Developing an integrated nurse and physiotherapist-led bladder, bowel and pelvic health team.

A service redesign in 2019 led to the formation of an integrated team of nurses and physiotherapists working together to form a bladder, bowel and pelvic health team across two hospitals and the community in Lewisham and Greenwich NHS Trust. The last few years have had their challenges, but the team is now very successful and has won awards for the integration and achievements, particularly in the redesign of the containment product service. Integrating two professional groups has led to excellent team-work and smoother patient journeys.

A systematic review of work related musculoskeletal disorders among physical therapists and physiotherapists.

Physical therapists and physiotherapists (PPTs) perform and repeat physical tasks that can lead to work-related musculoskeletal disorders (WMSD). The aim was to study the main research concerning this problem, i.e. the risk factors, activities that exacerbate WMSD symptoms, alterations in work habits and the proposed responses, and to estimate mean value (±standard deviation, STD) for the most studied parameters. This review was conducted according to the PRISMA guideline. Five databases (Pubmed, ScienceDirect, Google Scholar, Medeley and Science.gov) were scanned to identify works investigating the different aspects of WMSD among PPTs. Two reviewers independently selected relevant studies using inclusion/exclusion criteria, critically appraised, and extracted data. To homogenize the data, prevalence were reported to the total sample studied when necessary. Among the 9846 articles identified, 19 articles were included. The WMSD prevalence was over 50 %. The areas most affected were the lower back, neck and thumb. An exhaustive list of parameters were constructed for job risk factors (n = 19), activities that exacerbating symptoms (n = 13), altered work habits (n = 15), responses and treatments (n = 26). The mean prevalence (±STD) was calculated for the major parameters. Nine main job risk factors were extracted with an average prevalence of about 30 % and a relatively high variability. Seven activities exacerbating WMSD symptoms and five altered work habits were identified with a homogeneous rate (5-20 %). Three main responses and treatments were found with heterogeneous prevalence. This review provides useful results for the development of future protocols to prevent the occurrence of WMSD among PPTs and meta-analyses.

Manual and ventilator hyperinflation parameters used by intensive care physiotherapists in Sri Lanka: An online survey.

INTRODUCTION: Hyperinflation is a common procedure to clear secretion, increase lung compliance and enhance oxygenation in mechanically ventilated patients. Hyperinflation can be provided as manual hyperinflation (MHI) or ventilator hyperinflation (VHI), where outcomes depend upon the methods of application. Hence it is crucial to assess the application of techniques employed in Sri Lanka due to observed variations from recommended practices. OBJECTIVE: This study is aimed to evaluate the application and parameters used for MHI and VHI by physiotherapists in intensive care units (ICUs) in Sri Lanka. METHODOLOGY: An online survey was conducted among physiotherapists who are working in ICUs in Sri Lanka using WhatsApp groups and other social media platforms. RESULTS: A total of 96 physiotherapists responded. The survey comprised of three sections to obtain information about socio-demographic data, MHI practices and VHI practices. Most of the respondents (47%) worked in general hospitals and 74% of participants had a bachelor's degree in physiotherapy; 31.3% had 3-6 years of experience; 93.8% used hyperinflation, and 78.9% used MHI. MHI was performed routinely and as needed to treat low oxygen levels, abnormal breath sounds, and per physician orders while avoiding contraindications. Self-inflation bags are frequently used for MHI (40.6%). Only a few participants (26%) used a manometer or tracked PIP. In addition to the supine position, some participants (37.5%) used the side-lying position. Most physiotherapists followed the recommended MHI technique: slow squeeze (57.3%), inspiratory pause (45.8%), and quick release (70.8%). VHI was practised by 19.8%, with medical approval and it was frequently performed by medical staff compared to physiotherapists. Treatment time, number of breaths, and patient positioning varied, and parameters were not well-defined. CONCLUSION: The study found that MHI was not applied with the recommended PIP, and VHI parameters were not identified. The study indicates a need to educate physiotherapists about current VHI and MHI practice guidelines.

