Professional beliefs of physicians and allied health professionals and their willingness to promote health in primary care: a cross-sectional survey.

BACKGROUND: Primary care professionals could play a key role in health promotion implementation. A fundamental aspect that might affect the willingness of primary care professionals to strengthen health promotion, and about which we do not yet know much, are professional beliefs. Therefore, we conducted a quantitative survey to (1) compare professional beliefs and the willingness to work more in health promotion between five major primary care professions, and (2) investigate associations between professional beliefs and the willingness to work more in health promotion. METHODS: A large-scale cross-sectional study based on a nation-wide web-based survey of primary care professionals in Switzerland was conducted from January to July 2022. The survey was addressed to pharmacists, physicians, medical practice assistants, nurses, and physiotherapists working in primary care in Switzerland. Differences between groups were tested using T-tests and Chi-square tests. Multivariable logistic regression analyses were used to evaluate the association between variables related to professional beliefs and the willingness to work more in health promotion. RESULTS: The responses of 4'063 primary care professionals were used for analysis. Most primary care professionals revealed a salutogenetic attitude towards their primary care tasks. Members of all professions showed high awareness of their tasks in tackling increased risks of disease (80.2% of all participants). Especially allied health professionals wished to see a greater role of prevention in primary care (pharmacists: 72.4%, medical practice assistants: 63.9%, nurses: 75.6%, physiotherapists: 73.9% versus physicians: 46.9%). All professional groups showed a high willingness to work more in health promotion (88% of all participants). Salutogenetic beliefs of primary care professionals and their willingness to work more in health promotion are strongly associated. Participants agreeing that health promotion should play a greater role or that preventive consultations should be offered in primary care, are more willing to work more in health promotion compared to participants who disagree with these ideas. CONCLUSIONS: Both affiliation to allied primary care professions and salutogenetic professional beliefs are associated with higher willingness to work more in health promotion. The high willingness provides evidence of a large, yet untapped potential. Promoting salutogenetic beliefs might further increase the willingness to engage in health promotion.

Financial Resource Management Knowledge, Skills, and Attitudes for Entry-level Physical Therapist Practice: A Survey of Physical Therapists in Ohio.

INTRODUCTION: The purpose of this study was to explore the perceptions of physical therapists (PTs) regarding the importance of financial resource management (FRM) knowledge, skills, and attitudes (KSAs) for entry-level practice and investigate the roles of PT education programs (PTEPs), clinical education experiences (CEEs), and employers in addressing these KSAs. REVIEW OF LITERATURE: FRM KSAs have been identified as components of professionalism and leadership and, as such, are a required element in student PTs (SPTs) educational preparation. SUBJECTS: A purposive sampling of convenience strategy was employed by requesting a free mailing list for Ohio-licensed PTs. METHODS: An online survey was developed based on PT Clinical Performance Instrument Criterion #17, "Patient Management: Financial Resources," as this tool is frequently used to endorse entry-level status of SPTs. Potential participants were solicited through email. Mixed methodology was used to analyze survey results. RESULTS: The survey was completed by 266 PTs. FRM KSAs in legal and regulatory compliance were perceived as most important, followed by coding and billing. Forty-eight percent of participants indicated that FRM KSAs were "less important" (n = 111) or "considerably less important" (n = 17) than clinical care skills, whereas 39.8% (n = 106) believed that these skills are of the same level of importance. Ten themes were derived from qualitative responses regarding the FRM content that should be provided by PTEPs. Participants indicated that the role of PTEPs was to provide an introduction and foundation to FRM, whereas CEEs should facilitate intentional exposure and opportunities to apply FRM KSAs with supervision. Employers were expected to provide education regarding clinic-specific operations and reimbursement considerations, as well as mentorship that included reviewing complex billing for accuracy, offering guidance for improving time management skills, and discussing fiscal responsibilities to both the employer and patient. DISCUSSION AND CONCLUSION: This information may guide PTEPs and clinical personnel in providing focused meaningful instruction regarding FRM aspects of PT practice to SPTs and entry-level clinicians.

