this PNE intervention, in addition to best evidence physical therapy modalities for treatment and prevention of pain, physical, emotional and work-related functioning after breast cancer surgery, compared with a traditional biomedical educational intervention. METHODS: A double-blinded randomised controlled trial has been started in November 2017 at the University Hospitals of Leuven. Immediately after breast cancer surgery, all participants (n=184) receive a 12-week intensive standard physical therapy programme. They receive three additional refresher sessions at 6, 8 and 12 months postsurgery. In addition, participants receive three educational sessions during the first-month postsurgery and three 'booster sessions' at 6, 8 and 12 months postsurgery. In the intervention group, the content of the education sessions is based on the modern PNE approach. Whereas in the control group, the education is based on the traditional biomedical approach. The primary outcome parameter is pain-related disability 1 year after surgery. Secondary outcomes related to other dimensions of pain, physical, emotional and work-related functioning at 1-week, 4, 6, 8, 12 and 18 months postsurgery. ETHICS AND DISSEMINATION: The study will be conducted in accordance with the Declaration of Helsinki. This protocol has been approved by the ethical committee of the University Hospitals of Leuven. Results will be disseminated via peer-reviewed scientific journals and presentations at congresses. TRIAL REGISTRATION NUMBER: NCT03351075.

The effectiveness of training physical therapists in pain neuroscience education on patient reported outcomes for patients with chronic spinal pain: a study protocol for a cluster randomized controlled trial.

BACKGROUND: Chronic spinal pain affects many in the United States and is associated with rising healthcare costs - but not improved outcomes. Education and self-care promotion are hallmarks of the recommended approach for this condition. Pain Neuroscience Education (PNE) is a method of educating patients about the neurophysiology of pain that aims to reconceptualize pain from an indicator of damage to an interpretation of input signals by the brain and nervous system. PNE has shown efficacy in controlled situations when delivered by experts, but its effectiveness has not been investigated among trained clinicians in a pragmatic setting. METHODS: A cluster randomized trial will randomly assign 16 clinic regions to either receive PNE training or continue with usual care. Patients with chronic neck or back pain will be enrolled to provide outcome data. Measures will be collected at baseline, 2 weeks, and 12 weeks. The primary outcome will be the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function computer-adapted test (PF-CAT). Pre-specified statistical analyses will compare outcomes between clinic regions assigned to PNE treatment or usual care while using random effects to account for region-level clustering. DISCUSSION: Pain Neuroscience Education has been shown efficacious for a variety of patient-centered outcomes for those with chronic pain, but it has not yet been investigated outside of controlled settings. This trial has the potential to promote PNE as a low-cost intervention for chronic spinal pain and affect physical therapy education. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT03168165 , registered May 30, 2017.

Physical Therapy Self-Management Strategies for a Patient With a Total Hip Replacement and Heart Failure: A Case Report.

Heart failure (HF) is the most common reason for admission to the hospital in people over the age of 65 and has been found to be a possible complication following a joint replacement. Self-management education has been shown to reduce hospital readmissions rates among patients with HF and to cause significant improvements. The purpose of this case report was to describe physical therapy (PT) self-management education in the care of a patient with both a recent hip replacement (THR) surgery and HF. CASE DESCRIPTION: 85-year-old female with a THR and HF. Objective measurements included Timed Up and Go Test (TUG); 10-meter walk test (10MWT) and the 6-minute walk test (6MWT). Standard PT care for THR and self-management education strategies was provided. The patient was seen two times per week for nine weeks. Improvements were noted in all outcome measures: (TUG, 10MWT, 6MWT). The patient was able to meet all ambulation goals and become independent in transfers. In this case, self-management education was shown to provide positive benefits by increasing functional mobility and helping prevent further complications from HF. Self- management education in the home health setting is important for older adult patients who had a THR.

Educational impact of joint replacement school for patients undergoing total hip and knee arthroplasty: a prospective cohort study.

INTRODUCTION: Enhanced recovery programmes for hip and knee arthroplasty surgery have been shown to decrease length of stay and improve patient outcomes in the elective setting. There are limited studies looking at pre-operative patient education alone and its role, however, more recent studies have demonstrated that it can help reduce length of stay and health care costs. The elective orthopaedic unit at Tullamore Hospital was the first unit in the Irish public health system to have a joint school, pre-operative, educational session, and the aim of this study was to assess our patient understanding of this session to ensure a sustained, high level of patient care, quality assurance and educational standards. METHODS: A sample size of n = 51 was calculated to adequately power the study. Final sample size was 57. Data was collected across four joint school sessions. Patients were asked to complete a questionnaire before and after the session. RESULTS: Twenty-seven male (47.3%) and 30 female (52.7%) patients completed the surveys. Mean age overall was 64.5 years. All survey questions except those related to anaesthesia and physiotherapy showed a statistically significant improvement after the joint school session. A total knowledge score was calculated and revealed a statistically significant difference between pre- and post-joint school survey answering (P value < 0.001). CONCLUSION: Our joint school, pre-operative educational session remains a very effective way of delivering content to patients regarding their surgery. Continuous auditing is paramount to its success and there is potential scope for web-based learning as an adjunct to this validated session.