A Comparison of Physical Therapist Educational Outcomes Before and During the COVID-19 Pandemic: A Multicenter Study.

INTRODUCTION: The purpose of this study was to analyze and compare educational outcomes of Doctor of Physical Therapy (DPT) graduates before and during the COVID-19 pandemic. REVIEW OF LITERATURE: Reports show increased stress, anxiety, and burnout during the COVID-19 pandemic, which may have negatively affected academic performance. Historically, academic performance is predictive of National Physical Therapy Examination (NPTE) scores. Yet, there is little evidence analyzing student outcomes during the pandemic. SUBJECTS: Doctor of Physical Therapy graduate records (N = 1,897) were retrospectively collected from a multicenter convenience sample consisting of 5 blended programs. Records were sampled from existing "prepandemic" graduates of Fall 2018-2019 (n = 988) and "pandemic" graduates of Fall 2021-2022 (n = 909). METHODS: A causal comparative and correlational study design was used. Grade point average (GPA) and NPTE scores were collected. A general linear model examined differences between groups, and a multiple linear regression examined predictors of NPTE performance. RESULTS: Grade point average was a significant predictor of NPTE score (r2 = 0.56; P < .01) for the overall sample and for the prepandemic and pandemic cohorts (r2 = 0.38, P < .01; r2 = 0.45, P < .01, respectively). Grade point average was not significantly different between the groups (P = .09), nor did it significantly influence differences in NPTE scores (P = .13). Pandemic graduates displayed a significantly lower NPTE pass rate (85.1%) compared with prepandemic graduates (89.7%; P < .01). Pandemic graduates experienced higher rates of academic difficulty (20%; P < .01) and had a approximately 5 times higher likelihood of not passing the NPTE. DISCUSSION AND CONCLUSION: This is the first study to report on DPT graduate outcomes spanning the COVID-19 pandemic. Similar to previous studies, GPA remained the most significant predictor of NPTE scores. Pandemic graduates demonstrated significantly lower NPTE scores and higher rates of academic difficulty (GPA < 3.0). Continued monitoring of NPTE performance is warranted between prepandemic, pandemic, and postpandemic cohorts across modes of program delivery.

Reliability of a Musculoskeletal Imaging Competency Examination for Physical Therapists.

INTRODUCTION: The Burley Readiness Examination (BRE) for Musculoskeletal (MSK) Imaging Competency assesses physical therapists' baseline MSK imaging competency. Establishing its reliability is essential to its value in determining MSK imaging competency. The purpose of this study was to test the reliability of the BRE for MSK Imaging Competency among physical therapists (PTs) with varying levels of training and education. REVIEW OF LITERATURE: Previous literature supports PTs' utility concerning diagnostic imaging; however, no studies directly measure their competency. With PTs expanding their practice scope and professional PT education programs, increasing their MSK imaging instruction, assessing competency becomes strategic in determining the future of MSK education and training. SUBJECTS: One hundred twenty-three United States licensed PTs completed the BRE. METHODS: Physical therapists completed the BRE through an online survey platform. Point biserial correlation (rpb) was calculated for each examination question. Final analyses were based on 140 examination questions. Examination scores were compared using independent sample t-test and one-way analysis of variance. Chi-square tests and odds ratios (ORs) assessed the relationship of a passing examination score (≥75%) and the type of training. Reliability of the BRE was assessed using Cronbach's alpha (α). RESULTS: Mean overall examination score was 75.89 ± 8.56%. Seventy PTs (56.9%) obtained a passing score. Physical therapists with additional MSK imaging training, board certification, and residency or fellowship training scored significantly higher (P < .001) compared with those with only entry-level PT program education. Physical therapists with additional MSK imaging training scored significantly higher (x̄ = 81.07% ± 8.93%) and were almost 5 times (OR = 4.74, 95% CI [1.95-11.50]) as likely to achieve a passing score than those without. The BRE demonstrated strong internal consistency (Cronbach's α = 0.874). DISCUSSION AND CONCLUSIONS: The BRE was reliable, consistently identifying higher examination scores among those with increased MSK imaging training. Training in MSK imaging influenced competency more than other factors. The BRE may be of analytical value to PT professional and postprofessional programs.

