The challenges of ethical deliberation in palliative care settings: A descriptive study.

OBJECTIVE: Inadequate deliberation processes about ethical problems occurring in palliative care settings may negatively impact both patients and healthcare professionals. Better knowledge of the palliative care professionals' practices regarding such processes could help identify specific education needs to improve the quality of palliative care in the context of complex ethical situations. Therefore, this descriptive study aimed to (1) examine ethical deliberation processes in interprofessional teams in five palliative care settings; (2) identify organizational factors that constrain such processes; and (3) based on this knowledge, identify priority education needs for future and current palliative care professionals. METHOD: The study involved three data collection activities: (1) direct observation of simulated interprofessional ethical deliberations in various palliative care settings; (2) individual semi-structured interviews; and (3) deliberative dialogues. RESULTS: Thirty-six healthcare professionals took part in the simulated ethical deliberations and in the deliberative dialogue activities, and 13 were met in an individual interview. The study results revealed suboptimal interprofessional collaboration and ethical deliberation competencies, particularly regarding awareness of the ethical issue under consideration, clarification of conflicting values, reasonable decision making, and implementation planning. Participants also reported facing serious organizational constraints that challenged ethical deliberation processes. SIGNIFICANCE OF RESULTS: This study confirmed the need for professional education in interprofessional collaboration and ethical deliberation so that palliative care professionals can adequately face current and future ethical challenges. It also enabled the identification of educational priorities in this regard. Future research should focus on identifying promising educational activities, assessing their effectiveness, and measuring their impact on patient and family experience and the quality of palliative care.

La version franco-canadienne de l'outil Assessment of Multiple Systematic Reviews (AMSTAR).

Objectives: The primary objective was to produce a French-Canadian translation of AMSTAR (a measurement tool to assess systematic reviews) and to examine the validity of the translation's contents. The secondary and tertiary objectives were to assess the inter-rater reliability and factorial construct validity of this French-Canadian version of AMSTAR. Methods: A modified approach to Vallerand's methodology (1989) for cross-cultural validation was used.1 First, a parallel back-translation of AMSTAR2 was performed, by both professionals and future professionals. Next, a first committee of experts (P1) examined the translations to create a first draft of the French-Canadian version of the AMSTAR tool. This draft was then evaluated and modified by a second committee of experts (P2). Following that, 18 future professionals (master's students in physiotherapy) rated this second draft of the instrument for clarity using a seven-point scale (1: very clear; 7: very ambiguous). Lastly, the principal co-investigators then reviewed the problematic elements and proposed final changes. Four independent raters used this French-Canadian version of AMSTAR to assess 20 systematic reviews that were published in French after the year 2000. An intraclass correlation coefficient (ICC) and kappa coefficient were calculated to measure the tool's inter-rater reliability. A Cronbach's alpha coefficient was also calculated to measure internal consistency. In addition, factor analysis was used to evaluate construct validity in order to determine the number of dimensions. Results: The statements on the final version of the AMSTAR tool received an average ambiguity rating of between 1.0 and 1.4. No statement received an average rating below 1.4, which indicates a high level of clarity. Inter-rater reliability (n=4) for the instrument's total score was moderate, with an intraclass correlation coefficient of 0.61 (95% confidence interval [CI]: 0.29, 0.97). Inter-rater reliability for 82% of the individual items was good, according to the kappa values obtained. Internal consistency was excellent, with a Cronbach's alpha coefficient of 0.91 (95% CI: 0.83, 0.99). The French-Canadian version of AMSTAR is a unidimensional tool, as confirmed by factor analysis and community values greater than 0.30. Conclusion: A valid French-Canadian version of AMSTAR was created using this rigorous five-step process. This version is unidimensional, with moderate inter-rater reliability for the elements overall, and with excellent internal consistency. This tool could be valuable to French-Canadian professionals and researchers, and could also be of interest to the international Francophone community.

Internet-based implementation of non-pharmacological interventions of the "people getting a grip on arthritis" educational program: an international online knowledge translation randomized controlled trial design protocol.