LGBTQIA+ Cultural Competence in Physical Therapy: An Exploratory Qualitative Study From the Clinician's Perspective.

OBJECTIVE: The purpose of this study was to understand the lesbian, gay, bisexual, transgender, queer, intersex, agender, and other gender and sexually diverse identities (LGBTQIA+) health care experience and associated cultural competence from the physical therapist perspective (physical therapist and physical therapist assistant). METHODS: An exploratory qualitative approach implementing semi-structured focus groups and private interviews was utilized. To further anonymity, researchers allowed subjects to keep their camera off on Zoom. An interview protocol included questions guided by Campinha-Bacote domains of cultural competence (cultural awareness, skill, knowledge, encounter, and desire) to collect individual experiences, stories, discussions, thoughts, and opinions. Physical therapist clinicians were recruited from the clinical education affiliation lists of Regis University and Thomas Jefferson University. Seventy-one practicing physical therapists from the USA agreed to be part of the study. RESULTS: Themes were organized using the Social Ecological Model Framework. Themes are in parentheses following each level of the Social Ecological Model and include intrapersonal level (psychological stress and implicit and explicit biases), interpersonal (acceptance and competency), organizational (experience), community (advocacy), and society and policy (explicit biases and policy). CONCLUSION: Cultural competence in physical therapy is influenced by intrapersonal, interpersonal, organizational, community, and social and policy factors. Themes of psychological stress, limited awareness, decreased acceptance, and competency as well as limited exposure and experience, and a lack of advocacy and broader societal and policy issues prevent adequate LGBTQIA+ cultural competency of physical therapist providers. Further research in the physical therapist profession is needed to elaborate on the student, educator, and patient perspectives and how this information informs the LGBTQIA+ cultural competence of clinicians. IMPACT: This project may have a significant impact on suggestions for the delivery of content for health profession education to best impact health equity goals and save lives. Implementation of this content may have a direct impact on health disparities in LGBTQIA+ populations by reducing stigma and discrimination from health care providers, thus improving quality of health care and decreasing rates of patient mortality for LGBTQIA+ individuals.

Physiotherapists' perspectives on barriers to implementation of direct access of physiotherapy services in the United Arab Emirates: A cross-sectional study.

BACKGROUND: There are two primary ways of accessing physiotherapy for service users around the world. The direct access, as opposed to the indirect access which requires a referral from a general physician, has several merits including better quality, timeliness, cost effectiveness of treatment and better probability of preventing acute conditions from turning into chronic ailments. Despite these benefits, several countries including the UAE, do not allow direct access to physiotherapists. This study aims to understand the level of awareness among practicing physiotherapists in the United Arab Emirates (UAE) about direct access and to determine whether any of their demographic variables influence the way they perceive the concept. Further, the study sought to explore the perceived barriers and benefits of direct access according to the participating physiotherapists. SUBJECTS AND METHODS: An observational cross-sectional study was employed. The questionnaire survey developed by Bury and Stokes in 2013 was adapted and employed in this study. The instrument had six sections with close-ended items using a Likert five-point scale to rate them. Two hundred and sixty-four physiotherapists answered the questionnaire shared with them through a web link. Finally, MANOVA was employed to explore any influence of demographic variables on the opinions of the respondents. RESULTS: The findings showed that 70% of participants were aware about direct access while nearly 30% were completely unaware. Younger physiotherapists were more willing to endorse the practice whereas older ones were more apprehensive of the barriers. The main barriers reported were the limited support from the physicians and policy makers, professional autonomy, and the limited scope of practice for the physiotherapists, as well as evidence-based practice. The impact of demographic variables on direct access indicated that physiotherapists under the age of 23 endorsed direct access more strongly than other age groups. CONCLUSION: More efforts are needed to implement direct access in the UAE, considering the benefits of improved professional status, cost savings, patient satisfaction, and higher efficiency. This study recommends leadership support, professional autonomy, and mentorship as possible ways to achieve this goal.