Clinical Site Visits: Perspectives of Clinical Instructors and Site Coordinators of Clinical Education.

INTRODUCTION: Site visits (SVs) are a common component of clinical education. The purpose of this paper was to explore clinicians' perspectives regarding SVs, including methods of communication used and their effectiveness, purposes of SVs, and the level of interaction between the stakeholders. REVIEW OF THE LITERATURE: Several communication methods are used to conduct SVs, with varying levels of "richness" and effectiveness. Previous studies have explored the perceptions of physical therapist (PT) students and Directors of Clinical Education regarding communication methods used during SVs, as well as reporting the purposes, effectiveness, and logistics. SUBJECTS: Clinicians, including clinical instructors (CIs) and Site Coordinators of Clinical Education, from across the United States, representing various geographical locations and settings were invited to participate. METHODS: An electronic survey was distributed to participants using information from 2 PT education programs and the Physical Therapist Clinical Performance Instrument database. RESULTS: A total of 273 responses were included in the analysis. Clinicians ranked in-person visits as their first choice of communication for future SVs (n = 157, 59.9%) and indicated that in-person communication was "very effective" (n = 143, 52.4%) when compared with videoconferencing (n = 55, 20.1%) and telephone (n = 49, 17.9%). Clinicians ranked verifying the competency level of the student and verifying site resources during the SV as "extremely important" or "important" (n = 257, 94.2% and n = 250, 91.5%, respectively). Answering CI's questions and providing support to the CI were also identified as "extremely important" or "important" (n = 262, 96% and n = 244, 89.4%, respectively). Analysis of open-ended responses revealed 5 themes: Communication is important, flexibility allows best fit for a situation, on-site visits offer a more complete picture, real-time dialog is preferred, and email can lead to misinterpretation. DISCUSSION AND CONCLUSION: Communication is a key component of the clinical-academic relationship. Although clinicians prefer in-person communication, flexibility is necessary when planning and conducting SVs. Future research recommendations include gathering student and clinician perceptions regarding faculty involvement in SVs, as well as gathering faculty perspectives regarding their participation in SVs. In addition, the impact of the pandemic on the future of SVs warrants further exploration.

Financial Resource Management Knowledge, Skills, and Attitudes for Entry-level Physical Therapist Practice: A Survey of Physical Therapists in Ohio.

INTRODUCTION: The purpose of this study was to explore the perceptions of physical therapists (PTs) regarding the importance of financial resource management (FRM) knowledge, skills, and attitudes (KSAs) for entry-level practice and investigate the roles of PT education programs (PTEPs), clinical education experiences (CEEs), and employers in addressing these KSAs. REVIEW OF LITERATURE: FRM KSAs have been identified as components of professionalism and leadership and, as such, are a required element in student PTs (SPTs) educational preparation. SUBJECTS: A purposive sampling of convenience strategy was employed by requesting a free mailing list for Ohio-licensed PTs. METHODS: An online survey was developed based on PT Clinical Performance Instrument Criterion #17, "Patient Management: Financial Resources," as this tool is frequently used to endorse entry-level status of SPTs. Potential participants were solicited through email. Mixed methodology was used to analyze survey results. RESULTS: The survey was completed by 266 PTs. FRM KSAs in legal and regulatory compliance were perceived as most important, followed by coding and billing. Forty-eight percent of participants indicated that FRM KSAs were "less important" (n = 111) or "considerably less important" (n = 17) than clinical care skills, whereas 39.8% (n = 106) believed that these skills are of the same level of importance. Ten themes were derived from qualitative responses regarding the FRM content that should be provided by PTEPs. Participants indicated that the role of PTEPs was to provide an introduction and foundation to FRM, whereas CEEs should facilitate intentional exposure and opportunities to apply FRM KSAs with supervision. Employers were expected to provide education regarding clinic-specific operations and reimbursement considerations, as well as mentorship that included reviewing complex billing for accuracy, offering guidance for improving time management skills, and discussing fiscal responsibilities to both the employer and patient. DISCUSSION AND CONCLUSION: This information may guide PTEPs and clinical personnel in providing focused meaningful instruction regarding FRM aspects of PT practice to SPTs and entry-level clinicians.