BACKGROUND: Rheumatoid arthritis (RA) affects 2.1% of the Australian population (1.5% males; 2.6% females), with the highest prevalence from ages 55 to over 75 years (4.4-6.1%). In Canada, RA affects approximately 0.9% of adults, and within 30 years that is expected to increase to 1.3%. With an aging population and a greater number of individuals with modifiable risk factors for chronic diseases, such as arthritis, there is an urgent need for co-care management of arthritic conditions. The increasing trend and present shifts in the health services and policy sectors suggest that digital information delivery is becoming more prominent. Therefore, it is necessary to further investigate the use of online resources for RA information delivery. OBJECTIVE: The objective is to examine the effect of implementing an online program provided to patients with RA, the People Getting a Grip on Arthritis for RA (PGrip-RA) program, using information communication technologies (ie, Facebook and emails) in combination with arthritis health care professional support and electronic educational pamphlets. We believe this can serve as a useful and economical method of knowledge translation (KT). METHODS: This KT randomized controlled trial will use a prospective randomized open-label blinded-endpoint design to compare four different intervention approaches of the PGrip-RA program to a control group receiving general electronic educational pamphlets self-management in RA via email. Depending on group allocation, links to the Arthritis Society PGrip-RA material will be provided either through Facebook or by email. One group will receive feedback online from trained health care professionals. The intervention period is 6 weeks. Participants will have access to the Internet-based material after the completion of the baseline questionnaires until the final follow-up questionnaire at 6 months. We will invite 396 patients from Canadian and Australian Arthritis Consumers' Associations to participate using online recruitment. RESULTS: This study will build on a pilot study using Facebook, which revealed promising effects of knowledge acquisition/integration of the evidence-based self-management PGrip educational program. CONCLUSIONS: The use of online techniques to disseminate knowledge provides an opportunity to reduce health care costs by facilitating self-management of people with arthritis. Study design strengths include the incorporation of randomization and allocation concealment to ensure internal validity. To avoid intergroup contamination, the Facebook group page security settings will be set to "closed", thus allowing only invited participants to access it. Study limitations include the lack of participant blinding due to the characteristics of this KT randomized controlled trial and a potential bias of recruiting patients only online, though this was proven effective in the previous pilot study. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12614000397617; http://www.anzctr.org.au/TrialSearch.aspx (Archived by WebCite at http://www.webcitation.org/6PrP0kQf8).

[Not Available]. / Une version franco-canadienne de la Physiotherapy Evidence Database (PEDro) Scale : L'Échelle PEDro.

PURPOSE: To prepare a Canadian French translation of the PEDro Scale under the proposed name l'Échelle PEDro, and to examine the validity of its content. METHODS: A modified approach of Vallerand's cross-cultural validation methodology was used, beginning with a parallel back-translation of the PEDro scale by both professional translators and clinical researchers. These versions were reviewed by an initial panel of experts (P1), who then created the first experimental version of l'Échelle PEDro. This version was evaluated by a second panel of experts (P2). Finally, 32 clinical researchers evaluated the second experimental version of l'Échelle PEDro, using a 5-point clarity scale, and suggested final modifications. RESULTS: The various items on the final version of l'Échelle PEDro show a high degree of clarity (from 4.0 to 4.7 on the 5-point scale). CONCLUSION: The four rigorous steps of the translation process have produced a valid Canadian French version of the PEDro scale.

Enhancing patient-engaged teamwork in healthcare: an observational case study.

The purpose of this study was to describe how teamwork that effectively engaged patients and families, manifested itself in an acute rural care setting in order to inform the development of teamwork skills. One hundred and forty participants were included in the study representing providers, patients, family, hospital and clinical support personnel, education specialists and students. Using a modified grounded theory approach, and informed by activity theory, observational field notes and interview transcripts were analyzed. Through the analysis of 343 events of providers interacting with, or exchanging information about, patients, three patterns of teamwork emerged that facilitated patient-engaged care: uniprofessional, multiprofessional and interprofessional. The data indicated that providers navigated between these patterns, as well as others, throughout their workday. Providers should be skilled in applying the construct of situation awareness in order to adopt a pattern of teamwork that best facilitates patient-engaged care. Interventions that can enhance teamwork should focus on: valuing the perspectives of others; developing relational competence and resilience; employing reflective learning and shared decision-making skills; and incorporating principles of change theory for both individuals and systems.