Post-stroke gait training practices in a low resource setting: a cross-sectional survey among Indian physiotherapists.

BACKGROUND: Independent mobility is the most important determinant of quality of life after stroke and it is vital that training aimed at restoration of gait is based on contemporary evidence. Despite several practice guidelines for gait rehabilitation after stroke existing globally, their feasibility of application in low-resource settings is often questionable. OBJECTIVE: To investigate the current practices in gait training among Indian physiotherapists involved in the rehabilitation of stroke survivors. METHODS: A questionnaire on the various aspects of gait training was developed and the content was validated by experts. The survey was made available online and distributed among Indian physiotherapists working in the field of stroke rehabilitation, using snowball sampling. Frequency distribution was used to summarize responses to each component of the questionnaire. RESULTS: Responses were obtained from 250 practicing physiotherapists. The majority of the respondents (55%) reported that they initiate gait training within seven days after stroke. Gait training sessions ranged from 15-30 minutes (55%), once every day (44%), and the majority (89%) reported use of subjective outcome measures to evaluate gait. Although most respondents agreed on the use of assistive aids, 24% indicated that their use may deter gait, rather than improve it. Nearly 86% of the respondents reported that they do not follow standard guidelines pertaining to gait rehabilitation for stroke survivors. CONCLUSION: The findings of the study point toward a lack of evidence-based practice among Indian physiotherapists while training gait after stroke. This implied the urgent need for development and implementation of country specific guidelines for stroke rehabilitation.

Assessment of Professional Quality of Life in the Alabama Physical Therapy Workforce.

OBJECTIVE: The purposes of this study were to 1) determine the level of professional quality of life among physical therapists and physical therapist assistants in Alabama and 2) to identify personal or professional factors that may contribute to compassion satisfaction (CS), burnout, and secondary traumatic stress (STS). METHODS: This study used a cross-sectional design and mixed-methods survey methodology to calculate odds ratios for factors affecting professional quality of life. Respondents completed a survey that included the Professional Quality of Life (ProQOL) scale, an open-ended question regarding their experience with professional burnout, and personal and professional demographics. RESULTS: Of the 742 physical therapists and physical therapist assistants in Alabama who completed the survey, the majority experienced moderate-high levels of CS and moderate-low levels of burnout and STS. Regression analyses indicated clinicians working 40 or more hours per week in patient care had greater odds for low-moderate CS and moderate-high burnout and STS subscale scores. Clinicians in our sample licensed between 6 to 15 or more than 30 years and those working in private outpatient settings had reduced odds of having moderate-high burnout, whereas those working 16 or more years had significantly increased odds for high CS scores. Responses to the open-ended question indicated workload demands and documentation as the top factors contributing to clinician burnout, while the connections with patients and coworkers help minimize such feelings. CONCLUSION: Individuals later in their career may develop protective factors to mitigate feelings of burnout compared to those early in their career. Also, clinicians working 40 or more hours per week may be more vulnerable to experiencing low-moderate CS and moderate-high burnout. Thus, individual clinicians and employers must evaluate personal, occupational, and systemic factors that contribute to reduced professional quality of life to inform preventive strategies for mitigating burnout.

Occupational burnout among active physiotherapists working in clinical hospitals during the COVID-19 pandemic in south-eastern Poland.