An Exploration of Support for Clinical Education Partners.

INTRODUCTION: Effective academic-clinical partnerships require a greater understanding of how academic programs can best support clinical education (CE) faculty. This study aimed to determine resources and support that clinical partners need. REVIEW OF LITERATURE: As the number of physical therapist (PT) programs, cohort sizes, and CE weeks have risen, so has demand for CE sites. Conversely, staffing reductions, increased administrative duties, and rising productivity expectations have decreased the time available for clinical instruction. To promote a successful CE experience, there must be a renewed understanding of CE faculty needs. SUBJECTS: Clinical education faculty affiliated with any of the 8 contributing programs from the Ohio-Kentucky Consortium participated in survey research (n = 24) and subsequent interview (n = 4) and focus group (n = 6) research. METHODS: Constructivist grounded theory design was used to explore the needs of CE faculty. Academic and clinical partners developed the initial survey and used survey results to establish interview questions. The investigators iteratively assessed data saturation and clarity of results of coded survey, interview, and focus group data to determine whether the study's aims of identifying CE faculty needs had been met. RESULTS: The aggregated results yielded 5 main themes of Director of Clinical Education support for CE faculty needs: student readiness for CE experience; effective academic-clinical partner communication; collaborative management of exceptional students; judicious standardization of CE processes; and provision of CE faculty development resources. DISCUSSION AND CONCLUSION: Clinical education faculty have noted challenges that affect their ability to mentor students. They want academic programs to be more collaborative and proactive with communication, resources, and support. Future research should address aids and barriers to proactive communication, resource provision, and academic-clinical partner collaboration.

Use of the International IFOMPT Cervical Framework to inform clinical reasoning in postgraduate level physiotherapy students: a qualitative study using think aloud methodology.

BACKGROUND: Vascular pathologies of the head and neck are rare but can present as musculoskeletal problems. The International Federation of Orthopedic Manipulative Physical Therapists (IFOMPT) Cervical Framework (Framework) aims to assist evidence-based clinical reasoning for safe assessment and management of the cervical spine considering potential for vascular pathology. Clinical reasoning is critical to physiotherapy, and developing high-level clinical reasoning is a priority for postgraduate (post-licensure) educational programs. OBJECTIVE: To explore the influence of the Framework on clinical reasoning processes in postgraduate physiotherapy students. METHODS: Qualitative case study design using think aloud methodology and interpretive description, informed by COnsolidated criteria for REporting Qualitative research. Participants were postgraduate musculoskeletal physiotherapy students who learned about the Framework through standardized delivery. Two cervical spine cases explored clinical reasoning processes. Coding and analysis of transcripts were guided by Elstein's diagnostic reasoning components and the Postgraduate Musculoskeletal Physiotherapy Practice model. Data were analyzed using thematic analysis (inductive and deductive) for individuals and then across participants, enabling analysis of key steps in clinical reasoning processes and use of the Framework. Trustworthiness was enhanced with multiple strategies (e.g., second researcher challenged codes). RESULTS: For all participants (n = 8), the Framework supported clinical reasoning using primarily hypothetico-deductive processes. It informed vascular hypothesis generation in the patient history and testing the vascular hypothesis through patient history questions and selection of physical examination tests, to inform clarity and support for diagnosis and management. Most participant's clinical reasoning processes were characterized by high-level features (e.g., prioritization), however there was a continuum of proficiency. Clinical reasoning processes were informed by deep knowledge of the Framework integrated with a breadth of wider knowledge and supported by a range of personal characteristics (e.g., reflection). CONCLUSIONS: Findings support use of the Framework as an educational resource in postgraduate physiotherapy programs to inform clinical reasoning processes for safe and effective assessment and management of cervical spine presentations considering potential for vascular pathology. Individualized approaches may be required to support students, owing to a continuum of clinical reasoning proficiency. Future research is required to explore use of the Framework to inform clinical reasoning processes in learners at different levels.

