Developing a consolidated research framework for clinical allied health professionals practising in the UK.

BACKGROUND: Allied Health Professionals (AHPs) form a significant part of the healthcare workforce and have great potential to improve services through research and research-informed practice. However, there is a lack of tradition in research embedded in practice in these professional groups. Barriers include clinical caseload pressures, a lack of sustainable training and consequent lack of confidence in practitioners. Practice managers are ill-equipped to monitor and guide staff research development. The modern healthcare system is a multi-disciplinary environment focused on the needs of the patient. A common framework across all AHP disciplines, offering equality in research knowledge and skills and shared language, might be helpful in planning and developing clinical career pathways. Our aim is to develop a consolidated research framework to help AHPs to plan and guide research activity throughout their career. METHODS: The study was conducted in three phases. Phase one identified existing AHP research frameworks (AHPRF) through expert consultations and literature searches. Phase two involved framework analysis of the AHPRFs to develop a single consolidated framework. Phase three included a workshop with experts to validate and adapt the framework for practice. RESULTS: Nineteen AHPRFs were identified. A consolidated framework was shaped by analysis of the AHPRFs resulting in a consolidated framework of eight sections, each containing a series of statements. Each section relates to an analytic theme within the framework analysis, and the statements were based on sub-categories of themes. The final framework was further shaped by the phase three workshop into a set of 'stem' statements that can be adapted to reflect different levels of expertise and the inclusion of a set of guiding principles developed through expert consultation. CONCLUSION: The consolidated framework was entitled 'Shaping Better Practice Through Research: A Practitioner Framework' by stakeholders, thus emphasising its ambition to embed research activity into practice. It instigates a new perspective within AHP research by offering practitioners and managers a tool that can be applied across public, private, and voluntary settings for AHPs in all disciplines. Its ambition is to develop capacity in the AHPs that can undertake research to improve services and the health of service users.

A grounded theory study of the narrative behind Indian physiotherapists global migration.

It is estimated that an additional 6.4 million allied health professionals are required to address India's health challenges. Physiotherapy is amongst the largest of these professions. Over the last decade, thousands of Indian physiotherapists have sought to study and work overseas. In this study, 19 physiotherapists from across India were interviewed. Data were collected and analysed using construct+ivist grounded theory methods. The findings indicate that the Indian physiotherapy profession faces many political and clinical hierarchical challenges within the Indian healthcare infrastructure. The profession's education provision has developed, and the private clinical sector has grown, but there are significant disparities in quality and standards across the sector. The profession in India has variable autonomy, is not nationally regulated, is poorly paid, and the leadership has been divided. The political, educational, and clinical context in Indian physiotherapy impacts upon physiotherapists' ability to practise effectively to their professional satisfaction. Individual physiotherapists are frustrated by their workplace and travel overseas where they hear that the physiotherapy profession and practice is different. Whilst the disjunctures influencing these factors continue, and overseas physiotherapy practice is perceived as different and superior, Indian physiotherapists will continue to seek to migrate overseas, and facilitating their return will be challenging.

Barriers and Motivators of Physical Activity Participation in Middle-aged and Older-adults - A Systematic Review.

Identifying the difference in barriers and motivators between middle-age and older adults could contribute toward the development of age-specific health promotion interventions. The aim of this review was to synthesize the literature on barriers and motivators for physical activity in middle-aged (50-64 years) and older adults (65-70 years). The review examined qualitative and quantitative studies using the theoretical domain framework as the guiding theory. The search generated 9400 results from seven databases. A total of fifty-five articles meeting the inclusion criteria. Results indicate that barriers are comparable across the two age groups with environmental factors and resources being the most commonly identified barriers. In older adults, social influences, reinforcement and assistance in managing change were the most identified motivators. Middle-aged identified goals settings, believe that activity will be beneficial and social influences were most important. Findings can be used by professionals to encourage engagement with and adherence to physical activity.

Decision-making processes in image guided radiotherapy: A think aloud study.