Preoperative Physical Therapy Education Reduces Time to Meet Functional Milestones After Total Joint Arthroplasty.

BACKGROUND: As length of stay decreases for total joint arthroplasty, much of the patient preparation and teaching previously done in the hospital must be performed before surgery. However, the most effective form of preparation is unknown. This randomized trial evaluated the effect of a one-time, one-on-one preoperative physical therapy education session coupled with a web-based microsite (preopPTEd) on patients' readiness to discharge from physical therapy (PT), length of hospital stay, and patient-reported functional outcomes after total joint arthroplasty. QUESTIONS/PURPOSES: Was this one-on-one preoperative PT education session coupled with a web- based microsite associated with (1) earlier achievement of readiness to discharge from PT; (2) a reduced hospital length of stay; and (3) improved WOMAC scores 4 to 6 weeks after surgery? METHODS: Between February and June 2015, 126 typical arthroplasty patients underwent unilateral TKA or THA. As per our institution's current guidelines, all patients attended a preoperative group education class taught by a multidisciplinary team comprising a nurse educator, social worker, and physical therapist. Patients were then randomized into two groups. One group (control; n = 63) received no further education after the group education class, whereas the intervention group (experimental; n = 63) received preopPTEd. The preopPTEd consisted of a one-time, one-on-one session with a physical therapist to learn and practice postoperative precautions, exercises, bed mobility, and ambulation with and negotiation of stairs. After this session, all patients in the preopPTEd group were given access to a lateralized, joint-specific microsite that provided detailed information regarding exercises, transfers, ambulation, and activities of daily living through videos, pictures, and text. Outcome measures assessed included readiness to discharge from PT, which was calculated by adding the number of postoperative inpatient PT visits patients had to meet PT milestones. Hospital length of stay (LOS) was assessed for hospital discharge criteria and 6-week WOMAC scores were gathered by study personnel. At our institution, to meet PT milestones for hospital discharge criteria, patients have to be able to (1) independently transfer in and out of bed, a chair, and a toilet seat; (2) independently ambulate approximately 150 feet; (3) independently negotiate stairs; and (4) be independent with a home exercise program and activities of daily living. Complete followup was available on 100% of control group patients and 100% patients in the intervention group for all three outcome measures (control and intervention of 63, respectively). RESULTS: The preopPTEd group had fewer postoperative inpatient PT visits (mean, 3.3; 95% confidence interval [CI], 3.0-3.6 versus 4.4; 95% CI, 4.1-4.7; p < 0.001) and achieved readiness to discharge from PT faster (mean, 1.6 days; 95% CI, 1.2-1.9 days versus 2.7 days; 95% CI, 2.4-3.0; p < 0.001) than the control group. There was no difference in hospital LOS between the preopPTEd group and the control group (2.4 days; 95% CI, 2.1-2.6; p = 0.082 versus 2.6 days; 95% CI, 2.4-2.8; p = 0.082). There were no clinically relevant differences in 6-week WOMAC scores between the two groups. CONCLUSIONS: Although this protocol resulted in improved readiness to discharge from PT, there was no effect on LOS or WOMAC scores at 6 weeks. Preoperative PT was successful in improving one of the contributors to LOS and by itself is insufficient to make a difference in LOS. This study highlights the need for improvement in other aspects of care to improve LOS. LEVEL OF EVIDENCE: Level II, therapeutic study.

Variability of online available physical therapy protocols from academic orthopedic surgery programs for arthroscopic meniscus repair.