Low back pain patients' experience and expectations: A qualitative study focusing on physiotherapist and physician care.

BACKGROUND: Low back pain (LBP) is a common and disabling musculoskeletal disorder. LBP experiences and expectations can vary from one person to another and influence their clinical outcomes. Despite the existence of numerous evidence-based treatment recommendations, LBP management in primary care remains challenging. This study aims to investigate the experiences and expectations of patients with LPB in primary care settings. METHODS: A qualitative study with an inductive thematic analysis was conducted. Semi-structured interviews were performed using individuals who had experienced LBP in the past year and had consulted a family physician (FP) or a physiotherapist (PT). RESULTS: Ten participants with LBP were interviewed (5 women, 5 men, mean age 49 ± 17). Five themes were identified: (1) I am always upset because I can't do anything; (2) I waited to consult; I thought it would go away; (3) I want to see what is going on with my LBP; (4) I want to see the person that will provide the right treatment; (5) I need support to get over it. Participants consulted when their pain was severe and disabling. They expected an imaging test to explain the cause of their LBP and placed more importance on the imaging test results than the FP's or PT's evaluation. Their opinions on care selection and being listened to were important for the participants. CONCLUSION: This study has highlighted the importance of the patient's point of view in their care. This consideration is important to ensure a comprehensive and collaborative approach with evidence-based practice care.

Leadership and gender perspective in hospital physiotherapy units.

Analyze the gender stereotypes present in the leaders of the Hospital Physiotherapy Units, determine the level of acceptance of female leadership and identify which factors influence these perceptions. Observational, descriptive, exploratory and cross-sectional study. The study subjects are the census of leaders of the Physiotherapy Units of public hospitals. The measurement instruments used are the Acceptance of Female Leadership Questionnaire (ACT-LM), and the sociodemographic and job-related variables. Most of the leaders of the hospital physiotherapy units were women (69.4%) physiotherapists. Gender stereotypes emerge in the dimension of Instrumental Characteristics, with respondents not fully agreeing that women were sufficiently competitive (18.7%) or ambitious (20.8%) to be successful in the world of work. These data were influenced by gender, showing that men have a higher regard for female leadership abilities than women themselves. In the dimension of Acceptance of Female Leadership, 17.4% of those surveyed did not fully agree that women can rise to the same extent as men. Most of the leaders of the physiotherapy units in public hospitals in Spain are women, this is reversed in favor of men in highly complex hospitals. The stereotype persists, especially among women, that they do not have enough ambition and competitiveness to succeed in the world of work.

Occupational therapy practitioners' experiences with interprofessional collaborative practice.

Although occupational therapists engage as part of interprofessional healthcare teams, explicit investigation into their experiences of interprofessional collaborative practice (IPCP) has not been explored. This study evaluated occupational therapists in the United States experiences of IPCP with additional inquiry into which healthcare professionals occupational therapy practitioners interact with and how they engage in collaboration, during IPCP. An exploratory cross-sectional study was conducted using an online survey; 142 occupational therapy practitioners responded. Quantitative data were analyzed using descriptive and bivariate analyses; open-ended responses underwent consensual qualitative analysis. Participants reported most often engaging in IPCP with physical therapists, speech-language pathologists, nurses, physicians, and case managers, although variations in the top five professions were evident between practice settings. In addition, 82% of the respondents reported either feeling prepared or very prepared for IPCP after completing their pre-licensed educational programs. Two qualitative themes have emerged to describe key education-oriented and practice-oriented interprofessional experiences. To further enhance engagement in and preparedness for IPCP, occupational therapy professionals, and students may benefit from interprofessional training that involves the professions most often encountered during clinical practice. This type of learning could foster an understanding of communication and teamwork, thus enhancing readiness to participate in the IPCP team upon transition to practice.