INTRODUCTION: 3D Image Guided Radiotherapy (IGRT) using Cone Beam Computer Tomography (CBCT) has been implemented for a range of treatment sites across the UK in the last decade. A paucity of evidence exists to understand how radiation therapists (RTTs) make clinical decisions during image interpretation as part of the IGRT process. The aim of this study was to investigate the decision-making processes used by RTTs during image interpretation of IGRT. METHOD: Case study methodology was adopted utilising a think aloud observational method with follow-up interviews. 12 RTTs were observed and interviewed across three UK radiotherapy centres. Participants were observed reviewing and making clinical decisions in a simulated environment using clinical scenarios developed in partnership with each centres' Clinical Imaging Lead. Protocol analysis was used to analyse the observational data and thematic analysis was used to analyse the interview data. RESULTS: A range of approaches to decision-making was observed which varied in length from nine phrases to 57 (mean 24) per case. Six themes emerged from the data: Set Sequence, Site Specific Clinical Priorities, Initial Gross Review, Decision to treat, Compromise and experience. In addition, three cognitive decision-making processes were identified: Simple linear, Linear repeating and Intuitive decision-making process. The findings of the study align with general principles of expert performance, whereby experience in a specific scope of practice is more beneficial in developing expertise than overall experience. CONCLUSION: This study has provided new and original insight in the decision-making processes of RTTs. The study has highlighted three process models to explain how RTTs make decisions during IGRT: Simple linear, Linear repeating and Intuitive decision-making process. Intuitive processes are widely accepted to be error prone and linked to bias. When using this process, some RTTs followed this with a confirmation phase. This second phase of the process should be encouraged when teaching IGRT. The results of the study support the concept of expert performance, where performance and expertise are only improved by exposing individuals to specific types of experiences. RTTs, managers and Higher Education Institutions are encouraged to review these models and implement them into IGRT training. It is clear from the evidence base that understanding how we make decisions, enables us to develop expertise and reduce errors during the decision-making process.

Psychometric testing of the Maltese versions of the Exercise Benefits/Barriers Scale and Exercise Motivation Inventory - 2.

Background: Consideration of psychological factors towards exercise participation is important, especially when placed within a cultural context. Objective: The aim of this study was to translate the Exercise Benefits/Barriers Scale and Exercise Motivation Inventory-2 to Maltese and undertake psychometric testing. Methods: Maltese-speaking participants (n = 170) aged 18 to 69 years were recruited. 72% completed both questionnaires twice within an 8-to 48-hour period. Reliability was calculated using the Spearman correlation, intraclass correlation coefficient, and Bland-Altman plots. Convergent construct validity was tested using Spearman correlation between theoretical variables. Results: In total 155 participants completed the questionnaires at both time points. The test/re-test reliability of the two questionnaires was >0.7 for all analyses. Correlations for validity were statistically significant (p < 0.05). Conclusion: The translated tools have similar psychometric properties to the original version; the authors recommend that health care professionals and physical activity practitioners use these tools when examining population-level physical activity behaviour among Maltese-speaking individuals.

Physical Activity and Sedentary Behaviour with Retirement in Maltese Civil Servants: A Dialectical Mixed-Method Study.

(1) Background: Retirement is a life event that can influence physical activity (PA) and sedentary behaviour (SB) and can be used as an opportunity to promote positive lifestyle choices. The aims of this study were to (a) to identify changes in PA and SB resulting from retirement and (b) to explore predictors of any changes in PA and SB following retirement in Maltese civil servants. (2) Methods: a hybrid mixed-method (MM) study, using first quantitative followed by qualitative methods, of civil servants aged ≥60 years, who were followed during their retirement transition for two years. A proportion of the research participants in the MM study retired while the others remained employed. Questionnaires and semi-structured interviews were used to collect data. (3) Results: there were no changes in total PA and sitting behaviour with retirement in Maltese civil servants. People who retired carried out more domestic PA compared to when they were in employment, which resulted in more moderate-intensity PA behaviour. People perceived that their sitting time increased with retirement in the qualitative interviews, but this was not observed in the quantitative data. Past PA behaviour was an important predictor of future PA behaviour, but not for SB. (4) Conclusions: A change in PA occurs with the retirement transition. However, the uptake of exercise is a personal choice that is dependent on previous experience. Increasing SB is perceived as part of the retirement plan but is not necessarily seen in the measured quantitative data.

"It is Easy to do Nothing and Easy to Sit Down": Perceptions of Physical Activity and Sedentary Behaviors During Pre-retirement.

