Fluid professional boundaries: ethnographic observations of co-located chiropractors, osteopaths and physiotherapists.

BACKGROUND: Chiropractors, osteopaths and physiotherapists (COPs) can assess and manage musculoskeletal conditions with similar manual or physical therapy techniques. This overlap in scope of practice raises questions about the boundaries between the three professions. Clinical settings where they are co-located are one of several possible influences on professional boundaries and may provide insight into the nature of these boundaries and how they are managed by clinicians themselves. OBJECTIVES: To understand the nature of professional boundaries between COPs within a co-located clinical environment and describe the ways in which professional boundaries may be reinforced, weakened, or navigated in this environment. METHODS: Drawing from an interpretivist paradigm, we used ethnographic observations to observe interactions between 15 COPs across two clinics. Data were analysed using reflexive thematic analysis principles. RESULTS: We identified various physical and non-physical 'boundary objects' that influenced the nature of the professional boundaries between the COPs that participated in the study. These boundary objects overall seemed to increase the fluidity of the professional boundaries, at times simultaneously reinforcing and weakening them. The boundary objects were categorised into three themes: physical, including the clinic's floor plan, large and small objects; social, including identities and discourse; and organisational, including appointment durations and fees, remuneration policies and insurance benefits. CONCLUSIONS: Physical, social, organisational related factors made the nature of professional boundaries between COPs in these settings fluid; meaning that they were largely not rigid or fixed but rather flexible, responsive and subject to change. These findings may challenge patients, clinicians and administrators to appreciate that traditional beliefs of distinct boundaries between COPs may not be so in co-located clinical environments. Both clinical practice and future research on professional boundaries between COPs may need to further consider some of these broader factors.

Fostering collaborative practice through interprofessional simulation for occupational therapy, physiotherapy, dietetics, and nursing students.

Literature regarding simulation for learning interprofessional collaborative practice (IPCP) indicates a need to include a range of health professions and to focus on students' development of team communication and conflict resolution skills in day-to-day healthcare delivery. This study evaluated the impact of interprofessional simulation for occupational therapy, physiotherapy, dietetics, and nursing students on interprofessional collaboration competencies, specifically collaborative communication and conflict resolution during day-to-day interactions, and their intention for IPCP during placement. A series of simulations featuring the potential for interprofessional conflict and involving explicit coaching on communication and conflict resolution were conducted. A single cohort pre-test post-test design included the Students' Perceptions of Interprofessional Clinical Education Revised (SPICE-R), the Interprofessional Collaborative Competencies Attainment Survey (ICCAS), and an open response survey question on future intended practice. A total of 237 students participated in the simulation experience. Overall scores and scores on all IPCP competencies in the ICASS (n = 193) and SPICE-R (n = 226) improved for all professions post-simulation. The mean score of the ICCAS increased for 98% of the respondents and similarly the mean score of the SPICE-R increased for 71% of the respondents. Open-ended responses indicated students' intentions to pursue self-leadership in IPCP. Students who participated in an interprofessional simulation reported perceived improvements in IPCP competencies and were encouraged to initiate IPCP when on placement in the practice setting.

Systematic review of distributed practice and retrieval practice in health professions education.

To determine the effect of distributed practice (spacing out of study over time) and retrieval practice (recalling information from memory) on academic grades in health professions education and to summarise a range of interventional variables that may affect study outcomes. A systematic search of seven databases in November 2022 which were screened according to predefined inclusion criteria. The Medical Education Research Study Quality Instrument (MERSQI) and Newcastle-Ottawa Scale-Education (NOS-E) were used to critically appraise eligible articles. A summary of interventional variables includes article content type, strategy type, assessment type and delay and statistical significance. Of 1818 records retrieved, 56 were eligible for inclusion and included a total of 63 experiments. Of these studies, 43 demonstrated significant benefits of distributed practice and/or retrieval practice over control and comparison groups. Included studies averaged 12.23 out of 18 on the MERSQI and averaged 4.55 out of 6 on the NOS-E. Study designs were heterogeneous with a variety of interventions, comparison groups and assessment types. Distributed practice and retrieval practice are effective at improving academic grades in health professions education. Future study quality can be improved by validating the assessment instruments, to demonstrate the reliability of outcome measures. Increasing the number of institutions included in future studies may improve the diversity of represented study participants and may enhance study quality. Future studies should consider measuring and reporting time on task which may clarify the effectiveness of distributed practice and retrieval practice. The stakes of the assessments, which may affect student motivation and therefore outcomes, should also be considered.