Resident experiences of informal education: how often, from whom, about what and how.

CONTEXT: The merits of informal learning have been widely reported and embraced by medical educators. However, research has yet to describe in detail the extent to which informal intraprofessional or informal interprofessional education is part of graduate medical education (GME), and the nature of those informal education experiences. This study seeks to describe: (i) who delivers informal education to residents; (ii) how often they do so; (iii) the content they share; and (iv) the teaching techniques they use. METHODS: This study describes instances of informal learning in GME captured through non-participant observations in two contexts: a palliative care hospice and a paediatric hospital. Analysis of 60 hours of observation data involved a process of collaborative team consensus to: (i) identify instances of informal intraprofessional and informal interprofessional education, and (ii) categorise these instances by CanMEDS Role and teaching technique. RESULTS: Findings indicate that 84.8% of GME-level informal education that takes place in these two settings is physician-led and 15.2% is nurse-led. Organised by CanMEDS Role, findings reveal that, although all Roles are addressed by both physicians and nurses, those most commonly addressed are Medical Expert (physicians: 35.7%; nurses: 27.5%) and Communicator (physicians: 22.3%; nurses: 25.0%). Organised by teaching technique, findings reveal that physicians and nurses favour similar techniques. CONCLUSIONS: Although it is not surprising that informal interprofessional education plays a lesser role than informal intraprofessional education in GME, these findings suggest that the role of informal interprofessional education is worthy of support. Echoing the calls of others, we posit that medical education should recognise and capitalise on the contributions of informal learning, whether it occurs intra- or interprofessionally.

A systematic critical appraisal of non-pharmacological management of rheumatoid arthritis with Appraisal of Guidelines for Research and Evaluation II.

Clinical practice guidelines (CPGs) have been developed to summarize evidence about the management of rheumatoid arthritis (RA) and facilitate the uptake of evidence-based knowledge by consumers, health professionals, health administrators and policy makers. The objectives of this review was to assess the quality of CPGS on non-pharmacological management of RA with a standardized and validated instrument--the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool and summarize the key recommendations from these CPGs. Scientific literature databases from 2001 to 2013 were systematically searched and a total of 13 CPGs for RA was identified. Only a minority of AGREE II domains were effectively addressed by the CPGS. Scope and purpose was effectively addressed in 10 out of 13 CPGs, stakeholder involvement in 11 CPGs, rigor of development in 6 CPGs, clarity/presentation in 9 CPGs, editorial independence in 1 CPGs, and applicability in none of the CPGs. The overall quality of the included CPGs according to the 7-point AGREE II scoring system was 4.8 ± 1.04. Patient education/self-management, aerobic, dynamic and stretching exercises were the commonly recommended for the non-pharmacological management of RA by the high-quality CPGs. The general clinical management recommendations tended to be similar among high-quality CPGs. Non-pharmacological management interventions were superficially addressed in more than half of the selected CPGs. CPGs creators should use the AGREE II criteria when developing guidelines. Innovative and effective methods of CPGs implementation to users are needed to ultimately enhance the quality of life of arthritic individuals. In addition, it was difficult to establish between strongly recommended, recommended and weakly recommended, as there is no consensus between the strength of the recommendations between the appraised CPGs.

A systematic critical appraisal for non-pharmacological management of osteoarthritis using the appraisal of guidelines research and evaluation II instrument.

