Profile of Sport and Exercise Physician trainee's clinical practice within Australasia in 2019: a cross-sectional study.

Objective: To identify the patient population profile and the spectrum of training activities and influencing factors of Australasian College of Sport and Exercise Physician (ACSEP) trainees. Design: Retrospective cross-sectional design. Setting: Training settings for ACSEP trainees. Participants: Twenty ACSEP trainees undertaking full-time training in training period 2 of the 2019 training year (1 August 2019-31 January 2020). Exclusion criteria were trainees undertaking part time study and new fellows who completed their fellowship exams in 2019. Independent variables: Patient and practitioner demographics. Method: Retrospective cross-sectional design. Main outcome measurements: Patient data recorded in ACSEP trainees' logbook. Short questionnaire capturing pertinent trainee demographics. Results: Most ACSEP trainee patients are adults aged 18-65 years of age (78.2%), presenting with knee (18.7%), ankle (17%) and spinal complaints (13.1%) in clinical practice or sporting team environments. Youths 10-17 make up 13.1% of presentations and older adults 66 years and older make up 8%. Only Australian trainees are engaging in additional training activities, such as surgical assisting outside of the clinic or sporting team environment. Conclusion: Australasian Sport and Exercise Physician trainees appear to consult primarily musculoskeletal complaints, including providing broader care to paediatric and older populations, and work with sporting teams. There are differences between Australia and New Zealand trainee employment conditions, which appear to be affecting training experiences. These differences warrant consideration to ensure equitable training experiences and financial stability for trainees.

The efficacy of an eight-week exercise program for the management of chronic low back pain in the equestrian population.

BACKGROUND: Equestrians (horse riders) are more susceptible to low back pain than the general population due to loads placed on their bodies during the activity. A specific eight-week exercise intervention program targeting the muscles used during horse riding was implemented for a group of equestrians with low back pain. METHODS: Volunteers were invited to participate in the study through social media posts in Melbourne, Australia. The participants were required to complete an exercise screening test prior to enrolment in the study to ensure they were suitable to participate in the iteration program. Participants then completed the Brief Pain Inventory (BPI) (Short Form) and Patient Specific Functional Scale (PSFS) before commencing the exercise program. These outcome measures were completed again by participants after completing the 8-week exercise program. RESULTS: Nine equestrians (23-65 years of age; mean=43±14: average worst back pain on riding=7/10 with a range of 3-10/10) completed all outcome measures and the 8-week exercise intervention. Data indicate that all achieved improved pain severity, pain interference and riding functionality (P<0.01). CONCLUSIONS: An eight-week exercise program may be beneficial in improving a sample of equestrians' chronic LBP symptoms. From a practitioner's perspective, the findings provide an indication as to suitable exercises to prescribe to an equestrian to help reduce their LBP.

The transition of clinical nurses to nurse educator roles - A scoping review.

AIM: To explore what is known about the lived experiences of novice nurse educators, including preparation or support strategies that may assist this transition. BACKGROUND: Despite the crucial role of nurse educators in healthcare, the literature lacks clarity about the role and the preparation and support of nurse clinicians to transition into novice nurse educator roles. DESIGN: Scoping review METHODS: A scoping review was carried out according to the Joanna Briggs Institute Methodology for Scoping Reviews. The Cumulative Index of Nursing and Allied Health Literature Complete (CINAHL), Medline (OVID), EMBASE, APA PsycINFO and Google Scholar databases were searched for English language sources of evidence between 1992 and 2022. Sources of evidence related to nursing education, transition, lived experience, preparation and support were included. RESULTS: Fifty-two sources of evidence met the inclusion criteria with most originating in the United States and situated in the academic setting. There were 20 different titles used to identify nurse educators and a lack of clarity relating to the role and its expectations. There was alignment found between the lived experiences of novice nurse educators and Duchscher's transition shock model with a variety of preparation and support recommendations identified to mitigate this transition shock. CONCLUSION: Clinical nurses transitioning into novice nurse educator roles have a predominantly negative experience that aligns with Duchscher's transition shock model. Although recommendations exist for support and preparation strategies to ease this transition shock, further research is required to establish which of these strategies are effective, especially for novice nurse educators in clinical settings outside of the United States.

