An Exploration of Low Back Beliefs of Male Pre-Professional and Professional Dancers.

BACKGROUND: Globally, male dancers are affected by low back pain (LBP) up to 2.5 times more than female dancers. While female dancers' beliefs around LBP and dance-specific low back movements exist, no research has explored male dancers' beliefs. This study aimed to (1) examine the low back beliefs of Australian male professional and pre-professional dancers, and (2) determine if beliefs toward common low back movements and lifting differed when current LBP or history of disabling LBP (DLBP) were considered. METHODS: 40 male dancers (mean age [SD] 26.9 years [7.9]) from a range of dance backgrounds (all participating in ballet) were recruited to complete a cross-sectional survey comprising a beliefs questionnaire considering dance-specific movement and lifting tasks, the Back Pain Attitudes Questionnaire (Back-PAQ) and the Athletic Fear Avoidance Questionnaire (AFAQ). Primary analysis included initial descriptives, a repeated measures ANOVA for movement-specific beliefs and visual thematic analysis for written responses within the belief's questionnaire. Secondary subgroup analysis included independent T-tests for those with/without current LBP and those with/without a history of DLBP. RESULTS: Fourteen dancers reported current LBP and 30 reported a history of DLBP. Dancers held generally negative beliefs toward the low back (Back-PAQ mean 123.1 ± 9.7) with neither subgroup demonstrating significant between-group difference (P < .05). Dance-specific flexion movements were seen as safer than extension movements (P < .05), and more extended-spine lifting was seen as safer than more flexed-spine lifting (P < .05). Dancers experiencing current LBP held less positive beliefs surrounding some dance-specific movements. CONCLUSIONS: Dancers hold negative general beliefs toward the low back irrespective of current or historical DLBP, however their beliefs surrounding dance-specific movements were relatively positive. Dancers' beliefs surrounding some movements were affected by the presence of current LBP, in particular an arabesque and a fish dive.

Wellbeing After Finalization of a Workers' Compensation Claim: A Systematic Scoping Review.

OBJECTIVE: A workers' compensation claim may have significant negative impacts on an injured worker's wellbeing. Wellbeing provides a good global measure of potential effects of a claim on an individual, and is important for contemporary economic modelling. The purpose of this study was to synthesize knowledge about the wellbeing of injured workers after the finalization of a workers' compensation claim and identify gaps in the current literature. METHODS: A systematic scoping review was conducted. RESULTS: 71 full-text articles were screened for inclusion, with 32 articles eligible for this review. None of the included articles evaluated overall wellbeing. Included articles did evaluate a variety of constructs inherent in wellbeing. Injured workers were generally disadvantaged in some manner following claim finalization. The literature recommends a focus on reducing negative impacts on injured workers after finalization of a compensation claim, with a need for regulatory bodies to review policy in this area. CONCLUSION: There appears to be potential for ongoing burden for individuals, employers, and society after finalization of a workers' compensation claim. A gap in knowledge exists regarding the specific evaluation of wellbeing of injured workers following finalization of a workers' compensation claim.

Physiotherapists' decision-making about transition to independent walking in hospital after stroke: a qualitative study.

PURPOSE: Physiotherapists working in hospitals have a key role in decisions about when a person with stroke is safe to walk independently. The aim of this study was to explore the factors influencing decision-making of physiotherapists in this situation. METHODS: A qualitative design with semi-structured interviews and reflexive thematic analysis was used. Fifteen physiotherapists with recent experience working in inpatient stroke rehabilitation participated. RESULTS: Multiple factors influence decision-making about walking independence after stroke in hospitals. Four themes were identified: (1) Assessment of walking safety involves observation of walking function and consideration of complex individual factors; (2) Perspectives on risk vary, and influence whether a person is considered safe to walk; (3) Institutional culture involves background pressures that may influence decision-making; and (4) Physiotherapists adopt a structured, individualised mobility progression to manage risk. Physiotherapists consistently use observation of walking and understanding of attention and perception in this decision-making. There can sometimes be a conflict between goals of independence and of risk avoidance, and decisions are made by personal judgements. CONCLUSIONS: Decision-making about independent walking for people in a hospital after a stroke is complex. Improved guidance about clinical assessment of capacity and determining acceptable risk may enable physiotherapists to engage more in shared decision-making.IMPLICATIONS FOR REHABILITATIONRegaining independence in walking after a stroke comes with the potential risk of falls.Assessment of walking safety should be specific to the complexity of the situation and consider perception and cognition.Benefits of activity and autonomy, and the risk of falls need to be considered in decisions about walking independence.Patients with the capacity to understand consequences and accept risk can be active participants in determining what is sufficiently safe.