BACKGROUND: Occupational burnout, which is more and more commonly encountered among medical professionals and investigated by researchers worldwide, may in particular affect health care workers during the COVID-19 pandemic. OBJECTIVES: The aim of the study was to assess the risk of occupational burnout among physiotherapists working actively in clinical hospitals in south-eastern Poland during the COVID-19 pandemic. METHODS: The level of burnout among the studied physiotherapists was assessed using the Polish version of the Maslach Burnout Inventory by Maslach (MBI). The study was conducted from 20 March to 3 May, 2020 among physiotherapists working professionally during the COVID-19 pandemic in the south east of Poland, during which time health services related to therapeutic rehabilitation were suspended. The study was conducted among 1,540 physiotherapists with a license to practice who worked in clinical departments. Considering the inclusion and exclusion criteria, 106 physiotherapists were qualified for the study. RESULTS: The current findings show that during the COVID-19 pandemic physiotherapists present high burnout rates in all three dimensions: EE (Mean 32.31; CI 29.47-35.15); DP (Mean 16.25; CI 14.48-18.03); PA (Mean 26.25; CI 24.41-28.10). As for gender-related effects, higher burnout rates were observed in the male workers, compared to the females, in all three domains: EE (Men: Mean 34.70; CI 29.90-39.50 -Women: Mean 31.03; CI 27.45-34.60); DP (Men: Mean 18.78; CI 15.98-21.59 -Women: Mean 14.90; CI 12.64-17.16) and PA (Men: Mean 24.54; CI 21.32-27.76 -Women: Mean 27.17; CI 24.90-29.44). The highest burnout rates, presented by the physiotherapists working in the profession for more than 20 years, were identified in the domain of EE (Mean: 35.30; CI 30.51-40.10) and in those with 10-15 years of experience, in the domains of DP (Mean: 18.31; CI 14.89-21.73) and PA (Mean: 23.97; CI 20.13-27.81). The highest rate of occupational burnout, reflected by the scores in all three domains (EE, DP, PA), was identified in Department I -Intensive Care and Anaesthesiology Department: EE - (Mean: 40.89, CI 35.27-46.52); DP - (Mean: 21.39, CI 17.90-24.88); and PA - (Mean: 23.07, CI 20.04-26.10), compared to the other departments. The subjects who rarely participated in courses or training programs showed the highest burnout rates (EE- Mean: 33.55, CI 29.33-37.77; DP- Mean: 16.71, CI 13.99-19.43; PA- Mean: 25.45, CI 22.47-28.43). CONCLUSIONS: Occupational burnout during the COVID-19 pandemic is noticeable among physiotherapists working in clinical departments. The current findings show high burnout rates in all three domains: emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA). A comparative analysis of these findings with reference to related studies published before the pandemic shows that the burnout rates among physiotherapists may have significantly increased during the COVID-19 pandemic. However, given the scarcity of scientific evidence related to this specific problem in Poland and worldwide, it is necessary to continue research in occupational burnout affecting physiotherapists, particularly during the second wave of the pandemic, in order to gain a better understanding of the possible effects of social isolation and greater personal work-related health risks on the mental health of these medical professionals.

An exploratory content analysis of how physiotherapists perceive barriers and facilitators to participation in physical activity among adults with disability.

Purpose: To explore the perceived barriers and facilitators to participation in physical activity among adults with disability, from the perspective of physiotherapists. Method: A convenience sample of 20 participants recruited from delegates attending a symposium at the 2015 Australian Physiotherapy Association conference. The participants completed a brief questionnaire. Content analysis was completed using an inductive approach. Results: Participants reported 18 facilitators and 18 barriers to participation in physical activity among adults with disability. The top five reported facilitators were as follows: having support (n = 17 responses), having a choice of opportunities (n = 10 responses), access to suitable venues and equipment (n = 10 responses), enjoying physical activity (n = 8 responses), and high self-efficacy (n = 7 responses). The top five reported barriers were as follows: reduced access to programs and opportunities (n = 15 responses), lack of support or social isolation (n = 14 responses), lack of transport (n = 7 responses), financial strain (n = 7 responses), and physical ability (n = 7 responses). Conclusions: Physiotherapists who have a strong interest in the physical activity habits of adults with disabilities recognize a wide range of facilitators and barriers to their participation. Psychosocial beliefs and behaviors (i.e., self-efficacy, motivation, fear, and attitude) of adults with disability might be more important influencers of physical activity participation than impairments of body structure and function.