OBJECTIVES: To evaluate the variability of arthroscopic meniscus repair rehabilitation protocols. METHODS: Arthroscopic meniscus repair rehabilitation protocols from Accreditation Council for Graduate Medical Education (ACGME) accredited orthopedic surgery programs available online were included for review. Data collection was performed to evaluate recommended weight bearing status and immobilization as well as the presence or absence of recommended therapies, goals for progression of range of motion, functional milestones, and activity initiation time points within each protocol. RESULTS: Out of 162 institutions available for review, 24 (14.8%) institutions made their protocol available on their website, with 28 total protocols available. Initially following repair, 14 (50%) of the protocols allow for weight bearing as tolerated (WBAT). Of the 14 protocols, which do not allow immediate weightbearing, average time to WBAT was 4.7 ± 1.8 weeks. On average, immobilization was recommended for 6.5 ± 2.1 weeks (range 4-12 weeks). A large majority of protocols gave recommendations for flexion to 90 degrees (24 protocols, range 1-8 weeks), as well as full range of motion (22 protocols, range 6-16 weeks). Active range of motion was recommended to begin at 0-6 weeks (average 3.8 ± 1.9 weeks). Lastly, only 14 protocols (50%) gave an actual return to sport, with an average return recommended at 21.9 ± 3.4 weeks (range 12-24). CONCLUSION: A minority of ACGME-accredited orthopedic surgery programs make their meniscus repair rehabilitation protocols available online. Furthermore, protocols were found to be highly variable. This discrepancy may lead to confusion among therapists and patients.

Incidence of Obstetric Anal Sphincter Injuries After Training to Protect the Perineum.

OBJECTIVES: Obstetric anal sphincter injuries (OASISs) are a devastating postpartum complication; reducing rates is paramount to improving quality of care. In Norway, implementation of a perineal protection program decreased the incidence of OASIS by 48%. We sought to assess impact on OASIS rates following a similar program. METHODS: This institutional review board-approved, retrospective cohort study was performed in an academic hospital system. The periods of analysis were November 2014 through October 2015 for the preintervention arm and November 2015 through October 2016 for the postintervention arm. From November 2 to 6, 2015, 2 Norwegian experts conducted a didactic and hands-on, on-site workshop focusing on perineal protection. The experts were then present on labor and delivery wards to reinforce perineal protection in live deliveries. Teachings were emphasized at departmental meetings for the remainder of the year. Data were extracted from electronic medical records and manually audited. RESULTS: The rate of vaginal delivery was similar among both periods (6504 and 6650; P = 0.059). Obstetric anal sphincter injury rates decreased from 211 (3.2%) preintervention to 189 (2.8%) after the workshop. Although this represented 32 fewer injuries, it was not statistically significant (P = 0.179). Obstetric anal sphincter injuries following forceps-assisted deliveries did decline significantly from 103 (28%) to 81 (21%) (P = 0.014). In addition, incidence of fourth-degree lacerations during resident deliveries decreased significantly from 10 (0.6%) to 3 (0.2%) (P = 0.047). CONCLUSIONS: An educational workshop focusing on perineal support was not associated with a significant reduction in overall OASIS rates. Nevertheless, decreased forceps-related OASIS and fourth-degree lacerations rates support positive influence of the intervention.

Academic performance of bachelor students in medical doctor and physiotherapy determined by predictive analysis. / El rendimiento académico de los estudiantes de las licenciaturas de médico cirujano y fisioterapia determinado por análisis predictivo.

Objective: To identify and compare the predictive agents associated with medical students´ academic performance that are undertaking cellular biology and human histology, as well as those physiotherapists that take molecular, cellular and tissue biology. Methods: An academic follow up was carried out during school. Tools on previous knowledge, vocation, psychological and confrontational means were applied at the beginning of the school year; and the last two were applied two more times afterwards. Data were analyzed considering descriptive, comparative, correlational and predictive statistics. The students´ participation was voluntary and data confidentiality was looked after.

Perspectivas de los conceptos disciplinares en Fisioterapia / Perspectives of disciplinary concepts in Physiotherapy

Introducción: en el proceso de formación profesional, es importante que el estudiante de fisioterapia, además, del conocimiento adquirido, pueda contextualizar su saber y apropiarse de él. De allí la importancia de analizar las perspectivas de los estudiantes frente a los conceptos disciplinares, ya que estas aportan un imaginario de cómo se desenvuelven en el quehacer profesional. Objetivo: analizar las perspectivas de los estudiantes de Fisioterapia de la Universidad Manuela Beltrán acerca de los conceptos disciplinares. Métodos: investigación de tipo cualitativo con diseño fenomenológico y alcance exploratorio, realizada por medio de entrevistas semi-estructuradas a nueve alumnos del programa de Fisioterapia que cursaban un nivel de práctica II, III, IV o V que corresponde a estudiantes de sexto semestre en adelante. Se indagó acerca de las perspectivas de los estudiantes sobre los conceptos escogidos por los autores como representativos de la disciplina: salud, enfermedad, cuerpo, movimiento, discapacidad, rehabilitación e inclusión. Resultados: se evidenció que los profesionales en formación tienen enfoques diferentes para abordar los conceptos, asumiéndose algunos desde un paradigma biologicista y otros, desde un enfoque holístico. Adicional a los conceptos propuestos, surgen otras categorías emergentes descritas por los alumnos. Conclusiones: con el desarrollo del plan curricular, los alumnos evolucionan en la forma de comprender los conceptos disciplinares, teniéndose en cuenta que el programa se ajusta a la trayectoria histórica de estos, generándose en los estudiantes una aproximación a los modelos contemporáneos que se han venido desarrollando, como el multidimensional y el biopsicosocial(AU)