Immediate Effect of Physiotherapist-demonstrated Action Observation with Execution for Improving Upper Extremity Motor Function in Stroke: a Pre-post Pilot Study.

BACKGROUND: Video-demonstrated action-observation-execution is an effective intervention for motor re-learning in stroke rehabilitation. But customization of video for each task repeatedly questions its feasibility within limited resources, particularly for daily routine practice and in community settings. Physiotherapist-demonstrated action-observation-execution is a practical intervention based on the principle of observation and consecutive repetitions of observed real, live movements. The main objective of this study was to investigate the immediate effect of Physiotherapist-demonstrated action-observation-execution in upper extremity motor training in stroke. METHODS: Individuals with stroke were screened and 5 eligible participants were recruited. The research was a pre-post. A single session of Physiotherapist-demonstrated action-observation-execution was administered. A functional "Drinking" task was subdivided into simpler acts and trained. Pre and post intervention assessment of movement time using five hand-and-arm items of Nepali Wolf Motor Function Test were carried out. Global recovery was assessed in the form of Visual Analogue Scale. RESULTS: Paired t-test provided statistically significant difference in total movement time (mean difference=5.04 seconds, standard deviation=1.92, p=0.004) with larger effect size (0.95) indicating impressive improvement in movement time with the training. Substantial difference in global recovery score was noted (mean difference=17.40, standard deviation=3.65, p<0.0001, effect size=1.00) signifying the increased confidence and improved performance of upper extremity post treatment. CONCLUSIONS: The findings indicated that Physiotherapist-demonstrated action-observation-execution could be a feasible intervention to train motor functions in participants with stroke. Large-scale studies are recommended to establish the effectiveness of the intervention.

Therapeutic exercises in the clinical practice of Brazilian physical therapists in the management of rotator cuff tendinopathy: An online survey.

The objective of this study was to investigate how Brazilian physical therapists (PTs) use therapeutic exercises in the rehabilitation of individuals with rotator cuff (RC) tendinopathy. The study used an online survey with a mix of 62 open- and closed-ended questions divided into three sections: participant demographics, professional experience, and clinical practice in the rehabilitation of patients with RC tendinopathy. One hundred and fifty-nine Brazilian physical therapists completed the survey. Most of our sample recommended isometric exercises (69.9%) in the initial phase of rehabilitation and eccentric exercises (47.4%) in the advanced phase. However, there was a wide variability in determining the volume of exercises, particularly with isometric exercises. Most of our sample considered patient comfort and pain levels when adjusting exercise intensity, regardless of exercise type. The majority (48.40%) recommended weekly reassessment and modification of exercises. Additionally, despite pain being a key factor for discharge and the primary adverse effect of exercise, most of our sample would not discontinue exercises in case of pain during the early and late phases of rehabilitation. Despite the lack of consensus on some aspects, the clinical practice of our sample is in line with the current literature and practice in other countries. However, further research and implementation are crucial to enhance future rehabilitation outcomes, including exploring the exercise training volume, the safety and effectiveness of exercising with pain and identifying the optimal pain level for best results.

Treatment of shoulder impingement syndrome: a survey of physical therapists in Saudi Arabia.