A comparative case study of prescribing and non-prescribing physiotherapists and podiatrists.

BACKGROUND: Increasing numbers of nurses, pharmacists and allied health professionals across the world have prescribing rights for medicines: over 90,000 of the eligible United Kingdom workforce are qualified as non-doctor prescribers. In order to inform future developments, it is important to understand the benefits and impact of prescribing by allied health professionals including physiotherapists and podiatrists. AIM: to compare outcomes of physiotherapist and podiatrist Independent Prescriber (PP- IP) patients with those of physiotherapist and podiatrist non-prescribers (PP-NPs). Outcome measures included patient satisfaction, ease of access to services, quality of life and cost implications. DESIGN: a mixed method comparative case study. METHODS: Using mixed methods of data collection, outcomes were compared between 7 sites where care was provided from a PP-IP (3 podiatrist and 4 physiotherapist IPs) and 7 sites from a PP-NP (3 podiatrist and 4 physiotherapist NPs). Patients were followed up for 2 months (2015-2016). RESULTS: 489 patients were recruited: n = 243 IP sites, and n = 246 NP sites. Independent prescribing was found to be highly acceptable, and equivalent in terms of quality of life (p > 0.05) and patient satisfaction (p ≤ 0.05) compared to care provided by NPs. PP-IP care delivery was found to be more resource intensive than PP-NP, with longer consultation duration for IPs (around 6.5 mins), and a higher proportion of physiotherapy patients discussed with medical colleagues (around 9.5 min). CONCLUSION: This study provides new knowledge that PP-IPs provide high levels of care. PP-IP care delivery was found to be more resource intensive. Further research is required to explore cost effectiveness. A more focussed exploration within each profession using targeted outcome measures would enable a more robust comparison, inform future developments around the world and help ensure non-doctor prescribing is recognised as an effective way to alleviate shortfalls in the global workforce.

Assessment of work-related fatigue in Polish physiotherapists and of its effect on their diagnostic accuracy and physiotherapy planning.

Introduction. A physiotherapist's work requires constant focus, concentration and good physical constitution. Nowadays, we can observe an increasing demand for physiotherapist services, as the number of patients and working hours are increasing. As a result, physiotherapists experience growing work-related load and fatigue. The aim of this study was to assess the degree and characteristics of fatigue in physiotherapists, as well as to assess its effect on the accuracy of their functional diagnosis and the therapeutic treatment they propose. Methods. The study population consisted of 18 physiotherapists. To assess subjective fatigue, we used the Japanese questionnaire, and to assess the number of mistakes made, we used two films made by our group that presented a functional examination of patients. Results. The analysis of fatigue in physiotherapists after a day's work showed a significant decrease in activity, decrease in motivation and increase in physical fatigue. The number of mistakes made after a day's work increased. Conclusions. The study showed that the work of physiotherapists negatively affects the levels of activity, motivation and physical strength. Diagnostic accuracy and physiotherapy planning was worse after a day's work. The occupation of a physiotherapists was categorized as psychologically burdening.

Assessment of psychological capital at work by physiotherapists.

OBJECTIVE: Describe how psychological capital in the workplace impacts job satisfaction and quality life among Brazilian physiotherapists. METHODS: Questionnaires were distributed to physiotherapists of the Brazilian Physical Therapists Association working in clinical or managerial positions in the public or private sector. The response rate was 12%, with 389 participants. RESULTS: Job satisfaction was associated with self-efficacy, hope, optimism, and resilience, showing a direct relationship between satisfaction and psychological capital in the workplace. The self-employed physiotherapists were more satisfied and had higher psychological capital in the workplace than the physical therapists employed by a company. CONCLUSION: It is relevant that managers in the physiotherapy field recognize the relevance of psychological capital in the workplace and use it in their management practices. Understanding the individual characteristics of each employee is essential in promoting the personal development of physical therapists. This finding contributes to a healthier and more challenging work environment for physiotherapists in addition to developing their careers in physical therapy units.