Health Care Professionals' Decision Making Related to Mobility and Safety for People in the Hospital: A Scoping Review.

OBJECTIVE: Mobility dysfunction can have an impact on safety, and this fact is particularly relevant to hospital settings. There are no clear standards for how health care professionals should approach the aim to encourage mobility without compromising safety. The objective of this scoping review was to identify factors that shape health care professionals' decision making for people in hospitals, in situations in which mobility and safety are taken into consideration. METHODS: For this scoping review, 4 databases (Medline, CINAHL, PubMed, and Scopus) were searched. Terms previously agreed upon were used to identify peer-reviewed articles related to decision making by health care professionals in hospital settings (acute and rehabilitation), in which safety and mobility were factors for consideration. An initial screening of titles and abstracts was conducted by a single reviewer. Two reviewers independently screened the full texts of the remaining articles. The key findings of the articles were synthesized to determine common themes. RESULTS: After 10,717 articles were screened, 28 met the inclusion criteria. Ten themes influencing decision making were identified: Clinical factors assessed; health care professional experience; limited use of standardized tests; impact of institutional governance; risk/benefit trade-off; capacity for decision making; role of the multidisciplinary team; families and others; communication; and fear of negative outcomes. CONCLUSION: A wide range of factors influence health care professionals' decision making. The decisions can be complex, and individual priorities may vary in the balancing of safety with promotion of independence. Health care professionals rely on experience, clinical judgment, and shared decision making. IMPACT: This review brings attention to many factors that contribute to decision making when mobility and safety are the factors. Health care professionals should include patients' values and monitor the impact of their personal preferences on this process.

Patient experiences of referral practices and primary care physiotherapy for chronic nonspecific low back pain.

BACKGROUND: Low back pain (LBP) clinical practice guidelines recommend referral for patients with persistent LBP however discordance persists between recommended care and implementation in practice. Understanding patient experiences of referral practices and physiotherapy care could be important for optimizing LBP management in primary care settings. PURPOSE: This study explored referral experiences of people with nonspecific LBP in Australian primary care and their knowledge and experience of physiotherapy. METHODS: An interpretive descriptive qualitative framework was used with 17 participants interviewed from community-based physiotherapy practices. RESULTS: Four themes described the participants' experiences of referrals in primary care settings: 1) Referral practices ranged from formal to informal to non-existent; 2) Fragmented inter-and intra-professional LBP care management; 3) Patient perceived differences in the roles of physiotherapists and specialist physiotherapists; and 4) Patient nominated barriers and facilitators to optimal referral practices. CONCLUSION: Physiotherapists support people with LBP to improve strength and function, whereas the specialist physiotherapist's role was seen as more holistic. Referral pathways that align to clinical guideline recommendations for non-surgical management and treatment remain underdeveloped. Improved referral pathways to clinicians such as physiotherapists with additional credentialed skills and competence in musculoskeletal care could improve people's experiences of care and health outcomes.

Patient perspectives of care pathways for people with low back pain: A qualitative study.

BACKGROUND: Low back pain (LBP) care pathways aim to enhance health outcomes through patient-clinician mutual decision-making and care coordination. However, challenges to successful translation into practice include patients' understanding, expectation, and acceptance of treatment and management strategies for LBP. This study explored patients' perspectives and/or experience of care pathways and their involvement in decision-making in primary care. METHODS: A qualitative descriptive design was adopted. Semi-structured interviews were conducted with 14 participants with LBP recruited from the community. Inductive thematic analysis of the qualitative data was conducted within the design framework to enable a systematic comparison of experiences across participants and within individual cases. RESULTS: Five themes described participant perspectives and understanding of care pathways: i) care pathways can guide decision-making; ii) familiarity with no and/or stepped care pathway, but preference for matched or blend of care pathways; iii) engaging in shared decision-making; iv) patient-related barriers to implementation; v) patient-related facilitators to implementation. CONCLUSIONS: Participants felt that existing care pathways did not meet their needs when pain persisted. Participants preferred matched or hybrid care pathways and suggested that implementation of such pathways should focus on addressing an individual's needs. Adopting a holistic approach, and clarity in shared decision-making, were deemed crucial for effective implementation of LBP pathways in practice. Consumer (patient) engagement in the design of LBP care pathways is recommended.