Clinical practice CPGs (CPGs) have been developed to summarize evidence related to the management of osteoarthritis (OA). CPGs facilitate uptake of evidence-based knowledge by consumers, health professionals, health administrators and policy makers. The objectives of the present review were: 1) to assess the quality of the CPGs on non-pharmacological management of OA; using a standardized and validated instrument--the Appraisal of Guidelines Research and Evaluation (AGREE II) tool--by three pairs of trained appraisers; and 2) to summarize the recommendations based on only high-quality existing CPGs. Scientific literature databases from 2001 to 2013 were systematically searched for the state of evidence, with 17 CPGs for OA being identified. Most CPGs effectively addressed only a minority of AGREE II domains. Scope and purpose was effectively addressed in 10 CPGs on the management of OA, stakeholder involvement in 12 CPGs, rigour of development in 10 CPGs, clarity/presentation in 17 CPGs, editorial independence in 2 CPGs, and applicability in none of the OA CPGs. The overall quality of the included CPGs, according to the 7-point AGREE II scoring system, is 4.8 ± 0.41 for OA. Therapeutic exercises, patient education, transcutaneous electrical nerve stimulation, acupuncture, orthoses and insoles, heat and cryotherapy, patellar tapping, and weight control are commonly recommended for the non-pharmacological management of OA by the high-quality CPGs. The general clinical management recommendations tended to be similar among high-quality CPGs, although interventions addressed varied. Non-pharmacological management interventions were superficially addressed in more than half of the selected CPGs. For CPGs to be standardized uniform creators should use the AGREE II criteria when developing CPGs. Innovative and effective methods of CPG implementation to users are needed to ultimately enhance the quality of life of arthritic individuals.

WITHDRAWN: Therapeutic ultrasound for treating patellofemoral pain syndrome.

BACKGROUND: Therapeutic ultrasound is one of several rehabilitation interventions suggested for the management of pain due to patellofemoral knee pain syndrome. OBJECTIVES: To assess the effectiveness and side effects of ultrasound therapy for treating patellofemoral knee pain syndrome. SEARCH METHODS: We searched the Cochrane Musculoskeletal Review Group register, Cochrane Field of Physical and Related Therapies register, Cochrane Controlled Trials Register, MEDLINE, EMBASE, HealthSTAR, Sports Discus, CINAHL,and PEDro databases (to December 2000) according to the sensitive search strategy for RCTs designed for the Cochrane Collaboration. The search was complemented with handsearching of the reference lists. Key experts in the area were contacted for any further articles. SELECTION CRITERIA: All randomized controlled trials (RCTs), controlled clinical trials (CCTs), case-control and cohort studies comparing therapeutic ultrasound against placebo or another active intervention in people with patellofemoral pain syndrome were selected according to an a priori protocol. DATA COLLECTION AND ANALYSIS: Two reviewers determined the studies to be included based on a priori inclusion criteria. Data were independently extracted by the same two reviewers and checked by a third reviewer (BS) using a previously developed form. The same two reviewers independently assessed the methodological quality of the RCTs and CCTs using a validated scale. The data analysis was performed using Peto odds ratios. MAIN RESULTS: The search retrieved 85 articles. Of the eight that were potentially relevant, only one RCT, including 53 participants with patellofemoral pain syndrome, was identified for this review. All participants received an exercise program as concurrent therapy. Ultrasound combined with ice massage contrast (n of 13), where n equals the number of participants, was not statistically different from ice massage alone (n = 16) in terms of participant-rated pain relief or quadriceps and hamstring strengthening. In the ultrasound and ice massage group, 46% (6 of 13) reported improved pain relief compared to 31% (4 of 13) in the ice massage alone group. This difference of 15% does not meet international standards for clinically important improvements in osteoarthritis, which is 20%. Side effects were not reported. AUTHORS' CONCLUSIONS: Ultrasound therapy was not shown to have a clinically important effect on pain relief for people with patellofemoral pain syndrome. These conclusions are limited by the poor reporting of the therapeutic application of the ultrasound and low methodological quality of the one trial included. No conclusions can be drawn concerning the use, or non-use, of ultrasound for treating patellofemoral pain syndrome. More well-designed studies are needed.

Ottawa Panel evidence-based clinical practice guidelines on therapeutic massage for low back pain.