What should all health professionals know about movement behaviour change? An international Delphi-based consensus statement.

The WHO has called for action to integrate physical activity promotion into healthcare settings, yet there is a lack of consensus on the competencies required by health professionals to deliver effective movement behaviour change support. The objective of this study was to establish key competencies relevant for all health professionals to support individuals to change their movement behaviours. Consensus was obtained using a three-phase Delphi process. Participants with expertise in physical activity and sedentary behaviour were asked to report what knowledge, skills and attributes they believed health professionals should possess in relation to movement behaviour change. Proposed competencies were developed and rated for importance. Participants were asked to indicate agreement for inclusion, with consensus defined as group level agreement of at least 80%. Participants from 11 countries, working in academic (55%), clinical (30%) or combined academic/clinical (13%) roles reached consensus on 11 competencies across 3 rounds (n=40, n=36 and n=34, respectively). Some competencies considered specific to certain disciplines did not qualify for inclusion. Participants agreed that health professionals should recognise, take ownership of, and practise interprofessional collaboration in supporting movement behaviour change; support positive culture around these behaviours; communicate using person-centred approaches that consider determinants, barriers and facilitators of movement behaviours; explain the health impacts of these behaviours; and recognise how their own behaviour influences movement behaviour change support. This consensus defines 11 competencies for health professionals, which may serve as a catalyst for building a culture of advocacy for movement behaviour change across health disciplines.

The impact of rural nursing and midwifery clinical placements from the perspective of health service staff.

OBJECTIVE: To explore the impact of providing nursing and midwifery student placements from the perspective of regional, rural and remote health service staff involved in hosting students. SETTING: Hospital and health services across regional, rural and remote southern Queensland. PARTICIPANTS: Thirty-six nursing and midwifery staff working in clinical and/or management roles who were direct clinical supervisors of students or in leadership positions with responsibility for overseeing and supporting clinical placements. DESIGN: Semi-structured interviews exploring the experiences and perspectives of nursing and midwifery health service staff who support student placements. Data were subject to thematic analysis. RESULTS: Five key themes were identified as follows: (a) bringing new ideas and perspectives, (b) opportunities for development, (c) supporting the future rural workforce (d) impacts on workload and productivity and (e) strategies for balancing supervision. CONCLUSION: The results indicate that there are a range of perceived benefits and challenges of providing nursing and midwifery student placements within regional, rural and remote settings. The findings also indicate that there are opportunities to further support rural health services to optimise the positive impacts and mitigate the challenges of providing placements. To do so requires collaboration between health services and education providers to allocate students appropriately to health services and support health service staff.

Physiotherapy students' empathy towards Australians living in rural settings: A pre-test post-test evaluation of a stand-alone rural simulation activity.

OBJECTIVE: To investigate how a rural simulation activity influenced physiotherapy students' rural empathy, and to explore students' perception of the activity. SETTING: A metropolitan university in Queensland, Australia. PARTICIPANTS: Second year undergraduate physiotherapy students. DESIGN: A single cohort pre-test post-test evaluation was undertaken to evaluate a rural simulation activity. Participants received the rural simulation activity, featuring an immersive video and telehealth simulation with a standardised patient portrayed by an actor. Participants undertook a structured debrief and guided reflection following the simulation. Outcome measures included the Rural Comprehensive State Empathy Scale (R-CSES) and the Satisfaction with Simulation Experience Scale. Group interviews were undertaken regarding participant perceptions of the activity. Wilcoxon Rank-Sum tests were used to analyse survey data, and group interview data were subject to thematic analyses. RESULTS: A total of 102 students undertook the activity, with an outcome measure response rate of 92.2% (94/102). Intra-personal rural empathy increased following the activity as demonstrated by the overall R-CSES score [pre-test: 101.5 (90-110.75) vs post-test 107 (100-120); p = <0.001; r = 0.39]. There was high satisfaction with the experience [mean SSES score = 18/21]. Two themes were generated from the group interview data: (1) effect on perceptions of rural practice and (2) feedback regarding the simulation. CONCLUSION: A rural simulation activity using an immersive video, standardised patient, and a structured debrief increased physiotherapy students' empathy towards Australians living in rural settings. Students were satisfied with the activity and felt that it improved their understanding of the challenges of rural healthcare.