The Use of Exercise Prescription in Australian Osteopathy Practice: Secondary Analysis of a Nationally Representative Sample of the Profession.

Introduction: Exercise is beneficial for improving general health, wellbeing, and specific medical conditions. In musculoskeletal conditions such as chronic low back and neck pain, prescribed exercise has been found to be moderately effective in decreasing pain and improving function. Osteopaths are primary contact health professionals who manage predominantly musculoskeletal complaints. This work presents a secondary data analysis of the Australian osteopathy practice-based research network and profiles the characteristics of osteopaths who often use exercise prescription in patient care. Methodology. Secondary analysis of a cross-sectional survey of 992 osteopaths was registered with the Osteopathy Research and Innovation Network, an Australian practice-based research network. Demographics, practice, and treatment characteristics of Australian osteopaths who "often" use exercise prescription in patient care were examined. Results: Seven-hundred and thirty-three Australian osteopaths (74%) indicated that they use exercise prescription "often" in patient care. Australian osteopaths who often use exercise prescription are more likely to be colocated with another osteopath (ORa 1.54) and send referrals to an exercise physiologist (ORa 1.94) and a specialist medical practitioner (ORa 1.72). Those osteopaths who often used exercise prescription were also more likely to discuss physical activity (ORa 5.61) and nutrition (ORa 1.90). Australian osteopaths who use exercise prescription often were more likely to treat patients with sports injuries (ORa 2.43) and use soft tissue techniques (ORa 1.92), trigger point techniques (ORa 2.72), and sports taping (ORa 1.78). Conclusion: Osteopaths who utilise exercise prescription were more likely to discuss physical activity, diet, and nutrition and utilise referral networks with specialist medical practitioners and exercise physiologists. Australian osteopaths who often use exercise prescriptions were also more likely to treat patients with sport injury. The results suggest that most Australian osteopaths use exercise prescription and have referral networks with other health professionals for patient management. Further work is required to explore the type of exercise prescription used and for what conditions.

The effectiveness of an osteopathic manual technique compared with a breathing exercise on vagal tone as indicated by heart rate variability, a crossover study.

INTRODUCTION: Parasympathetic nervous system (PSNS) function can be inferred by heart rate variability (HRV) providing indications about an individual's health. Manual therapy may influence PSNS function, however the research outcomes in this regard are equivocal. This study explored the PSNS effect of a measured breathing technique with suboccipital balanced ligamentous tension, an osteopathic manipulative therapy technique. METHODS: Healthy adult participants in this crossover study (n = 18) were randomly allocated into two groups with differing order of interventions. A 1:1 breathing rate of 6 breaths per minute maintained for 5 min was compared to the osteopathic intervention. HRV was measured for 5 min before and after each intervention and analysed using the root mean square of successive differences (RMSSD) between normal heartbeats and high frequency normalised units (HFnu). RESULTS: The RMSSD data demonstrated no significant difference between groups or within groups (p > 0.05) over time. HFnu results showed a significant between-group difference over the four time points (p = 0.004) with a medium effect size (ηp2 = 0.240), and no significant within-group difference (p > 0.05). DISCUSSION: The osteopathic intervention raised HRV to a small extent, however measured breathing lowered HRV. In the group that received the osteopathic technique first, HFnu values continued to rise post-osteopathic treatment possibly indicating an increasing parasympathetic effect over time. Recommendations for future studies include changing the breathing ratio to ensure parasympathetic response, take into account potential delayed effects of interventions, consider outcome measures less variable than HRV, and longer follow up times. CONCLUSION: This study suggests parasympathetic stimulation may occur with the application of suboccipital balanced ligamentous tension and sympathetic stimulation from measured breathing.

How do Australian osteopaths manage migraines? Outcomes from a national practice-based research network.