OBJECTIVE: To update evidence-based clinical practice guidelines (EBCPG) on massage therapy compared to control or other treatment for adults (>18 years) suffering from acute, sub-acute and chronic low back pain (LBP). METHODS: A literature search was performed for relevant articles between January 1, 1948 and December 31, 2010. Eligibility criteria were then applied focussing on participants, interventions, controls, and outcomes, as well as methodological quality. Recommendations based on this evidence were then assigned a grade (A, B, C, C+, D, D+, D-) based on their strength. RESULTS: A total of 100 recommendations were formulated from 11 eligible articles, including 37 positive recommendations (25 grade A and 12 grade C+) and 63 neutral recommendations (49 grade C, 12 grade D, and 2 grade D+). DISCUSSION: These guidelines indicate that massage therapy is effective at providing pain relief and improving functional status. CONCLUSION: The Ottawa Panel was able to demonstrate that massage interventions are effective to provide short term improvement of sub-acute and chronic LBP symptoms and decreasing disability at immediate post treatment and short term relief when massage therapy is combined with therapeutic exercise and education.

Ottawa Panel evidence-based clinical practice guidelines on therapeutic massage for neck pain.

OBJECTIVE: To update evidence-based clinical practice guideline (EBCPG) on the use of massage compared to a control or other treatments for adults (>18 years) suffering from sub-acute and chronic neck pain. METHODS: A literature search was performed from January 1, 1948 to December 31, 2010 for relevant articles. The Ottawa Panel created inclusion criteria focusing on high methodological quality and grading methods. Recommendations were assigned a grade (A, B, C, C+, D, D+, D-) based on strength of evidence. RESULTS: A total of 45 recommendations from ten articles were developed including 8 positive recommendations (6 grade A and 2 grade C+) and 23 neutral recommendations (12 grade C and 11 grade D). DISCUSSION: Therapeutic massage can decrease pain, tenderness, and improve range of motion for sub-acute and chronic neck pain. CONCLUSION: The Ottawa Panel was able to demonstrate that the massage interventions are effective for relieving immediate post-treatment neck pain symptoms, but data is insufficient for long-term effects.

Development and validation of the interprofessional collaborator assessment rubric (ICAR).

There have been increasing calls for a competency-based approach in interprofessional education (IPE). The purpose of this multi-site research project was to develop a validated set of interprofessional collaborator competencies and an associated competency-based assessment rubric, in both English and French languages. The first phase involved a detailed comparative analysis of peer-reviewed and grey literature using typological analysis to construct a draft list of interprofessional collaborator competency categories and statements. A two-round Delphi survey of experts was undertaken to validate these competencies. In the second phase, an assessment rubric was developed based on the validated competencies and then evaluated for utility, clarity, practicality and fairness through multi-site focus groups with students and faculty at both college and university levels. The paper outlines an approach to developing, constructing and validating a bilingual instrument for interprofessional learning and assessment. The approach was collaborative in nature, involving an interprofessional project team and respondents from across multiple health profession education programs. The Delphi survey ratings indicate a high level of agreement with the importance of the competency statements and focus group participants rated the rubric positively and felt it had value. The focus group results were also useful in pre-piloting the contextual application of the instrument across multiple health profession education programs. This rubric instrument may be used across a variety of professions and learning contexts. Future work includes evaluation of further dimensions of validity and reliability for this tool across a variety of settings.

Ottawa Panel evidence-based clinical practice guidelines for the management of osteoarthritis in adults who are obese or overweight.