The management experiences, needs and preferences of individuals seeking care for persistent intra-articular temporomandibular disorders: A qualitative study.

BACKGROUND: Little is known about the management experiences, needs and preferences of individuals seeking care for persistent intra-articular temporomandibular disorders (TMD). Investigating these experiences may improve understanding of the impact management has on individuals, and factors that shape these experiences. This information may advance current practice and guide future management of individuals with intra-articular TMD. OBJECTIVES: To investigate the management experiences, needs and preferences of individuals with persistent intra-articular TMD. METHODS: A qualitative study was performed. Thirteen eligible participants (mean age 32.7 years, 12 female) were recruited via purposive sampling, and interviewed using a semi-structured framework. Data were analysed using a thematic analysis approach. RESULTS: Four themes were established from interview data: (i) searching for help; (ii) wanting answers; (iii) wanting to regain control; and (iv) meeting needs, preferences and expectations, and the implications on care. Numerous factors influenced the experiences of those seeking care, including the ability to navigate care and management expectations. Specific to intra-articular TMD, the absence of pain made seeking care harder, and often, patients perceived neglect of mechanical symptoms by healthcare practitioners, which negatively impacted care. Often, those wanting management expressed the need for answers and to regain control over their jaw symptoms. CONCLUSIONS: Strategies to improve healthcare navigation are needed for those wanting help for intra-articular TMD. Within management, a person-centred approach is encouraged. Practitioners should respect individuals' specific needs and preferences, and address underlying management expectations, to facilitate positive care experiences. Consideration of symptoms other than pain in intra-articular TMD populations is paramount.

Physiotherapy new graduate self-efficacy and readiness for interprofessional collaboration: a mixed methods study.

Effective interprofessional collaboration is a required competency for all health professionals including physiotherapists. Little is known about new graduate physiotherapists' self-efficacy and readiness for interprofessional collaboration. A sequential mixed-methods design was used to examine and explore (a) new graduate self-efficacy and (b) new graduate perception of the role and influence of curricular activities on their readiness for interprofessional collaboration. New graduate physiotherapists completed a self-efficacy measure based on the Interprofessional Care Core Competencies Global Rating Scales, and semi-structured interviews were undertaken and subjected to framework analysis. 150 surveys were completed (response rate 91%). Less than one quarter of all participants agreed or strongly agreed that they were confident in relation to all interprofessional competencies. New graduates attributed their self-efficacy to being directly exposed to interprofessional collaboration in a clinical setting during their placement year. The results demonstrate that new graduate physiotherapists have high self-efficacy communicating with other professionals and understanding their roles, however they have low self-efficacy with interprofessional conflict resolution and providing feedback to others. This study has implications for supporting new graduates in practice, and for preparing physiotherapy students for interprofessional collaboration.

Competencies for entry-level rural and remote physiotherapy practice: a Delphi approach.

INTRODUCTION: Rural physiotherapy is a challenging area of practice that requires clinicians to respond to the unique factors that contribute to rurality. This study aimed to outline an introductory set of competencies that contribute to effective physiotherapy practice in rural Australia. METHODS: A three-round Delphi study was undertaken using a panel of expert physiotherapists. The panel was asked to provide open-ended responses to the following question: 'What unique knowledge, skills, abilities, attributes or other characteristics do physiotherapists need to possess, or learn in order to provide effective physiotherapy specifically in a rural or remote setting?' These responses were then thematically analysed to create competencies. The competencies were evaluated in the subsequent rounds by the Delphi panel. Consensus was set at 80%. Rural and remote experts were determined through criteria including duration of practice, established expert frameworks, and self- or peer nomination. The publicly accessible Australian Physiotherapy Association database was used to access the contact details of 222 physiotherapists working in rural and remote locations across all Australian states and territories. Seventeen expert physiotherapists met inclusion criteria and consented to participation. RESULTS: Seventeen expert physiotherapists completed round one with a 100% response rate. Analysis of the expert panel responses yielded an initial 24 competencies. The second round had a response rate of 94.1%, and the third round 93.8%. A final set of 19 competencies was established. The knowledge, skills and attributes featured in the competencies relate to responsivity to rural locality, adapting to individual community needs and problem solving in response to challenges to practising in rural and remote locations. CONCLUSION: This study has introduced a set of competencies that may contribute towards effective physiotherapy practice in the rural setting. The competencies provide a common language for physiotherapists and their employers, and may be used to guide training or mentorship in this setting.