Reliability of the Swedish version of the Evidence-Based Practice Attitude Scale assessing physiotherapist's attitudes to implementation of evidence-based practice.

PURPOSE: To translate and apply a cross-cultural adaptation of the Evidence-Based Practice Attitude Scale (EBPAS) in Swedish and investigate its absolute and relative reliability. METHODS: The original EBPAS (a questionnaire assessing health professionals' attitudes to implementation of evidence-based practice) was translated into Swedish using a forward and backward procedure, including a group discussion and expert committee. To assess reliability, 55 physiotherapists (48 women) aged 23-64 years from different clinical settings in the Stockholm region answered the EBPAS by postal survey twice within an interval of 2 weeks. RESULTS: The Cronbach's alpha values for EBPAS were >0.721. The intraclass correlation (ICC) between test and retest (relative reliability) was moderate to good for the four subscales, with ICC(A.1) and ICC(C.1) values approximately equal and in the range 0.56-0.89. Values for the absolute reliability of the mean score were a standard error of measurement of about 7% and a smallest real difference of about 19%. CONCLUSION: The Swedish version of the EBPAS shows mainly good reliability.

Patients' ideas, concerns, expectations and satisfaction in primary health care - a questionnaire study of patients and health care professionals' perspectives.

Objective: Explore the perceptions of patients and health care professionals about patients' ideas, concerns, expectations (ICE), and satisfaction in consultations with general practitioners (GPs), district nurses (DNs) and physiotherapists (PTs).Design: Cross-sectional questionnaire study of participants in planned consultations.Setting: Five primary health care centers and two rehabilitation centers in Stockholm, Sweden.Subjects: Pairs of patients and GPs (n = 156), patients and DNs (n = 73), and patients and PTs (n = 69).Main outcome measures: Multiple-choice questions about patients' ICE and satisfaction.Results: Approximately 75% of patients and GPs reported that patients' thoughts and explanations about their symptoms emerged during the consultation. For patient-DN pairs, the figure was 60%, and for patient-PT pairs, 80%. A majority of patients reported not having concerns and anxiety about the investigation/treatment, whereas health care professionals thought patients were more concerned. One-third of patients consulting GPs and PTs expected to receive a reason/explanation for their symptoms. Figures were lower for the DNs. About 70% of patients were satisfied with the consultation.Conclusions: Most patients expressed their ideas, a minority had concerns, and a minority expected an explanation of their illness. Patients and health care professionals rated patient satisfaction high, but health care professionals tended to believe patients were less satisfied than patients reported they were.Key pointsPatient surveys show that important aspects of patient-centeredness remain weak in Swedish primary health care; for example, shared decision-making.In this study of planned consultations, few patients expected to receive an explanation of their symptoms, but most were satisfied with the consultation.Health care professionals thought patients' experiences were more negative than they were.This discrepancy was observed in responses to questions about patients' concerns, expectations and satisfaction.

Exploring physiotherapists' considerations regarding the use of psychosocial strategies in practice.