BACKGROUND AND PURPOSE: The objective of this review was to construct an updated evidence-based clinical practice guideline on the use of physical activity and diet for the management of osteoarthritis (OA) in adults (>18 years of age) who are obese or overweight (body mass index ≥25 kg/m(2)). DATA SOURCES: Articles were extracted from the following databases: MEDLINE, EMBASE (Current Contents), SPORTDiscus, SUM, Scopus, CINAHL, AMED, BIOMED, PubMed, ERIC, the Cochrane Controlled Trials, and PEDro. STUDY SELECTION: The Ottawa Panel and research assistance team strictly applied the inclusion and exclusion criteria from previous Ottawa Panel publications. DATA EXTRACTION: An a priori literature search was conducted for articles related to obesity and OA of the lower extremities that were published from January 1, 1966, to November 30, 2010. Inclusion criteria and the methods to grade the recommendations were created by the Ottawa Panel. RECOMMENDATIONS: were graded based on the strength of evidence (A, B, C, C+, D, D+, or D-) as well as experimental design (I for randomized controlled trials and II for nonrandomized studies). In agreement with previous Ottawa Panel methods, Cochrane Collaboration methods were utilized for statistical analysis. Clinical significance was established by an improvement of ≥15% in the experimental group compared with the control group. There were a total of 79 recommendations from 9 articles. From these recommendations, there were 36 positive recommendations: 21 grade A and 15 grade C+. There were no grade B recommendations, and all recommendations were of clinical benefit. LIMITATIONS: Further research is needed, as more than half of the trials were of low methodological quality. CONCLUSIONS: This review suggests that physical activity and diet programs are beneficial, specifically for pain relief (9 grade A recommendations) and improved functional status (6 grade A and 7 grade C+ recommendations), for adults with OA who are obese or overweight. The Ottawa Panel was able to demonstrate that when comparing physical activity alone, diet alone, physical activity combined with diet, and control groups, the intervention including physical activity and diet produced the most beneficial results.

[Not Available]. / Une version canadienne française du Lower Extremity Functional Scale (LEFS) : L'Échelle fonctionnelle des membres inférieurs (ÉFMI), partie I.

INTRODUCTION: The Rehabilitation Network of Ottawa-Carleton (RENOC) recommends that its institutions use the Lower Extremity Functional Scale (LEFS). Since RENOC serves both Francophone and Anglophone clients, the LEFS needed to be translated to assess the Francophone clientele. OBJECTIVE: To create a French-Canadian version of the LEFS, with the proposed title "Échelle fonctionnelle des membres inférieurs" (ÉFMI), and to examine its content validity. METHODOLOGY: A modified version of Vallerand's (1989) cross-validation technique for questionnaires was used to validate the equivalence of the French version of the LEFS. First, a parallel reverse translation of the LEFS was completed. Second, a committee of experts examined the two drafts and created a first experimental version of the ÉFMI. Third, this version was evaluated by a second committee of experts. Following the comments received, a second experimental version was created. Fourth, 35 rehabilitation professionals evaluated the second experimental version of the ÉFMI on a scale of ambiguity and proposed final changes. RESULTS: On the final version of the ÉFMI, the statements demonstrated a relatively low average level of ambiguity, ranging between 1 and 2.54. CONCLUSION: The rigorous four-step process followed in this study produced a French-Canadian version of the LEFS with demonstrated content validity.

[Not Available]. / Fiabilité test retest et validité de construit de la version française de L'Échelle fonctionnelle des membres inférieurs (ÉFMI), partie II.

INTRODUCTION: The Lower Extremity Functional Scale was translated into Canadian French in 2006; the translated version was titled Échelle fonctionnelle des membres inférieurs (EFMI). The construct validity and reliability of the EFMI have not been examined. OBJECTIVE: To examine the test-retest reliability, internal consistency, and construct validity of the EFMI. METHODOLOGY: Thirty-four participants who had undergone surgery or had an injury to the lower limb were asked to fill out a demographic questionnaire and complete the EFMI after their initial assessment while hospitalized. They completed the EFMI a second time within 72 hours. The intra-class correlation coefficient (ICC) and the kappa coefficient were chosen to examine the test-retest reliability of the EFMI, and Cronbach's alpha coefficient was calculated to assess internal consistency. A factor analysis was conducted to examine construct validity by determining the number of constructs and their meanings. RESULTS: The ICC value was 0.92 (95% CI: 0.88-0.96), and Cronbach's alpha was 0.95 (95% CI: 0.91-0.99). The factor analysis revealed that all elements of the EFMI share one principal construct. CONCLUSION: The results demonstrate that the French-Canadian version of the EFMI is a unidimensional tool with excellent test-retest reliability.