OBJECTIVE: Shoulder impingement syndrome (SIS) is one of the most frequent causes of shoulder pain. Evidence supported the use of conservative treatment for SIS. Clinical practice guidelines (CPGs) indicated that physical therapy interventions, including therapeutic exercises, manual therapy, patient education, and advice, were recommended for the treatment of SIS. This study's purpose was to investigate physical therapists' adherence to the CPGs for treating SIS. SUBJECTS AND METHODS: Physical therapists in Saudi Arabia were invited to participate in an online survey via the Saudi Physical Therapy Association between May and December 2022. The developed online survey consisted of 36 questions, divided into five sections: eligibility, demographics, clinical practice regarding the treatment of SIS, barriers, and facilitators for the use of CPGs. Descriptive and logistic regression analysis were employed to analyze study data. RESULTS: A total of 313 physical therapists completed the entire survey. In general, physical therapists were aligned with CPGs. Physical therapists advised their patients, utilized therapeutic exercises and manual therapy techniques, and used electrotherapy modalities despite being not recommended. Key challenges indicated by physical therapists for the use of CPGs include low patient adherence to therapists' instructions, lack of adequate knowledge, and limited clinical time. CONCLUSIONS: Overall, physical therapists in Saudi Arabia followed the CPGs for treating SIS. Therapeutic exercises combined with manual therapy were the most common treatment options. However, further research should consider exploring adherence to such guidelines over time.

Video interpretation in a medical spine clinic: A descriptive study of a diverse population and intervention.

OBJECTIVES: Back pain is one of the most challenging health conditions to manage. Healthcare providers face additional challenges when managing back pain for patients with culturally diverse backgrounds including addressing linguistic barriers and understanding patients' cultural beliefs about pain and healthcare. Knowledge about patients with culturally diverse backgrounds experiencing back pain and the interventions available to them is limited. Therefore, this study aims to describe the characteristics of patients with culturally diverse backgrounds experiencing back pain and the video interpretation intervention offered to them and further to explore the clinician's perspective on this intervention. METHODS: Data were collected from the electronic medical records and the Interpreter Gateway. Four clinicians participated in a group interview, where they described and evaluated the video interpretation intervention in detail inspired by the template for intervention description and replication (TIDieR) checklist and guide. RESULTS: A total of 119 (68%) patients accepted the intervention (53% women, mean 44 years). These patients represent 24 different languages, with 50% having at least one hospital-registered diagnosis and a mean number of five outpatient contacts, 1 year before receiving the intervention. Fifty-seven patients did not accept the intervention and declined interpretation or opted to use relatives or through video conferencing equipment. The intervention was positively evaluated by the clinicians. CONCLUSIONS: The detailed description of the population and the intervention together with the clinician perspective provides a valuable foundation for developing and refining similar interventions, allocating resources, and designing future research studies. The intervention consisted of a consultation lasting up to 2 h delivered by a rheumatologist and a physiotherapist, with a remote interpreter connected.

Current views on preoperative rehabilitation practice after anterior cruciate ligament injury among licensed physical therapists in Saudi Arabia: An online-based cross-sectional survey.

Preoperative rehabilitation is an important stage to both physically and mentally prepare patients for anterior cruciate ligament reconstruction (ACLR) and postoperative rehabilitation. This study aimed to investigate the current preoperative rehabilitation practice after anterior cruciate ligament injury among licensed physical therapists in Saudi Arabia. This was an online-based cross-sectional survey. A total of 114 physical therapists completed the survey. The survey consisted of 16 mandatory questions about management strategies, prescribed exercises, patients' physical and psychological concerns, and discussions about nonoperative management. The majority of the respondents used the following preoperative interventions: education (89.5%), closed kinetic chain exercises (66.7%), stretches (63.2%), open kinetic chain exercises (61.4%), proprioceptive exercises (59.6%), cold (56.1%), and activity modification advice (52.6%). More than half of the respondents would recommend patients awaiting ACLR to complete the exercises 2 to 4 times weekly (56.1%) for up to 8 weeks (80.7%) before ACLR. The respondents (73.7%) reported that patients awaiting ACLR did not receive preoperative rehabilitation due to 2 primary factors: the orthopedic team did not refer patients to rehabilitation specialists, and there was a lack of awareness about preoperative rehabilitation. Most therapists (86%) would discuss conservative management if a patient returned to their preinjury level of function before surgery. The surveyed physical therapists reported using various interventions and preoperative rehabilitation lengths with patients awaiting ACLR. The majority of the therapists indicated that patients awaiting ACLR did not receive preoperative rehabilitation. Future studies are needed to establish a consensus on the optimal preoperative rehabilitation program.