New-graduate physiotherapists' perceptions of their preparedness for rural practice.

OBJECTIVE: Providing health care in a rural or remote setting requires physiotherapists to adapt to a number of unique challenges. New-graduates working in rural or remote settings must respond to these challenges in addition to those of being a novice practitioner. This study investigated the perceived preparedness of new-graduate physiotherapists for work in rural or remote settings. DESIGN: A qualitative general inductive approach. SETTING: Rural and remote Queensland. PARTICIPANTS: New-graduate physiotherapists   working in rural or remote locations were contacted via a snowballing recruitment strategy. MAIN OUTCOME MEASURE: Semi-structured interviews. RESULTS: Four key themes emerged from the data: (a) adjusting to rural life, (b) embracing opportunities, (c) stepping up to the plate and (d) preparing through authentic experiences. CONCLUSION: New-graduate physiotherapists perceived rural and remote practice to be a challenging but valuable opportunity with many social and professional rewards. The complex clinical demands and unique cultural factors inherent in rural and remote locations were experienced as additional obstacles to the transition from student to clinician. New-graduate physiotherapists were satisfied that their entry-level training provided the necessary skills required to practise rurally and remotely; however, they expressed 'shock' at the rapid adaptations needed to provide effective service in these settings. New-graduates are confident that exposure to authentic rural and remote clinical practice during their training was integral to their preparedness.

Factors associated with patient-reported mouth opening activity limitations in individuals with persistent intra-articular temporomandibular disorders: A cross-sectional study exploring physical and self-reported outcomes.

BACKGROUND: Individuals living with intra-articular temporomandibular disorders (IA-TMDs) often report limitations with mouth opening activities. While clinical measures such as active range of motion (AROM) and movement quality are often used to assess mouth opening function, it is unclear if and how these relate to patient-reported limitations and whether other factors such as kinesiophobia influence mouth opening activities in those with IA-TMDs. OBJECTIVES: Compare clinical measures of mouth opening function in those with IA-TMDs to asymptomatic controls. In those with an IA/TMD, explore relationships between patient-reported mouth opening limitations, and mouth opening function and kinesiophobia. DESIGN: Cross-sectional study. METHOD: Clinical mouth opening function (AROM, movement quality, pain on movement/10, stiffness on movement/10) was compared between groups (n = 30 IA-TMD, n = 30 controls). Within the IA-TMD group, correlations between patient-reported mouth opening limitations (Patient specific functional scale), kinesiophobia (Tampa Scale for Kinesiophobia for Temporomandibular Disorders) and clinical measures of mouth opening function were explored. RESULTS: Impairments in AROM (-4 mm, p = 0.04, d = 0.5), movement quality (p < 0.01, φ = 0.6), pain on movement (p < 0.01, d = 0.8) and stiffness on movement (p < 0.01, d = 1.6) were observed in the IA-TMD group compared to controls. Patient-reported mouth opening limitations and kinesiophobia were significantly correlated (r = -0.48, p < 0.01); no correlation was found between patient-reported limitations and clinical mouth opening measures (r < 0.3, p > 0.05). CONCLUSIONS: Mouth opening function is impaired in IA-TMD. However, kinesiophobia appears more related to patient-reported mouth opening limitations than clinical impairments. Consideration of clinical, kinesiophobia and patient-reported limitation measures are necessary to direct management of IA-TMD in those presenting for care.