Taking the strain: An examination of upper back musculoskeletal tissue sensitivity in relation to upper back pain and breast size. A cross-sectional study.

BACKGROUND: The physiological basis for upper back pain experienced by women with large breasts is unclear but could relate to sensitivity of musculoskeletal tissues strained from the postural adaptations to large breasts. The aim of this cross-sectional study was to examine if upper back pain and breast size were associated with greater localised sensitivity of upper back musculoskeletal tissues. METHODS: 119 healthy postmenopausal women (mean age 61 years) had their upper back pain (numerical rating scale), breast size (breast size score), and upper back tissue sensitivity (pressure pain thresholds (digital algometry, kPa)) assessed. The pressure pain thresholds of six skeletal sites (T2, T4, T6, T8, T10 and T12) and six muscular sites (pectoralis major, levator scapulae, sternocleidomastoid, and upper, middle, and lower trapezius muscles) were examined. Linear mixed models with random subject effects were used to evaluate differences in sensitivity at each anatomical site between participants grouped by upper back pain (nil-mild, moderate-severe) and breast size (small, large). FINDINGS: For most sites, the differences in sensitivity between upper back pain groups were highly significant (P < 0.002) with significantly lower pressure pain thresholds (Mean difference (MD): 74.6 to 151.1 kPa) recorded for participants with moderate-severe upper back pain. There were no differences in sensitivity between breast size groups. INTERPRETATION: Increased upper back musculoskeletal sensitivity is related to perceived upper back pain but not to breast size. It remains unclear if and how structural or mechanical factors related to breast size contribute to upper back pain in women with large breasts.

Is Breast Size Related to Prevalent Thoracic Vertebral Fracture? A Cross-Sectional Study.

Large breasts may increase the likelihood of thoracic vertebral fractures by increasing the mechanical loading of the spine. We examined breast size as a factor associated with prevalent thoracic vertebral fractures, also considering its relationship with thoracic kyphosis and upper back extensor muscle endurance. Using a cross-sectional study, the design measurements collected were thoracic vertebral fractures (≥20% loss in vertebral body height on lateral radiograph), breast size (bra size converted to an ordinal breast size score), BMD (g/cm2 averaged femoral neck, DXA), upper back extensor muscle endurance (isometric chest raise test), body composition (DXA), thoracic kyphosis (radiograph), and upper back pain (numerical rating scale). Correlations and multivariable logistic regression examined relationships between characteristics and their association with vertebral fracture. Participants were 117 healthy postmenopausal women. The 17 (15%) women with ≥1 thoracic vertebral fracture had larger breast size (mean difference [MD]: 2.2 sizes; 95% CI, 0.6 to 3.8 sizes), less upper back extensor muscle endurance (MD: -38.6 s; 95% CI, -62.9 to -14.3 s), and greater thoracic kyphosis (MD: 7.3°; 95% CI, 1.7° to 12.8°) than those without vertebral fracture. There were no between group differences in age, height, weight, and BMD. Breast size (r = -0.233, p = 0.012) and thoracic kyphosis (r = -0.241, p = 0.009) correlated negatively with upper back extensor muscle endurance. Breast size was unrelated to thoracic kyphosis (r = 0.057, p = 0.542). A (final) multivariable model containing breast size (OR 1.85; 95% CI, 1.10 to 3.10) and thoracic kyphosis (OR 2.04; 95%CI, 1.12 to 3.70) explained 18% of the variance in vertebral fracture. Breast size had a significant, but weak relationship with vertebral fracture (R 2 = 0.10), which was independent of BMD and unrelated to thoracic kyphosis. Further work is needed to confirm larger breast size as a risk factor for vertebral fracture. © 2020 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

The relationship between breast size and aspects of health and psychological wellbeing in mature-aged women.

