What matters, what is valued and what is important in mentorship through the Appreciative Inquiry process of co-created knowledge.

BACKGROUND: A key element in the provision of safe and competent midwifery care is how learning experiences are construed and translated into practice. This process can be supported through clinical/professional mentoring. What constitutes 'good mentorship' has been the topic of much debate. While research exploring mentorship exists, there is less research exploring co-created perceptions of mentorship by the mentee and mentor. OBJECTIVES: To explore student and registered midwives' co-created perspectives of what matters, what is valued and what is important in mentorship. DESIGN: An adapted Appreciative Inquiry methodology guided this study with thematic analysis used for data analysis. SETTINGS: One regional Australian university. PARTICIPANTS: A convenience sampling, from a population of 39 third-year Bachelor of midwifery students and 39 registered midwives providing clinical supervision for students enrolled in a specific unit of study and concurrently undertaking midwifery practice experience were recruited into this study. METHODS: Following the four-step process of Appreciative Inquiry; Appreciate, Envision, Co-create and Embed, imagery cards were provided, and participants selected the image that resonated with their understanding of mentorship. Shared understandings were cultivated to co-create what worked well and what was valued in facilitating a positive learning experience. RESULTS: Trust developed over time is a valued component of mentorship relationships. Similarly valued is the sense of belonging and feeling safe, elements reliant on the establishment of effective and respectful communication. CONCLUSION: What matters, what is valued and what is important in midwifery mentorship is a mutually respectful relationship between mentee and mentor. This requires time and trust and the creation of a space where the student can develop a sense of professional belonging and feel safe to learn. Further research is needed to explore ways to co-create safe learning environments. Appreciative Inquiry is a method suited to studying this area.

Low level laser treatment of tendinopathy: a systematic review with meta-analysis.

OBJECTIVES: To assess the clinical effectiveness of Low Level Laser Therapy (LLLT) in the treatment of tendinopathy. Secondary objectives were to determine the relevance of irradiation parameters to outcomes, and the validity of current dosage recommendations for the treatment of tendinopathy. BACKGROUND: LLLT is proposed as a possible treatment for tendon injuries. However, the clinical effectiveness of this modality remains controversial, with limited agreement on the most efficacious dosage and parameter choices. METHOD: The following databases were searched from inception to 1(st) August 2008: MEDLINE, PubMed, CINAHL, AMED, EMBASE, All EBM reviews, PEDro (Physiotherapy Evidence Database), SCOPUS. Controlled clinical trials evaluating LLLT as a primary intervention for any tendinopathy were included in the review. Methodological quality was classified as: high (> or =6 out of 10 on the PEDro scale) or low (<6) to grade the strength of evidence. Accuracy and clinical appropriateness of treatment parameters were assessed using established recommendations and guidelines. RESULTS: Twenty-five controlled clinical trials met the inclusion criteria. There were conflicting findings from multiple trials: 12 showed positive effects and 13 were inconclusive or showed no effect. Dosages used in the 12 positive studies would support the existence of an effective dosage window that closely resembled current recommended guidelines. In two instances where pooling of data was possible, LLLT showed a positive effect size; in studies of lateral epicondylitis that scored > or =6 on the PEDro scale, participants' grip strength was 9.59 kg higher than that of the control group; for participants with Achilles tendinopathy, the effect was 13.6 mm less pain on a 100 mm visual analogue scale. CONCLUSION: LLLT can potentially be effective in treating tendinopathy when recommended dosages are used. The 12 positive studies provide strong evidence that positive outcomes are associated with the use of current dosage recommendations for the treatment of tendinopathy.

The effectiveness of manual therapy in the management of musculoskeletal disorders of the shoulder: a systematic review.

A systematic review of randomised controlled trials (RCTs) was conducted to determine the effectiveness of manual therapy (MT) techniques for the management of musculoskeletal disorders of the shoulder. Seven electronic databases were searched up to January 2007, and reference lists of retrieved articles and relevant MT journals were screened. Fourteen RCTs met the inclusion criteria and their methodological qualities were assessed using the PEDro scale. Results were analyzed within diagnostic subgroups (adhesive capsulitis (AC), shoulder impingement syndrome [SIS], non-specific shoulder pain/dysfunction) and a qualitative analysis using levels of evidence to define treatment effectiveness was applied. For SIS, there was no clear evidence to suggest additional benefits of MT to other interventions. MT was not shown to be more effective than other conservative interventions for AC, however, massage and Mobilizations-with-Movement may be useful in comparison to no treatment for short-term outcomes for shoulder dysfunction.

Laser therapy in the treatment of achilles tendinopathy: a pilot study.

OBJECTIVE: To test the feasibility of a randomized controlled trial to assess the clinical effectiveness of low-level laser therapy (LLLT) when used in addition to eccentric exercise in the management of Achilles tendinopathy. BACKGROUND DATA: LLLT has emerged as a possible treatment modality for tendon injuries. Over the past 20 years only three human studies have investigated LLLT for Achilles tendinopathy. MATERIALS AND METHODS: Twenty patients were randomized into an active laser or placebo group; all patients, therapists, and investigators were blinded to allocation. All patients were given a 12-week eccentric exercise program and irradiated three times per week for 4 wk with either an active or placebo laser at standardized points over the affected tendons. Irradiation parameters in the active treatment group were: 810 nm, 100 mW, applied to six points on the tendon for 30 s, for a total dose of 3 J per point and 18 J per session. Outcome measures were the VISA-A questionnaire, pain, and isokinetic strength. Patients were measured before treatment and at 4 and 12 wk. Analysis of covariance was used to analyze data, using the effects of baseline measurements as a covariate. RESULTS: Within groups, there were significant improvements (p < 0.05) at 4 and 12 wk for all outcome measures, except eccentric strength for the placebo group at 4 wk (p = 0.11). Based on the results of the current study, recruitment of 20 subjects per group would be required to perform an adequately powered study based on minimally important clinical differences in VISA-A scale. CONCLUSION: This study has demonstrated the feasibility of undertaking a randomized controlled trial of LLLT for Achilles tendinopathy. Conclusions regarding effectiveness cannot be made due to the low statistical power of this pilot study.