OBJECTIVES: To investigate what factors physiotherapists consider when deciding whether to use psychosocial strategies with their patients and what factors they consider when choosing a specific approach. METHODS: Content analysis of two open-ended questions contained within a cross-sectional survey was conducted. Australian physiotherapists (N = 201) provided written comments. RESULTS: Textual data were subjected to content analysis. Two key categories emerged: practitioner considerations and patient considerations. Subcategories included physiotherapist factors, practice environment, patient biological factors, patient psychological factors, and patient social factors. When contemplating the use of psychosocial strategies, physiotherapists' responses aligned with a biopsychosocial perspective. The most common consideration overall was patient attitudes. Physiotherapists reflected on which specific psychosocial strategies they perceived were beneficial for a particular patient based on their presentation. Scope of practice was a minor factor in their decision-making process, as physiotherapists considered their knowledge, confidence, and skill base more frequently. CONCLUSION: Physiotherapists incorporate a biopsychosocial framework in their assessment of patients with regard to potential use of psychosocial strategies. Physiotherapists displayed language that reflected a developed understanding of psychological and social issues with respect to their patients' presentation. Nonetheless, selection of psychosocial strategies was predominantly based on experience, success with an approach, perceived knowledge, skill, and confidence, as opposed to evidence-based efficacy of such strategies. These findings have implications for the training of physiotherapists. Desired outcomes are enhancing management of patients based on a biopsychosocial approach and ensuring inclusion of appropriate, relevant, and evidence-based psychosocial strategies within their accepted scope of practice.

Perceptions about the implementation of physiotherapist prescribing in Australia: a national survey of Australian physiotherapists.

OBJECTIVES: To explore: (1) the views of Australian physiotherapists regarding potential implementation of non-medical prescribing in Australia, (2) how the geographical location and health sector in which a clinician works may influence their perceptions and (3) the perceptions of Australian physiotherapists about how physiotherapist prescribing might impact the care that the profession can provide. DESIGN: A cross-sectional descriptive survey using open and closed questions. SETTING: Participants completed an online questionnaire. PARTICIPANTS: 883 Australian Health Professionals Registration Authority (AHPRA)-registered physiotherapists, working across all states and territories. OUTCOME MEASURES: An online questionnaire was developed by a panel of subject experts and pretested (n=10) for internal consistency. A hyperlink to the questionnaire was emailed to all members of the Australian Physiotherapy Association. A reminder email was sent 4 weeks later. Quantitative data were analysed descriptively, with use of absolute risk reductions (ARRs) and 95% CIs to determine the likelihood that health sector or geographical location were associated with specific views. Thematic analysis enabled synthesis of the qualitative data. RESULTS: 79.0% participants felt that physiotherapist prescribing should be introduced in Australia, with 71.2% wanting to train as prescribers. Clinical governance, risk management, regulation of clinicians and the development of an education framework were identified as priorities for implementation. Participants working in the private sector were significantly more likely to train as prescribers than those in the public sector (ARR 9.9%; 95% CI 3.5 to 16.4) or educational/research institutions (ARR 23.3%; 95% CI 12.8 to 33.8), with city dwellers significantly more likely to train compared with physiotherapists in remote regions (ARR 19.8%; 95% CI 0.8 to 39.2). Physiotherapist prescribing was predicted to improve efficiency of healthcare delivery, access to medicines and reductions in healthcare costs. CONCLUSIONS: AHPRA-registered physiotherapists perceive that the introduction of autonomous physiotherapist prescribing would be beneficial for the Australian population and should be introduced. Decision makers should consider the results of this survey in conjunction with cost-benefit and risk analysis when planning the introduction of physiotherapist prescribing.

Perceptions of the professional and personal impact of hybrid fellowship training: a qualitative study.

OBJECTIVES: This study aimed to elucidate graduate perceptions of how fellowship training impacted their post-training professional and personal lives. METHODS: Interviews were conducted with 13 graduates of a hybrid (e.g. blended-learning) fellowship program. All participants were at least 1 year post completion of fellowship to limit recall bias and allow for post-training personal and professional development. Qualitative analysis was performed on interview transcriptions using directed content analysis with two coders other than the interviewers, followed by discussion until agreement was reached if there were disputes related to coding analysis. If needed, arbitration was provided from one of two interviewers. RESULTS: Analysis revealed three primary constructs of post-fellowship impact: practical, social, and personal. Practical subthemes were centric to care delivery. Social subthemes extended to intra, inter, and non-professional connections. Personal subthemes noted professional and cognitive evolution. DISCUSSION: Participants clearly described impact extending well beyond day-to-day practice suggesting that fellowship impacted the whole person versus sole practitioner. This study may impact program structure and content inclusion for fellowship programs as well as providing support for fellows in training.