OBJECTIVES: Increases in breast size with age are common but have not been widely examined as a factor that could affect the health and psychological wellbeing of mature-aged women. The purpose of this study was to examine the relationships between breast size and aspects of health and psychological wellbeing in mature-aged women. METHODS: This was a cross-sectional study of mature-aged women (⩾40 years). Breast size (breast size score) was determined from self-reported bra size and was examined against health-related quality of life (Medical Outcomes Study Short-Form 36 and BREAST-Q), body satisfaction (numerical rating scale), breast satisfaction (BREAST-Q), physical activity levels (Human Activity Profile), the presence of upper back pain and breast and bra fit perceptions. RESULTS: Two hundred sixty-nine women (40-85 years) with bra band sizes ranging from 8 to 26 and bra cup sizes from A to HH participated. The mean (standard deviation) breast size score of 7.7 (2.7) was equivalent to a bra size of 14DD. Increasing breast size was associated with significantly lower breast-related physical wellbeing (p < 0.001, R2 = 0.043) and lower ratings of body (p = 0.002, R2 = 0.024) and breast satisfaction (p < 0.001, R2 = 0.065). Women with larger breasts were more likely to be embarrassed by their breasts (odds ratio: 1.49, 95% confidence interval: 1.31 to 1.70); more likely to desire a change in their breasts (odds ratio: 1.55, 95% confidence interval: 1.37 to 1.75) and less likely to be satisfied with their bra fit (odds ratio: 0.84, 95% confidence interval: 0.76 to 0.92). Breast size in addition to age contributed to explaining upper back pain. For each one-size increase in breast size score, women were 13% more likely to report the presence of upper back pain. CONCLUSION: Larger breast sizes have a small but significant negative relationship with breast-related physical wellbeing, body and breast satisfaction. Larger breasts are associated with a greater likelihood of upper back pain. Clinicians considering ways to improve the health and psychological wellbeing of mature-aged women should be aware of these relationships.

Satisfaction after total knee replacement for osteoarthritis is usually high, but what are we measuring? A systematic review.

Objective: Patient satisfaction is considered an important outcome measure after total knee replacement, but the construct is complex. There is large variation both in how satisfaction is measured and estimates of the proportion of people who are satisfied after surgery. The aim of this systematic review was to i) evaluate the proportion of people reported to be satisfied after total knee replacement for osteoarthritis; and ii) assess the content validity of the utilised satisfaction measures. Methods: We searched four literature databases with search phrases 'Total Knee Arthroplasty' OR 'Total Knee Replacement' AND 'Patient satisfaction' for studies that measured satisfaction at least 6 month post-unilateral primary total knee replacement for knee osteoarthritis. Identified studies were assessed for risk of bias, and studies at high risk of bias were excluded (PROSPERO: CRD42017058936). Meta-analysis was not appropriate due to the heterogeneity in satisfaction instruments, thus satisfaction scores were described. The content validity of satisfaction questionnaires was assessed using the COnsensus-based Standards for the selection of health status Measurement Instruments criteria. Results: The present review found heterogeneity in the satisfaction questions used, as well as the satisfaction estimates from the various studies. Only two satisfaction instruments were relevant for a Total Knee Replacement population and both failed assessment for content validity due to lack of patient involvement during development and testing in accordance with the COnsensus-based Standards for the selection of health status Measurement Instruments criteria. Conclusion: Future research should focus on qualitative methods to elicit patients' perspectives of satisfaction to build theoretical understanding.

Physiotherapists' views about providing physiotherapy services to people with severe and persistent mental illness: a mixed methods study.

QUESTIONS: What perceptions do physiotherapists have about their role in managing the physical health of people with severe and persistent mental illness (SPMI)? What are the barriers to treating physical health conditions in this clinical population, and what enablers may improve access to physiotherapy services? DESIGN: Mixed-methods research design combining focus groups, interviews and an online survey. PARTICIPANTS: Eighty-eight Australian registered physiotherapists: 31 in the focus groups and interviews (mean age 32 years, 68% female) and 57 in the survey (mean age 38 years, 86% female). METHODS: Focus groups and interviews explored participants' understanding of mental illness; their role in managing the physical health of people with SPMI; and the barriers and enablers to service delivery. Key themes were derived using an inductive approach. The survey was used to determine physiotherapists' attitudes and knowledge regarding mental illness; perceived role of physiotherapy in mental health; and need for professional development in the mental health area. Participant characteristics and survey information were analysed using descriptive statistics. RESULTS: Qualitative and quantitative results were confirmatory. Participants indicated that physiotherapists can play a role in the management of physical health conditions in people with SPMI. Participants also stated that such treatment was part of their job, given the extensive evidence that physiotherapy interventions are effective for the comorbidities that are common among people with SPMI. Barriers included: limited education about and confidence in how to manage people with SPMI; health system structure; and stigmatisation of people with SPMI. CONCLUSION: Physiotherapists are ideally poised to become leaders in managing the physical health of people with SPMI. To improve the physical health in this important yet overlooked population, it is recommended that: physiotherapists take up general mental health training opportunities; undergraduate physiotherapy education increases content in this clinical area; physiotherapy-specific professional development opportunities are developed further; and health system barriers are addressed.

