The experiences of physiotherapy independent prescribing in primary care: implications for practice.

AIM: To explore the experiences of musculoskeletal (MSk) physiotherapy independent prescribing in primary care from the perspectives of physiotherapists and General Practitioners (GPs) and identify the implications these have for contemporary physiotherapy practice in primary care. BACKGROUND: Legislative change in the United Kingdom (UK) in 2013 enabled physiotherapists holding a postgraduate non-medicalprescribing qualification to independently prescribe certain drugs that assist in patient management. Independent prescribing by physiotherapists is a relatively contemporary development in role change and purpose, occurring alongside the development of physiotherapy first contact practitioner (FCP) roles in primary care. METHODS: A critical realist approach was used, with qualitative data collected via 15 semi-structured interviews with physiotherapists and GPs in primary care. Thematic analysis was applied. PARTICIPANTS: Fifteen participants were interviewed (13 physiotherapists, 2 GPs). Of the 13 physiotherapists, 8 were physiotherapy independent prescribers, 3 were MSk service leads, and 3 were physiotherapy consultants. Participants worked across 15 sites and 12 organisations. FINDINGS: Whilst physiotherapists were empowered by their independent prescribing qualification, they were frustrated by current UK Controlled Drugs legislation. Physiotherapists reported vulnerability, isolation, and risk as potential challenges to independent prescribing, but noted clinical experience and 'patient mileage' as vital to mitigate these. Participants identified the need to establish prescribing impact, particularly around difficult to measure aspects such as more holistic conversations and enhanced practice directly attributed to prescribing knowledge. GPs were supportive of physiotherapists prescribing. CONCLUSIONS: Establishment of physiotherapy independent prescribing value and impact is required to evaluate the role of, and requirement for, physiotherapy independent prescribers within primary care physiotherapy FCP roles. Additionally, there is a need for a review of physiotherapy prescribing permitted formulary, and development of support mechanisms for physiotherapists at individual and system levels to build prescribing self-efficacy and autonomy, and to advance and sustain physiotherapy independent prescribing in primary care.

Self-Compassion in Chinese Young Adults: Its Measurement and Measurement Construct.

OBJECTIVES: Self-compassion is the ability to be kind to oneself in adversity. This multidimensional construct is typically assessed by the Self-Compassion Scale (SCS). In Chinese samples, there have been inconsistent psychometric findings that impede cross-cultural research. This study aimed to explore the factor structure of the Chinese version (SCS-C). METHODS: Two samples of young Chinese adults were recruited (Sample 1, N = 465, 141 men, Mean age [Mage] = 20.26; Sample 2, N = 392, 71 men; Mage = 18.97). Confirmatory factor analyses and exploratory structural equation modeling (ESEM) were used to examine previously reported four- and six-factor structures of SCS-C. RESULTS: Although ESEM supported the six-factor structure when a problematic item was omitted, we found stronger evidence for a novel four-factor structure of the SCS-C revealed with self-kindness, common humanity, mindfulness, and uncompassionate self-responding. This suggests that Chinese individuals have a different understanding of the negative components of the original self-compassion definition, which was based on the United States and other mostly Western samples. Omega coefficients of the bifactor models suggested that using the SCS total score in Chinese samples is inappropriate. However, high factor determinacy and construct replicability indicated that the general factor of SCS-C could be used in a structural equation modeling context for both four-factor and six-factor structures. CONCLUSIONS: When using the existing SCS-C in path models, researchers should use a latent variable approach and establish the measurement construct rather than sum scores of the scale or subscales without checking the factor structure in future empirical studies. Also, the SCS-C needs to be revised, and we proposed directions forward for future research.

The experience of using complementary therapies after a diagnosis of cancer: a qualitative synthesis.

This article describes a qualitative synthesis of published research on cancer patients' experiences of complementary therapies. We conducted a systematic search for qualitative studies on this subject published between 1998 and 2007. Twenty-six refereed journal articles met the inclusion criteria. These 26 articles were repeatedly read by the research team and key concepts emerging from them were identified. Differences and variations were examined in association with treatment, therapy type and by stage of cancer (early stage, mid-treatment, advanced cancer, palliative care and long term 'survivors'). Six overarching concepts were located, which describe the key aspects of patients' experiences of the use of complementary and alternative medicine after a diagnosis of cancer: Connection; Control; Well-being; Transformation; Integration; and Polarization. These are described in a 'line of argument' synthesis, and differences associated with treatment type and stage of disease are noted. The findings are presented in a table showing the six concepts according to treatment type and stage; as a composite story; and in a diagrammatic model showing the individual, practitioner and organizational levels. The synthesis identified various specific ways in which complementary therapies supported cancer patients, as well as occasional negative effects. The most notable barrier was the perceived polarization of complementary therapies and biomedicine; patients reported better experiences in integrated settings.

Cancer patients' experiences of using complementary therapies: polarization and integration.

OBJECTIVE: The use of complementary therapies by people with cancer is commonplace. In a recent synthesis of 26 qualitative studies of patients' experiences of complementary therapy use after a diagnosis of cancer, the emergent theme of 'polarization' was the most notable barrier to a positive experience of complementary therapies. In this paper, we explore the two synthesis concepts of 'polarization' and 'integration', and their relationship to health service policies and guidelines on integrated services. METHODS: A systematic literature search and a meta-ethnography to synthesize key concepts. RESULTS: The majority of patients who used complementary therapies after a diagnosis of cancer wanted to be certain that the therapies were not interfering with their conventional cancer treatment. They valued the therapies in wider terms including: taking 'a niche of control', relieving symptoms, improving wellbeing, and promoting reconnection and social interaction. The emergent theme of 'polarization' suggested that conventional physicians who are perceived to be poorly informed or negative about complementary approaches induce patient anxiety, safety concerns, and difficulties in access. They may compromise their therapeutic relationship and, rarely, they may trigger patients to abandon conventional medicine altogether. In contrast, integrated advice and/or services were highly valued by patients, although some patients preferred their complementary health care to be provided in a non-medicalized environment. CONCLUSIONS: Our findings suggest that the current polarized situation is unhelpful to patients, detrimental to therapeutic relationships and may occasionally be dangerous. They indicate that complementary therapies, in a supportive role, should be integrated into mainstream cancer care.