Introduction: In the professional training process, it is important for the Physiotherapy student, besides acquiring the knowledge, to contextualize that knowledge and apprehend it. Therefore, it is important to analyze the perspectives of the students regarding the disciplinary concepts, as these provide an idea of how they practice in their professional work. Objective: To analyze the perspectives on disciplinary concepts of Physiotherapy students at Manuela Beltran University. Methods: A qualitative study with a phenomenological design and an exploratory scope was carried out, by means of semi-structured interviews with nine students of the Physiotherapy program undergoing the practice levels II, III, IV or V, which corresponds to students in their sixth semester or later. We asked about the students' perspectives on the concepts chosen by the authors as being representative of the discipline: health, disease, body, movement, disability, rehabilitation, and inclusion. Results: It was showed that the undergraduate students manifested different approaches to address the concepts, assuming some from the biological paradigm, while other do it from a holistic approach. In addition to the proposed concepts, other categories described by students appeared. Conclusions: With the development of the syllabus, students had an evolution regarding their understanding of the disciplinary concepts, taking into account that the program is consistent with their historical background, being generated in the students an approach to contemporary models lately developed, such as the multidimensional and the iopsychosocial(AU)

Reflexión acerca de los conceptos disciplinares de los directivos de un programa de fisioterapia / Reflection about the disciplinary concepts of the officials of a physiotherapy program

Introducción: la Fisioterapia se ha establecido como una profesión del área de la salud que se encamina a buscar el bienestar del individuo, por medio de acciones e intervenciones que promueven la conservación del movimiento corporal humano. Objetivo: analizar las perspectivas de los conceptos disciplinares de los directivos de un programa de Fisioterapia de Bogotá en Colombia. Métodos: estudio cualitativo, fenomenológico, a través de grupo focal y entrevistas semiestructuradas. El procesamiento de la información se realizó por medio de la técnica de Análisis de contenido teniéndose en cuenta categorías pre establecidas por los autores donde se incluyeron los conceptos disciplinares de: salud, enfermedad, discapacidad, movimiento, rehabilitación, y cuerpo. Resultados: se encontraron respuestas formuladas desde una visión biomédica por parte de la mayoría de los participantes alrededor de los conceptos revisados, y se tomaron aislados, cada uno de ellos. Conclusiones: abordar los conceptos disciplinares implica realizar una mirada histórica de la profesión, en donde el campo de estudios del movimiento corporal humano, desde la academia se encuentra vinculado muy estrecho a estos paradigmas en salud y sus transformaciones(AU)

Introduction: Physiotherapy has established itself as a profession of the health area that looks forward to the individual's well-being, by means of actions and interventions that promote the conservation of human corporal movement. Objective: To analyze the perspectives of the disciplinary concepts of the officials of a physiotherapy program in Bogotá, Colombia. Methods: Qualitative, phenomenological study, by means of the focal group and semi-structured interviews. Information processing was carried by the content analysis technique, considering the categories pre-established by the authors, which included the disciplinary concepts of health, disease, disability, movement, rehabilitation, and body. Results: Answers formulated from a biomedical vision were found as given by most of the participants around the revised concepts, and each of them was taken isolated. Conclusions: To address the disciplinary concepts implies carrying out a historical look to the profession, in which the field of studies of human corporal movement, from the academy area, is tied very narrowly to these health paradigms and transformations(AU)

Changes in use, knowledge, beliefs and attitudes relating to tobacco among nursing and physiotherapy students: a 10-year analysis.