This study explored the insights of old age pre-retirement employees towards physical activity and sedentary behavior. A quota sampling of 20 participants from within the Civil Service in Malta were invited to an interview. Participants who were included met the statutory requirement for retirement within the subsequent 6 months to 1 year. Semi-structured interviews were conducted using a narrative approach. Structural narrative analysis and reflective thematic analysis were used. The story structure highlighted the significance of the individual experiences on the perceptions towards future physical activity during retirement. Two themes were identified using the thematic analysis, influencers, and perceptions. Triangulation identified that sedentary behavior was not part of the narration. The transition from work to retirement is a unique and personal experience and therefore when promoting an active lifestyle, the individual experience and past behaviors must be actively considered.

The motivations and aspirations of Indian physiotherapists who migrate overseas to study and work: a grounded theory study.

OBJECTIVE: To explore why Indian physiotherapists seek to migrate overseas for study and work. DESIGN: Qualitative research using Constructivist Grounded Theory (CGT) methodology. SETTING: Individual interviews and focus groups were conducted in the UK and India, at university, clinic or hotel locations convenient to the participants. PARTICIPANTS: Nineteen physiotherapists from across India. Thirteen had studied or worked in the UK, Australia or Kuwait, and six had no overseas experience. FINDINGS: The participants desired a 'better life' due to factors perceived as less favourable in India: pay levels, professional respect and professional development. These elements were inter-dependent and their importance varied between participants and according to gender. Indian societal values amplified the importance of pay for male physiotherapists, whereas females prioritised professional development. Migrant physiotherapists aspired to professional autonomy through the development of knowledge, skills and experience. Respect was important, but there were different perspectives on its achievement and the relevance of titles. For those studying overseas, work was sought to recoup the cost of that study, and, importantly to consolidate learning and experience of autonomous physiotherapy practice. They all planned to return to India and wished to transfer their knowledge and skills back into practice in India. CONCLUSION: Pay, respect and professional development are all motivators for Indian physiotherapists to study and work overseas. An ability to practise physiotherapy autonomously is a key factor underpinning the achievement of each of these elements and thus the ultimate aspiration to have a 'better life'.

A systematic review of grounded theory studies in physiotherapy.

Aim: This systematic review aimed at appraising the methodological rigor of grounded theory research published in the field of physiotherapy to assess how the methodology is understood and applied. A secondary aim was to provide research implications drawn from the findings to guide future grounded theory methodology (GTM) research. Methods: A systematic search was conducted in MEDLINE, CINHAL, SPORT Discus, Science Direct, PubMed, Scopus, and Web of Science to identify studies in the field of physiotherapy that reported using GTM and/or methods in the study title and/or abstract. The descriptive characteristics and methodological quality of eligible studies were examined using grounded theory methodology assessment guidelines. Findings: The review included 68 studies conducted between 1998 and 2017. The findings showed that GTM is becoming increasingly used by physiotherapy researchers. Thirty-six studies (53%) demonstrated a good understanding and appropriate application of GTM. Thirty-two studies (47%) presented descriptive findings and were considered to be of poor methodological quality. Conclusions: There are several key tenets of GTM that are integral to the iterative process of qualitative theorizing and need to be applied throughout all research practices including sampling, data collection, and analysis.

'Student-y or studious': An exploration of students' perceptions of parallel learning in preregistration physiotherapy education.

BACKGROUND/AIM: Within the United Kingdom (UK), physiotherapy preregistration training is provided at both undergraduate and postgraduate level at 17 higher education institutions (HEIs). Some course teams approach this by teaching preregistration BSc and MSc students simultaneously to meet the same learning outcomes. This is often termed "parallel learning" and it is not known how students perceive this mode of learning. The aim of the study was to explore the perceived benefits and challenges to parallel learning of preregistration BSc and MSc physiotherapy students. METHODS: Students from two different UK-based HEIs participated in an exploratory qualitative research design, with data collected in focus groups of each cohort and HEI. Data were analyzed using thematic analysis. RESULTS: Several themes arose from student perceptions of parallel learning that were sceptical: "starting over again," "misunderstanding each other's motivations," "establishing knowledge hierarchies," and "competing for space". However, some themes emerged from students reflections on the perceived benefits of parallel learning including "healthy competition" and "learning from difference." CONCLUSIONS: It is clear from findings that students perceive the benefits of parallel learning of mixed groups. However, to avoid perceptions that it is merely cost cutting, learning resources need to be maintained and from the outset clear explanations of the purposes should be given to students.