Juggling roles and generating solutions; practice-based educators' perceptions of performance-based assessment of physiotherapy students.

OBJECTIVES: Physiotherapy lacks the significant body of evidence that underpins performance-based assessments in disciplines such as medicine and nursing. In particular, very few studies have examined stakeholder perspectives of the process. This study set out to explore the perceptions of clinicians who undertake student assessment in the workplace in order to inform further development of performance-based assessment in physiotherapy. DESIGN: A qualitative, descriptive design was employed where focus group interviews were utilised for data collection. Inductive thematic analysis was used to analyse the data. PARTICIPANTS: Clinical educator and practice tutor volunteers affiliated with three Irish universities participated in one of seven focus groups (n=46). RESULTS: Two themes were identified; 1) Tensions in the clinical learning environment, 2) An optimal PBA process. The first theme describes clinical educators' struggle with juggling multiple roles and highlights the challenges of sustaining a balance between student mentoring and patient care. The second theme outlines factors perceived to contribute to an optimal performance-based assessment process; these include maintaining aspects of the current process and expanding the employment of dedicated educational roles in the workplace. CONCLUSION: Our findings illustrate a complex working environment for clinicians involved in student supervision and assessment. A dedicated educational role was perceived to provide a more standardised and rigorous approach to performance-based assessment. These findings provide critical stakeholder-centred insights, which may inform development of this process by addressing critical aspects deemed to facilitate and challenge clinical educator's roles as assessors.

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.

Clinical assessment and patient-reported outcome measures in low-back pain - a survey among primary health care physiotherapists.

Purpose: We aimed to map the physiotherapy practice in Sweden of clinical tests and patient-reported outcome measures in low-back pain (LBP), and to study advantages and barriers in using patient-reported outcome measures. Methods: An online survey was mailed to 4934 physiotherapists in primary health care in Sweden. Multiple choice questions investigated the use of clinical tests and patient-reported outcome measures in assessing patients with LBP. Open questions investigating the advantages and barriers to the use of patient-reported outcome measures were analyzed with content analysis. Results: The response rate was 25% (n = 1217). Clinical tests were used "always/often" by >60% of the participants, while most patient-reported outcome measures were used by <15%. Advantages in using patient-reported outcome measures were: the clinical reasoning process, to increase the quality of assessment, to get the patient's voice, education and motivation of patients, and communication with health professionals. Barriers were lack of time and knowledge, administrative aspects, the interaction between physiotherapist and patient and, the applicability and validity of the patient-reported outcome measures. Conclusion: Our findings show that physiotherapists working in primary health care use clinical testing in LBP to a great extent, while various patient-reported outcome measures are used to a low-to-very-low extent. Several barriers to the use of patient-reported outcome measures were reported such as time, knowledge, and administrative issues, while important findings on advantages were to enhance the clinical reasoning process and to educate and motivate the patient. Barriers might be changed through education or organizational change-work. To enhance the use of patient-reported outcome measures and thus person-centered care in low-back pain, recommendation, and education on various patient-reported outcome measures need to be advocated. Implications for rehabilitation To increase the effects of rehabilitation in low-back pain, yellow flags, and other factors need to be taken into the consideration in the assessment which means the use of patient-reported outcome measures in addition to clinical testing. The use of patient-reported outcome measures is an advantage in the clinical reasoning process to enhance the quality of assessment and to educate and motivate the patient. Barriers to use patient-reported outcome measures are mainly lack of time and knowledge, and administrative aspects. Through education or organizational change-work, barriers to the use of patient-reported outcome measures might be changed.