Is proprioception affected in those with persistent intra-articular temporomandibular disorders? A cross-sectional study exploring joint position sense and force sense of the jaw.

BACKGROUND: Proprioception is an important component of normal jaw function, although to date it is unknown if and how proprioception is affected in those with intra-articular temporomandibular disorders (IA-TMDs). This challenges effective management of this subgroup. OBJECTIVES: Determine whether differences in local joint position sense and force sense exist between individuals with IA-TMD and those without a jaw problem. DESIGN: Cross-sectional study. METHOD: Sixty age and sex matched participants were recruited (n = 30 IA-TMD, n = 30 healthy controls). Temporomandibular joint position sense was tested to one target (50% of maximal mouth opening) using a ruler. Temporomandibular force sense was tested to two targets (50% and 70% of maximal molar pain-free bite force) using a bite sensor. Constant, absolute and variable errors were calculated for each outcome and compared between groups using p-values and 95% confidence intervals for effect size (d). RESULTS: Significantly greater degrees of constant, absolute and variable error were seen for force sense testing at the 50% target (p < 0.05). No statistically significant difference was observed between groups for joint position sense, or for constant or variable force sense error at the 70% target (p > 0.05). Despite this, all joint position sense and force sense measures demonstrated possible clinical significance (upper limits 95% CI d ≥ 0.5). CONCLUSIONS: Force sense, particularly at lower levels, appears impaired in those with IA-TMD. Joint position sense and force sense at higher levels appear less affected, although may still be important to consider in the management of IA-TMD in some patients.

"This patient is not appropriate": Perspectives of physiotherapy students and clinical educators on exposing students to patients with complex needs during clinical practice placements.

BACKGROUND: Clinical practice placements play an important role in preparing students for challenging areas of clinical practice. Little is known about student learning needs for working with patients with complex needs during clinical practice placements, and clinical educator decision-making that underpins this exposure. PURPOSE: To explore the perspectives of physiotherapy students and clinical educators on exposing students to working with and learning from patients with complex needs during clinical practice placements across Queensland and New South Wales, Australia. METHODS: Six semi-structured focus groups with pre-registration physiotherapy students undertaking clinical practice placements (n = 19) and semi-structured one-on-one interviews with clinical educators (n = 20). Data were analyzed using reflexive thematic analysis. RESULTS: Four overarching themes were generated following analysis: 1) Complexity is challenging; 2) Tension between student exposure and patient care; 3) Variance in expectations; and 4) Readiness for complexity. CONCLUSION: Physiotherapy students and clinical educators recognize the challenges and importance of exposure to patients with complex needs. Student learning experiences are influenced by clinical educator decision-making, which is often unclear, leading to varying opportunities. This study highlights the need for enhanced support from clinical educators to prepare students for working with patients with complex needs.

Identifying and navigating suspected serious pathologies: New-graduate physiotherapists' perspectives and developmental needs.

BACKGROUND: Physiotherapists in Australia play a vital first-contact role in identifying suspected serious pathologies and navigating their management pathways. Current literature highlights challenges faced by physiotherapists including implications of ineffective identification and management of suspected serious pathologies, yet the perspectives of new-graduate physiotherapists related to this area of practice remain unknown. OBJECTIVE: The aim of this study was to explore new-graduate physiotherapists' perspectives and developmental needs related to identifying suspected serious pathologies and navigating their management pathways in patients with musculoskeletal complaints. DESIGN: and Method: A qualitative study using a reflexive thematic analytical approach was undertaken. Eighteen semi-structured interviews were conducted. Thematic analysis was utilized on the interview data. RESULTS: Four key themes were generated: (1) Physiotherapists as advocates; (2) Navigating uncertainties and complexities; (3) Safe and accessible workplace support builds confidence; and (4) Importance of direct learning opportunities. CONCLUSION: New-graduate physiotherapists recognize their imperative role as first-contact practitioners in identifying and navigating suspected serious pathologies yet also experience significant uncertainties. The findings highlight key developmental needs, including supportive workplaces, established referral frameworks and direct learning opportunities during pre-professional training.

Writing for the role: A qualitative exploration of new graduate physiotherapists' transition to practice of clinical documentation.