W(e)Learn: a framework for online interprofessional education.

A framework is required to guide online Interprofessional Education (IPE) (Casimiro et al., 2009). The purpose of this paper is to present such a framework: W(e)Learn. W(e)Learn can be used as a quality standard and a guide to design, develop, deliver and evaluate online IPE in both pre- and post-qualification educational settings. The framework is presented in the spirit that educational programs have defining features that, when carefully designed with the appropriate blend of factors, can help achieve desired outcomes. W(e)Learn must now be applied in various contexts to assess its constructs and its applicability.

Canadian physiotherapists' views on certification, specialisation, extended role practice, and entry-level training in rheumatology.

BACKGROUND: Since the last decade there has been a gradual change of boundaries of health professions in providing arthritis care. In Canada, some facilities have begun to adopt new arthritis care models, some of which involve physiotherapists (PT) working in extended roles. However, little is known about PTs' interests in these new roles. The primary objective of this survey was to determine the interests among orthopaedic physiotherapists (PTs) in being a certified arthritis therapist, a PT specialized in arthritis, or an extended scope practitioner in rheumatology, and to explore the associated factors, including the coverage of arthritis content in the entry-level physiotherapy training. METHODS: Six hundred PTs practicing in orthopaedics in Canada were randomly selected to receive a postal survey. The questionnaire covered areas related to clinical practice, perceptions of rheumatology training received, and attitudes toward PT roles in arthritis care. Logistic regression models were developed to explore the associations between PTs' interests in pursuing each of the three extended scope practice designations and the personal/professional/attitudinal variables. RESULTS: We received 286 questionnaires (response rate = 47.7%); 258 contained usable data. The average length of time in practice was 15.4 years (SD = 10.4). About 1 in 4 PTs agreed that they were interested in assuming advanced practice roles (being a certified arthritis therapist = 28.9%, being a PT specialized in rheumatology = 23.3%, being a PT practitioner = 20.9%). Having a caseload of > or = 40% in arthritis, having a positive attitude toward advanced practice roles in arthritis care and toward the formal credentialing process, and recognizing the difference between certification and specialisation were associated with an interest in pursing advanced practice roles. CONCLUSION: Orthopaedic PTs in Canada indicated a fair level of interest in pursuing certification, specialisation and extended scope practice roles in arthritis care. Future research should focus on the effectiveness and cost-effectiveness of the emerging health service delivery models involving certified, specialized or extended scope practice PTs in the management of arthritis.

Grounding theories of W(e)Learn: a framework for online interprofessional education.

Interprofessional care (IPC) is a prerequisite for enhanced communication between healthcare team members, improved quality of care, and better outcomes for patients. A move to an IPC model requires changing the learning experiences of healthcare providers during and after their qualification program. With the rapid growth of online and blended approaches to learning, an educational framework that explains how to construct quality learning events to provide IPC is pressing. Such a framework would offer a quality standard to help educators design, develop, deliver, and evaluate online interprofessional education (IPE) programs. IPE is an extremely delicate process due to issues related to knowledge, status, power, accountability, personality traits, and culture that surround IPC. In this paper, a review of the pertinent literature that would inform the development of such a framework is presented. The review covers IPC, IPE, learning theories, and eLearning in healthcare.

Health information systems design to support a nursing model of care: opportunities and challenges.

The design and implementation of health information systems (HISs) in team-based settings is complex owing to the multiple users with different perspectives who interact with the system. We argue that such perspectives must be understood prior to designing and implementing HISs. One specific type of team-based model is a nursing care model. In such a model, care is provided through an interdisciplinary team that is lead by the nursing staff. We analyze a nursing-based model of care according to the context of the organization, clinical unit, and individual as defined by the Contextual Implementation Model [1]. We then discuss how the nursing model will be affected by automation using different HISs.