Test-retest reliability of the Short-Form McGill Pain Questionnaire: assessment of intraclass correlation coefficients and limits of agreement in patients with osteoarthritis.

OBJECTIVES: No previous study has adequately demonstrated the test-retest reliability of the Short-Form McGill Pain Questionnaire, yet it is increasingly being used as a measure of pain. This study evaluates the test-retest reliability in patients with osteoarthritis. METHODS: A prospective, observational cohort study was undertaken using serial evaluation of 57 patients at 2 time points. A sample of patients awaiting primary hip or knee joint replacement surgery were recruited in clinic or via mail (mean age 64.8 years). Short-Form McGill Pain Questionnaires were delivered by mail 5 days apart, and a supplementary questionnaire was completed on the second occasion to explore if the patients' pain report had remained stable. RESULTS: The intraclass correlation coefficient was used as an estimate of reliability. For the total, sensory, affective, and average pain scores, high intra-class correlations were demonstrated (0.96, 0.95, 0.88, and 0.89, respectively). The current pain component demonstrated a lower intraclass correlation of 0.75. The coefficient of repeatability was calculated as an estimation of the minimum metrically detectable change. The coefficients of repeatability for the total, sensory, affective, average, and current pain components were 5.2, 4.5, 2.8, 1.4 cm, and 1.4, respectively. DISCUSSION: Problems of adequate completion of the Short-Form McGill Pain Questionnaire were highlighted in this sample, and supervision via telephone contact was required. Patients recruited in clinic who had practiced completing the Short-Form McGill Pain Questionnaire demonstrated fewer errors than those recruited by mail. The Short-Form McGill Pain Questionnaire was demonstrated to be a highly reliable measure of pain. These results should not be generalized to a more elderly population, as increasing age was correlated with greater variability of the sensory component scores.

A survey on the use of outcome measures by musculoskeletal physiotherapist's in India.

In recent times, there has been great pressure on physiotherapists to become accountable for their practices and to provide evidence for effectiveness of their treatment. Therefore, it has become necessary to integrate standardised outcome measures (OMs) into clinical practice and boost evidence-based practice. The aim of this study was to determine the extent of use of outcome measures among physiotherapists in India and to identify the commonly used measures. A survey was conducted using a questionnaire consisting of 23 closed-ended questions. It was administered face-to-face and via email to Indian physiotherapists working with musculoskeletal patients. The response rate was 54% (n = 81). The results indicated 80% of the respondents used OMs with impairment-based measures being the most commonly used. Education qualifications, years of work experience and workplace setting were not significantly associated with utilisation of OMs. Various benefits and barriers to use of OMs were also identified. The findings of this study give insight into possible changes that could be incorporated in clinical practice and educational system for developing a standardised level of assessing patients and to tailor future implementation strategies.

The intra and inter-rater reliability of a modified weight-bearing lunge measure of ankle dorsiflexion.

This study assessed the intra and inter-rater reliability of a modified weight-bearing lunge measure of ankle dorsiflexion range of movement. Thirteen healthy subjects were recruited. Each subject performed 3 repetitions of the lunging method with one rater and 3 more repetitions with a second rater within 30 min. The process was repeated within 3 h. Intra-rater reliability results indicated excellent correlation of measurements (intraclass correlation coefficients (ICCs) of 0.98-0.99). Standard error of measurement (SEM), 95% limits of agreement (LOA) and coefficient of repeatability (CR) calculations indicated suitably low ranges of measurement variance (SEM = 0.4 cm, LOA = ± 1.28 to ± 1.47 cm and CR = 1.21-1.35 cm). Inter-rater reliability was also deemed excellent (ICC = 0.99, SEM = 0.3 cm, LOA = ± 0.83 to ± 1.47 cm, CR = 1.44 cm). The modified lunge technique therefore demonstrates excellent intra and inter-rater reliability.