Barriers and facilitators to implementation of an exercise and education programme for osteoarthritis: a qualitative study using the consolidated framework for implementation research.

Targeted efforts to better understand the barriers and facilitators of stakeholders and healthcare settings to implementation of exercise and education self-management programmes for osteoarthritis (OA) are needed. This study aimed to explore the barriers and facilitators to the implementation of Good Life with osteoArthritis in Denmark (GLA:D), a supervised group guideline-based OA programme, across Irish public and private healthcare settings. Interviews with 10 physiotherapists (PTs; 8 public) and 9 people with hip and knee OA (PwOA; 4 public) were coded by the Consolidated Framework for Implementation Research (CFIR) constructs in a case memo (summary, rationale, quotes). The strong positive/negative implementation determinants were identified collaboratively by rating the valence and strength of CFIR constructs on implementation. Across public and private settings, PTs and PwOA strongly perceived GLA:D Ireland as evidence-based, with easily accessible education and modifiable marketing/training materials that meet participants' needs, improve skills/confidence and address exercise beliefs/expectations. Despite difficulties in scheduling sessions (e.g., work/caring responsibilities), PTs in public and private settings perceived advantages to implementation over current clinical practice (e.g., shortens waiting lists). Only PTs in public settings reported limited availability of internal/external funding, inappropriate space, marketing/training tools, and inadequate staffing. Across public and private settings, PwOA reported adaptability, appropriate space/equipment and coaching/supervision, autonomy, and social support as facilitators. Flexible training and tailored education for stakeholders and healthcare settings on guideline-based OA management may promote implementation. Additional support on organising (e.g., scheduling clinical time), planning (e.g., securing appropriate space, marketing/training tools), and funding (e.g., accessing dedicated internal/external grants) may strengthen implementation across public settings.

Influencing Physical Therapist's Self-efficacy for Musculoskeletal Ultrasound Through Blended Learning: A Mixed Methods Study.

BACKGROUND AND PURPOSE: With the growing interest for physical therapists to incorporate musculoskeletal (MSK) ultrasound comes a need to understand how to organize training to promote the transfer of training to clinical practice. A common training strategy blends asynchronous learning through online modules and virtual simulations with synchronous practice on live simulated participants. However, few physical therapists who attend MSK ultrasound continuing education courses integrate ultrasound into clinical practice. Self-efficacy is a significant predictor of training transfer effectiveness. This study describes to what degree and how a blended learning strategy influenced participants' self-efficacy for MSK ultrasound and transfer of training to clinical practice. SUBJECTS: Twenty-one outpatient physical therapists with no previous MSK ultrasound training. METHODS: Twenty-one participants assessed their self-efficacy using a 26-item self-efficacy questionnaire at 3 intervals: before asynchronous, before synchronous training, and before returning to clinical practice. Participants were interviewed within 1 week of training using a semi-structured interview guide. Quantitative analysis included descriptive statistics and repeated-measures ANOVA. Thematic analysis was used to examine participants' experiences, and "following the thread" was used to integrate findings. RESULTS: Self-efficacy questionnaire mean scores increased significantly across the 3- time points ( F [2, 40] = 172.7, P < .001, η 2 = 0.896). Thematic analysis indicated that asynchronous activities scaffolded participants' knowledge, enhanced their self-efficacy, and prepared them for synchronous learning; however, it did not replicate the challenges of MSK ultrasound. Synchronous activities further improved self-efficacy and helped participants better calibrate their self-judgments of their abilities and readiness to integrate MSK ultrasound training into clinical practice. Despite individual-level improvements in self-efficacy, interviewees recognized their limitations and a need for longitudinal training in a clinical environment. DISCUSSION AND CONCLUSION: A blended learning approach positively affects participants' self-efficacy for MSK ultrasound; however, future training designs should provide learners with additional support during the transition phase.