BACKGROUND: Individuals who experience migraines often seek out a variety of treatment options including manual or physical therapy. Evidence suggests that manual therapy, including osteopathy, can play a role in the management of migraines. Whilst there is some literature on the role osteopathy therapy plays in migraine management, none describes the treatment approaches used by practitioners. OBJECTIVES: To explore the demographic, practice and clinical management characteristics of Australian osteopaths who report treating migraine 'often' in clinical practice. METHODS: Secondary analysis of a cross-sectional survey of 988 osteopaths from the Osteopathy Research and Innovation Network (ORION), an Australian practice-based research network. Regression analysis was used to identify demographic, practice and clinical management characteristics of Australian osteopaths who reported 'often' treating migraine patients. RESULTS: Over 40% of respondents (n = 400) indicated treating patients with migraines 'often'. These osteopaths were less likely to be involved in research and be co-located with a dietician compared to osteopaths who do 'not often' treat migraine. Osteopaths who reported 'often' treating migraine were: five times as likely to treat non-English speaking ethnic groups; 2.5 times as likely to treat chronic pain, temporomandibular joint disorders and hand musculoskeletal complaints; compared to those that do not treat migraines 'often'. CONCLUSION: Australian osteopaths who treat migraine are five times more likely to treat non-English speaking ethnic groups; twice as likely to treat chronic pain; temporomandibular joint disorders, and hand musculoskeletal complaints. More research is needed to identify the practices and patient outcomes associated with osteopathy care for those experiencing migraines.

Teaching clinical reasoning in gerontological physiotherapy: Experiences and perceptions of clinical supervisors.

INTRODUCTION: Teaching clinical reasoning to physiotherapy students is essential for preparing them to work effectively with patients. OBJECTIVE: This qualitative study aimed to explore the experiences and perceptions of clinical supervisors of teaching clinical reasoning in gerontological physiotherapy. METHODS: Australian-based clinical supervisors for student placements in gerontological physiotherapy (n = 9) participated in individual semi-structured interviews via videoconferencing. Data were analyzed using Braun and Clark's reflexive thematic analysis. RESULTS: Four themes were developed from the data: 1) Preparedness for placement: students and supervisors; 2) Dynamic placement adaptations to meet individual learning needs; 3) Negotiating clinically complex and variable patient needs; and 4) Crafting learning opportunities amidst complexities. Clinical supervisors perceive that teaching clinical reasoning is influenced by student and supervisor preparedness and the complexity of gerontological practice. Supervisors engage in planning prior to placements, adapt tasks, discussions and feedback throughout the placement, and promote multi-disciplinary learning experiences to highlight person-centered and collaborative care. CONCLUSION: This research enhances physiotherapy academics,' clinical supervisors' and students' understanding of the factors influencing teaching clinical reasoning to students in gerontological settings. The challenges and strategies identified can improve students' and supervisors' preparedness for placements, assist them to negotiate complexity and create opportunities to strengthen the learning experience.

Osteopathy Referrals to and from General Practitioners: Secondary Analysis of Practitioner Characteristics from an Australian Practice-Based Research Network.

Australian osteopaths engage in multidisciplinary care and referrals with other health professionals, including general practitioners (GPs), for musculoskeletal care. This secondary analysis compared characteristics of Australian osteopaths who refer to, and receive referrals from, GPs with osteopaths who do not refer. The analysis was undertaken to identify pertinent characteristics that could contribute to greater engagement between Australian osteopaths and GPs. Data were from the Australian osteopathy practice-based research network comprising responses from 992 osteopaths (48.1% response rate). Osteopaths completed a practice-based survey exploring their demographic, practice, and clinical management characteristics. Backward logistic regression identified significant characteristics associated with referrals. Osteopaths who reported sending referrals (n = 878, 88.5%) to GPs were more likely than their non-referring colleagues to receive referrals from GPs (aOR = 4.80, 95% CI [2.62-8.82]), send referrals to a podiatrist (aOR = 3.09, 95% CI [1.80-5.28]) and/or treat patients experiencing degenerative spinal complaints (aOR = 1.71, 95% CI [1.01-2.91]). Osteopaths reporting receiving referrals (n = 886, 89.3%) from GPs were more likely than their non-referring colleagues to send referrals to GPs (aOR = 4.62, 95% CI [2.48-8.63]) and use the Medicare EasyClaim system (aOR = 4.66, 95% CI [2.34-9.27]). Most Australian osteopaths who report engaging in referrals with GPs for patient care also refer to other health professionals. Referrals from GPs are likely through the Chronic Disease Management scheme. The clinical conditions resulting in referrals are unknown. Further research could explore the GP-osteopath referral network to strengthen collaborative musculoskeletal care. The outcomes of this study have the potential to inform Australian osteopaths participating in advocacy, public policy and engagement with Australian GPs.