Upper back pain in postmenopausal women and associated physical characteristics.

The physical characteristics of postmenopausal women that are associated with upper back pain are not well-understood. The aim of this cross-sectional study was to identify the physical characteristics associated with presence and severity of upper back pain in healthy postmenopausal women. Self-reported upper back pain presence (within the previous month) and severity (numerical rating scale) were examined against the physical characteristics: height; weight; body mass index; breast size; breast ptosis; upper back extensor muscle endurance (isometric chest raise test); head, shoulder and upper back posture (photogrammetry); thoracic extension mobility (photogrammetry); bone mineral density (dual-energy x-ray absorptiometry (DXA)); body composition (DXA); and thoracic kyphosis, thoracic osteoarthritis and thoracic vertebral fracture (all radiography). A multivariable logistic regression model, adjusted for age, was built using physical characteristics with a significant univariate association with upper back pain. Censored Tobit regression, adjusted for age, was used to examine each physical characteristic against upper back pain severity. Postmenopausal women (n = 119) with a mean (SD) age of 61.4 (7.0) years participated in the study. After adjusting for age, the physical characteristics independently associated with upper back pain were: height (OR: 0.50, 95% CI: 0.31-0.79); and upper back extensor muscle endurance (OR: 0.46, 95%CI: 0.28-0.75). This model explained 31% of the variance in upper back pain (p<0.001). After adjusting for age, being taller and having better upper back extensor muscle endurance were associated with lower odds for upper back pain. After adjusting for age, differences in upper back pain severity were explained by upper back extensor muscle endurance (p = <0.001) and lean mass (p = 0.01). Conclusion: As a modifiable physical characteristic of postmenopausal women with upper back pain, upper back extensor muscle endurance is worth considering clinically.

Two subtypes of symptomatic joint hypermobility: a descriptive study using latent class analysis.

OBJECTIVE: To investigate a cohort of children with symptomatic joint hypermobility. METHODS: Case notes for 318 children with joint hypermobility attending a rheumatology clinic were reviewed for clinical presentation, medical history, psychosocial factors and physical examination findings. Seven key variables were extracted and used as indicator variables in a latent class analysis to estimate the presence and number of subgroups of children with symptomatic joint hypermobility. RESULTS: Two subgroups with differing clinical presentations were identified accounting for age and gender: an 'athletic-persistent' class (62%) characterised by higher probabilities for recurrent and chronic musculoskeletal pain, and less severe hypermobility; and a 'systemic-profound' class (38%) characterised by generalised hypermobility, recurrent musculoskeletal pain, gastro-oesophageal reflux and motor delay. CONCLUSION: Findings suggest the presence of two distinct presentations of children with hypermobility. This finding may be important for clinical decision-making and management of this group of children.

Correlations between the active straight leg raise, sleep and somatosensory sensitivity during pregnancy with post-partum lumbopelvic pain: an initial exploration.

Background and aims For some women, lumbopelvic pain (LPP) developed during pregnancy becomes a continuing post-partum problem. Increased understanding of potential prognostic factors is required. This study investigated whether active straight leg raise (ASLR), sleep dysfunction and pressure pain sensitivity during pregnancy are correlated with LPP intensity and quality, disability, and physical health-related quality of life (HRQoL) post-partum. Methods An exploratory, prospective cohort study design was used. Baseline factors of interest were: (1) ASLR, (2) Pittsburgh Sleep Quality Index, and (3) pressure pain thresholds (PPTs) collected from pregnant women from sites local and distal to the lumbopelvic area. Follow-up data collected 11-18 months post-partum (n=29) were: (1) pain intensity score (numerical rating scale), (2) pain quality (McGill Pain Questionnaire), (3) disability (Pelvic Girdle Questionnaire), and (4) HRQoL (36-item Short Form Health Survey). Correlation analysis was performed. Results Greater difficulty with an ASLR during pregnancy correlated with lower post-partum physical HRQoL scores (r=-0.563, p=0.002). Likewise, reduced PPTs at the sacrum during pregnancy was correlated with a higher post-partum pain quality score (r=-0.384, p=0.040). Conclusions In this cohort, findings indicate that poor ASLR performance and localised pressure pain hypersensitivity at the pelvis during pregnancy are correlated with post-partum physical HRQoL and pain quality, respectively. Implications Pain sensitivity may contribute to the prognosis of women with LPP during pregnancy. These explorative findings may be important for designing larger prognostic studies and may assist in directing potential pain management in post-partum LPP.