INTRODUCTION: Clinical documentation is an integral component of effective physiotherapy practice. Minimal research has explored how new graduate physiotherapists transition to practice of documentation. OBJECTIVE: To understand new graduate physiotherapists' experiences and support needs for transitioning into this professional role, from the perspectives of new graduates and clinical supervisors. METHODS: This study utilized the qualitative methodology of reflexive thematic analysis, situated within a critical realist framework and informed by Duchscher's stages of transition theory. Semi-structured interviews of 16 new graduate physiotherapists (less than two years post-graduation) and seven clinical supervisors (of new graduate physiotherapists) were subjected to inductive analysis, where codes were organized into themes and subthemes. RESULTS: Three overarching themes were generated with associated subthemes. Variable preparedness for documentation identified that new graduates were equipped with the basics of documentation, yet challenged by unfamiliarity and complexity. Documentation practices evolve over time outlined experiences of new graduates developing a "written voice" and improving documentation efficiency. Workplace support is necessary irrespective of preparedness, discusses: i) opportunities to practice, reflect and refine skills, ii) protected time for documentation, and iii) access to templates and examples. CONCLUSION: New graduate physiotherapists enter the workforce with variable levels of preparedness for clinical documentation, and may experience challenges when facing unfamiliar contexts and clinical complexity. Understanding expectations and engaging in opportunities to improve documentation skills were perceived as beneficial for enhancing new graduate practice of clinical documentation across workplace settings. Implications for workplace support to promote safe and effective practice of documentation are discussed.

Embarking on a cultural journey: a qualitative study of new graduate physiotherapists' experiences of working in First Nations Australian health settings.

INTRODUCTION: Internationally, there is growing momentum in the physiotherapy profession to improve the cultural safety and capabilities of physiotherapists. In Australia, this is essential given the important role physiotherapists play in the delivery of healthcare to First Nations Australians. Understanding the experiences of the newest members of the profession who work with First Nations Australians is an important step in exploring the broader professions' cultural safety journey. OBJECTIVE: To explore new graduate physiotherapists' experiences working in First Nations Australian health settings. METHODS: The study used an interpretative phenomenological approach through semi-structured interviews to explore the experiences of seven new graduate physiotherapists, in their first 2 years of practice. All participants worked within a First Nations Australian health setting for some or all of their experience as a new graduate physiotherapist. RESULTS: Three themes were generated: 1) enrichment through connection; 2) navigating challenges; and 3) a catalyst for self-reflection. CONCLUSION: New graduate physiotherapists reported positive experiences when working within a First Nations Australian health setting, underpinned by building a strong therapeutic relationship through rapport building; navigating challenges alongside their clients; and delving into critical self-reflection.

Professional development needs and decision-making of new graduate physiotherapists within Australian private practice settings.

INTRODUCTION: Professional development contributes to new graduate health professionals' transition into the workplace. Current literature indicates that new graduate physiotherapists are often underprepared to work within private practice settings, however little is known of their professional development needs to facilitate their transition. OBJECTIVES: This study aimed to understand new graduate physiotherapists' perceived needs and decision-making for professional development within private practice settings. METHODS: This study used a qualitative interpretative phenomenological approach. A sample of new graduate physiotherapists employed within private practice settings (n = 14) participated in semi-structured telephone interviews, after being selected through convenience and randomized sampling. Interview data was subject to thematic analysis. RESULTS: Four key themes emerged from the data: 1) practical and commercial relevance; 2) influence of self and others in decision-making; 3) professional development as a social construct; and 4) access is critical. CONCLUSION: New graduate physiotherapists expressed needs for practically and clinically relevant professional development within formal and informal settings, and this extended to non-clinical skills specific to private practice. Their decision-making was shaped by social influences and perceived barriers to access. This study has identified implications for employers and professional development providers to support and cater to new graduate physiotherapists' perceived needs for professional development, which may facilitate their transition into private practice.

Perceived preparedness and training needs of new graduate physiotherapists' working with First Nations Australians.