AIM: To analyse changes in prevalence, knowledge, beliefs and attitudes relating to smoking among undergraduate nursing and physiotherapy students over a 10-year period. BACKGROUND: Few studies have been performed to describe changes in the use of tobacco and associated characteristics. DESIGN: This study was a sequential cross-sectional study. METHODS: A self-administered survey was performed during three academic years among nursing and physiotherapy students in a Spanish Faculty of Health Sciences. FINDINGS: The proportion of smokers among nursing and physiotherapy students in 2003, 2008 and 2013 was 29·3%, 24·7% and 18·2% respectively. The ages when participants first smoked did not vary over the years. The Fagerström test showed low nicotine dependence. A significantly high percentage of students stated they were unaware of the link between smoking and bladder cancer and oral leukoplakia. Students declared they were unaware of the association between under-weight new-borns and second-hand smoke. The majority of students recognized that healthcare professionals were role models in society, there being little variation over the years studied. In relation to education and training, the study showed a need to inform students about methods and strategies to help people quit smoking. CONCLUSIONS: The prevalence of smoking among nursing and physiotherapy students decreased over the ten years. Active programmes should be implemented to encourage those university students who smoke to break this habit. The decline over the years in knowledge about smoking provided evidence of a significant deficit in undergraduate training.

Integrality and higher education aimed at the Brazilian Unified Health System from the perspective of physical therapy undergraduate students / Integridad y formación para el Sistema Único de Saúde em la perspectiva de estudiantes universitários de Fisioterapia / Integralidade e formação para o Sistema Único de Saúde na perspectiva de graduandos em Fisioterapia

In recent years, there has been the need to reorganize the curriculum of undergraduate courses in the health science field in order to educate professionals to be able to practice the principles of the Brazilian Unified Health System from the perspective of integrality. From a qualitative research perspective, this study aimed to identify the perceptions and opinions of physical therapy undergraduate students regarding comprehensive health care and about the principle of comprehensive health care in their education. Three focus groups were conducted with students in their senior year of the undergraduate course in physical therapy enrolled in three universities in the Federal District. After analyzing the content, results show that despite government efforts and changes in the curriculum proposals, it was observed that undergraduate education in physical therapy still does not favor the Brazilian Unified Health System and its guiding principles, in particular comprehensive health care. It is necessary to invest in reflective spaces that articulate university (faculty and students), health services, management authorities, municipal policies and social movements in order to yield new teaching and learning possibilities that will contribute to the transformation of the university education aimed at the Brazilian Health System.

En los últimos años, ha habido una necesidad de reorganización de los planes de estudio de los cursos superiores del área de salud buscando formar a profesionales capaces de llevar a cabo los principios del Sistema Único de Salud (SUS), en la perspectiva de la integralidad. En la vertiente de la investigación cualitativa, este estudio tuvo como objetivo identificar las percepciones y opiniones de estudiantes de pregrado de Fisioterapia en cuanto a la integralidad de la asistencia y acerca de la inclusión de este principio en su formación universitaria. Se realizaron 3 grupos de enfoque (GEs) con 30 estudiantes del último año del curso de pregrado de fisioterapia inscritos en tres instituciones de educación superior (IESs) en el Distrito Federal (DF). Después del análisis de contenido, los datos mostraron que, a pesar de los esfuerzos del gobierno y cambios en las propuestas curriculares, se observa que la educación en Fisioterapia todavía no privilegia el SUS y sus principios y ejes orientadores, especialmente la integralidad. Es necesario invertir en espacios críticos y reflexivos que articulan la universidad (docentes y estudiantes), los servicios de salud, los niveles de gestión y las políticas municipales y los movimientos sociales, con el fin de producir nuevas posibilidades de enseñanza-aprendizaje que contribuyan a la transformación de la formación para el SUS.

Nos últimos anos, constata-se a necessidade de reorganização dos currículos dos cursos superiores da área da saúde buscando formar profissionais capazes de efetivar os princípios do Sistema Único de Saúde (SUS), na perspectiva da integralidade. Na vertente da pesquisa qualitativa, este estudo teve como objetivo identificar as percepções e opiniões de estudantes de graduação em Fisioterapia em relação à integralidade da assistência e acerca da inclusão desse princípio em sua formação universitária. Foram realizados 3 grupos focais (GFs) com 30 estudantes do último ano do curso de graduação em Fisioterapia matriculados em 3 instituições de ensino superior (IESs) no Distrito Federal (DF). Após análise de conteúdo, os dados apontam que, apesar dos esforços governamentais e das mudanças nas propostas curriculares, observa-se que o ensino em Fisioterapia ainda não privilegia o SUS e seus princípios e eixos norteadores, em especial a integralidade. Faz-se necessário o investimento em espaços críticos e reflexivos que articulem universidade (docentes e discentes), serviços de saúde, instâncias gestoras e políticas municipais e movimentos sociais, a fim de produzir novas possibilidades de ensino-aprendizagem que contribuam para a transformação da formação para o SUS.