Physical activity and sedentary behaviour in a residential aged care facility.

OBJECTIVE: To evaluate sedentary behaviour and physical activity levels in independently mobile older adults with and without dementia living in residential aged care. METHODS: Sedentary behaviour and physical activity were measured in 37 residents of an aged care facility using an accelerometer worn during waking hours for five days. RESULTS: Participants with valid accelerometer data (n = 28) spent 85% of the time sedentary, and 12% in low-intensity, 2% in light-intensity and 1% in moderate-to-vigorous-intensity physical activity. Over half of sedentary time was accumulated in bouts of greater than 30 minutes. Physical activity at any level of intensity was performed in bouts of less than 10 minutes. CONCLUSION: Residents were highly sedentary and inactive. In particular, the short duration of each bout of activity amongst lengthy periods of sedentary behaviour was a substantial finding. The study suggests the need to develop innovative ways of breaking up sedentary behaviour in residential aged care.

Characterisation of pain in people with hereditary neuropathy with liability to pressure palsy.

Hereditary neuropathy with liability to pressure palsy (HNPP) has historically been considered a pain-free condition, though some people with HNPP also complain of pain. This study characterised persistent pain in people with HNPP. Participants provided cross-sectional demographic data, information on the presence of neurological and persistent pain symptoms, and the degree to which these interfered with daily life. The painDETECT and Central Sensitization Inventory questionnaires were used to indicate potential neuropathic, central sensitisation and musculoskeletal (nociceptive) pain mechanisms. Additionally, participants were asked if they thought that pain was related to/part of HNPP. 32/43 (74%) subjects with HNPP had persistent pain and experience this pain in the last week. Of those with pain, 24 (75%) were likely to have neuropathic pain and 27 (84%) were likely to have central sensitisation. All 32 participants felt that their pain could be related to/part of their HNPP. Significant negative impact of the pain was common. Pain characterisation identified neuropathic pain and/or central sensitisation as common, potential underlying processes. Pain may plausibly be directly related to the underlying pathophysiology of HNPP. Further consideration of including pain as a primary symptom of HNPP is warranted.

Assessing Implementation Readiness and Success of an e-Resource to Improve Prelicensure Physical Therapy Workforce Capacity to Manage Rheumatoid Arthritis.

Study Design Prospective within-subject, cross-sectional, between-group, nested qualitative designs within an implementation science framework. Background Physical therapy is recommended for rheumatoid arthritis (RA) care, yet prelicensure RA curriculum time remains limited. Objectives To determine readiness for, and success of, implementing an e-learning tool, Rheumatoid Arthritis for Physiotherapists e-Learning (RAP-eL), within the prelicensure physical therapy curriculum. Methods All physical therapy students in a 1-year cohort in 2014 had RAP-eL embedded in their curriculum. Rheumatoid Arthritis for Physiotherapists e-Learning is an online platform that delivers RA disease information with translation to clinical practice. Implementation readiness, determined by acceptability of RAP-eL to students, was evaluated using focus groups (n = 23). Implementation success was measured using quantitative data from a previously validated questionnaire, including changes in students' self-reported confidence in knowledge (out of 45) and skills (out of 40) in managing RA after 4 weeks of access to RAP-eL, retention of learning over 14 months, and differences in workforce readiness between students in the cohort who had access to RAP-eL and a historical control cohort. Results Acceptability of RAP-eL was confirmed from qualitative data, demonstrating implementation readiness. Short-term improvements were observed in RA knowledge (mean difference, 16.6; 95% confidence interval [CI]: 15.7, 17.6) and RA skills (mean difference, 14.9; 95% CI: 13.9, 15.9; n = 137). Retention was demonstrated after 14 months (P<.001; n = 62). Students in the 1-year cohort who had RAP-eL embedded in the curriculum scored significantly higher on knowledge (mean difference, 3.6; 95% CI: 1.3, 5.9) and skills (mean difference, 3.3; 95% CI: 0.9, 5.7; n = 62) compared to those without RAP-eL (n = 36). Rheumatoid Arthritis for Physiotherapists e-Learning remains embedded in the curriculum. Conclusion This study demonstrated both readiness and success of the sustainable implementation of RAP-eL within a prelicensure physical therapy curriculum. J Orthop Sports Phys Ther 2017;47(9):652-663. doi:10.2519/jospt.2017.7281.