INTRODUCTION: There is a considerable and ongoing health gap experienced by First Nations Australians. Physiotherapists play an integral role in the health care of this population; however, little is known about new graduate preparedness and training needs to work in a First Nations context. OBJECTIVE: To explore the perceptions of new graduate physiotherapists regarding their preparedness and training needs for working with First Nation Australians. METHODS: Qualitative telephone, semi-structured interviews of new graduate physiotherapists (n = 13) who have worked with First Nations Australians in the last two years. Inductive, reflexive thematic analysis was used. RESULTS: Five themes were generated: 1) limitations of pre-professional training; 2) benefits of work integrated learning; 3) 'on the job' development; 4) intrapersonal factors and efforts; and 5) insights into improving training. CONCLUSION: New graduate physiotherapists perceive that their preparedness to work in a First Nations health context is supported by practical and varied learning experiences. At the pre-professional level, new graduates benefit from work integrated learning and opportunities that evoke critical self-reflection. At the professional level, new graduates express a need for 'on the job' development, peer supervision, and tailored professional development, that focuses on the unique perspectives of the specific community in which they work.

A survey of patient education practices and perceptions of physiotherapists: a mixed methods study.

INTRODUCTION: Patient education is an integral part of physiotherapy practice. The use of patient education and the adoption of a patient-centered approach to education has not been examined in a European setting. OBJECTIVE: To explore the frequency and perceived importance of patient education practices of physiotherapists in Iceland. METHODS: A convergent mixed methods study design was utilized. A cross-sectional, web-based survey was completed by 216 physiotherapists (35.1% response rate). Transformed qualitative data played a secondary role to quantitative results measuring frequencies of use and perceived importance of a spectrum of patient education practices. RESULTS: Providing exercise and diagnostic information had the highest rated frequency and importance. Advising on social support and having the patient explain why their home exercises were important were rated lowest. A large difference was reported between frequency and importance when collaborating with patients on goal-setting. Therapists reported delivering education through discussions and physical demonstrations, while relying on visual cues and return demonstrations to evaluate education effectiveness. Patient-specific education, including preferred learning style, was not always considered. The highest-rated barriers to patient education were patient characteristics that were psychosocial in nature. Results regarding readiness for education indicated needs to assess patient motivation while managing external barriers. CONCLUSION: The results indicate that physiotherapists engage in a wide variety of patient education activities that they consider important. Barriers to patient education identified by therapists may be managed by further skill development in a collaborative patient-centered approach to patient education.

Do intra-articular temporomandibular disorders show an association between physical bite function, self-perceived bite limitation and kinesiophobia? A case-control study.

BACKGROUND: Little is known about the impact of intra-articular temporomandibular disorders (TMDs) on bite function, or how bite impairments in this subgroup relate to self-perceived bite limitation or kinesiophobia. This presents a challenge to practitioners involved in delivering care. OBJECTIVES: To determine what bite impairments are associated with intra-articular TMDs, and explore how these impairments relate to self-perceived bite limitations and kinesiophobia. DESIGN: Observational, case-control study. METHOD: Sixty participants (n = 30 intra-articular TMDs, n = 30 healthy controls) were recruited via convenience sampling. Bite function was explored using pain-free bite force and bite endurance/steadiness (submaximal bite hold) measures. Self-perceived bite function and kinesiophobia were evaluated via the Patient specific functional scale (PSFS) and the Tampa Scale for kinesiophobia of Temporomandibular disorders (TSK-TMD) respectively. Between-group data were compared and associations between physical bite impairments, self-perceived bite limitation and kinesiophobia were explored in the intra-articular TMD group. RESULTS: Pain-free bite force was significantly impaired in the intra-articular TMD group (-108N, p < 0.01, d = 0.9), and this impairment demonstrated moderate association with degree of kinesiophobia (p < 0.01, r = -0.4). No significant between-group difference was observed for bite endurance or force steadiness (p > 0.05). No association was observed between pain-free bite force and self-perceived bite limitation, or self-perceived bite limitation and kinesiophobia (p > 0.05). CONCLUSIONS: Impaired pain-free bite force appears to be an important feature of intra-articular TMDs which should be considered within management. Kinesiophobia may be important to consider when assessing bite function in this subgroup. Future research is needed to guide optimal interventions and inform subsequent management guidelines.