Limited interface between physiotherapy primary care and people with severe mental illness: a qualitative study.

QUESTIONS: How do mental health professionals perceive the role of physiotherapists in the care of people with severe and persistent mental illness, and what factors do they perceive as influencing access to physiotherapy services? How do people with severe and persistent mental illness understand the potential role of physiotherapy in their healthcare, and what factors do they perceive as influencing access to physiotherapy services? DESIGN: Qualitative study. PARTICIPANTS: Twenty-four mental health professionals and 35 people with severe and persistent mental illness. METHODS: Interview schedules were developed to explore participants' understanding of physiotherapy, as well as barriers and enablers to service access. Focus groups and interviews were conducted for each group of participants. Transcripts were analysed using an inductive approach to derive key themes. RESULTS: Both the mental health professionals and the people with severe and persistent mental illness expressed a limited understanding of the role and relevance of physiotherapy for physical health in mental healthcare. Common barriers to service access were cost, transport and lack of motivation. Likewise, enablers of reduced cost, provision of transport and education about physiotherapy to improve their understanding were identified. The health system structure and perceived lack of mental health knowledge by physiotherapists influenced referrals from mental health professionals. Consequently, education in mental health for physiotherapists and integration of the service within mental health were identified as potential enablers to physiotherapy access. CONCLUSION: Limited understanding about physiotherapy and its relevance to physical health in mental healthcare among mental health professionals and people with severe and persistent mental illness was found to be a key factor influencing service access. Limited physiotherapy presence and advocacy within mental health were also highlighted. There is a need for greater understanding about physiotherapy among stakeholders, and for physiotherapists to be well equipped with skills and knowledge in mental health to facilitate greater involvement. [Lee S, Waters F, Briffa K, Fary RE (2017) Limited interface between physiotherapy primary care and people with severe mental illness: a qualitative study. Journal of Physiotherapy 63: 168-174].

Physiotherapy students' perspectives of online e-learning for interdisciplinary management of chronic health conditions: a qualitative study.

BACKGROUND: To qualitatively explore physiotherapy students' perceptions of online e-learning for chronic disease management using a previously developed, innovative and interactive, evidence-based, e-learning package: Rheumatoid Arthritis for Physiotherapists e-Learning (RAP-eL). METHODS: Physiotherapy students participated in three focus groups in Perth, Western Australia. Purposive sampling was employed to ensure maximum heterogeneity across age, gender and educational background. To explore students' perspectives on the advantages and disadvantages of online e-learning, ways to enhance e-learning, and information/learning gaps in relation to interdisciplinary management of chronic health conditions, a semi-structured interview schedule was developed. Verbatim transcripts were analysed using inductive methods within a grounded theory approach to derive key themes. RESULTS: Twenty-three students (78 % female; 39 % with previous tertiary qualification) of mean (SD) age 23 (3.6) years participated. Students expressed a preference for a combination of both online e-learning and lecture-style learning formats for chronic disease management, citing flexibility to work at one's own pace and time, and access to comprehensive information as advantages of e-learning learning. Personal interaction and ability to clarify information immediately were considered advantages of lecture-style formats. Perceived knowledge gaps included practical application of interdisciplinary approaches to chronic disease management and developing and implementing physiotherapy management plans for people with chronic health conditions. CONCLUSIONS: Physiotherapy students preferred multi-modal and blended formats for learning about chronic disease management. This study highlights the need for further development of practically-oriented knowledge and skills related to interdisciplinary care for people with chronic conditions among physiotherapy students. While RAP-eL focuses on rheumatoid arthritis, the principles of learning apply to the broader context of chronic disease management.