Efectividad de la entrevista motivacional en la atención fisioterápica de los trastornos musculoesqueléticos de la espalda / Effectiveness of the motivational interview in the physiotherapy care of musculoskeletal disorders of the back: A quasi-experimental study

Objetivo: Evaluar la efectividad de la entrevista motivacional (EM) junto al tratamiento fisioterapéutico habitual en pacientes con trastornos musculoesqueléticos (TME) de la espalda en atención primaria (AP). Métodos: Estudio cuasiexperimental en pacientes que iniciaron su tratamiento en el año 2020 en una unidad de fisioterapia tras diagnóstico médico de TME en la espalda, con seguimiento prospectivo de 2grupos con actuación terapéutica: grupo experimental (GE) y grupo de control (GC). Se empleó la EM solo en el GE. A ambos grupos se les entrevistó telefónicamente a los 3y 6meses de finalizar el tratamiento fisioterápico, preguntando por el cumplimiento de pautas domiciliarias y por la percepción subjetiva del estado de salud (escala de Barthel). Se ajustaron modelos de regresión lineales (coeficiente de regresión, IC del 95%) y logísticos (OR, IC del 95%). Resultados: La población de estudio fue de 154 personas (76,6% mujeres). La salud percibida fue significativamente mejor (p<0,001) en el GE que en el GC, tanto a los 3meses de seguimiento (7,4 versus 5,0, respectivamente) como a los 6(7,1 versus 4,6, respectivamente). Hubo una fuerte asociación entre percepción de salud y cumplimiento (coeficiente de regresión 3,0 [IC del 95%=2,5-3,4]). La asociación entre la EM y el cumplimiento terapéutico se mantuvo tras ajustes multivariados (OR a 6meses=383,6 [IC del 95% = 31,0-4.742,4]). Conclusiones: la incorporación de la EM como complemento de los tratamientos de fisioterapia es una herramienta factible y efectiva para mejorar el cumplimiento de las pautas domiciliarias y la percepción subjetiva de salud. (AU)

Objective: To evaluate the effectiveness of motivational interviewing (MI) combined with the usual physiotherapy treatment in patients with back musculoskeletal disorders (MSD) in primary care (PC). Methods: Quasi-experimental study with 2groups with therapeutic action (control group and experimental group) and prospective follow-up, in a physiotherapy unit in PC, in patients who began their treatment in 2020, with a medical diagnosis of MSD in the back. MI was used only in the face-to-face visits of the experimental group. Both groups were interviewed by telephone about 3and 6months after finishing the physiotherapy treatment. For this purpose, the Barthel scale was used for the subjective perception of the state of health, and the scale of compliance with home guidelines. Linear (regression coefficient, 95% CI) and logistic (OR, 95% CI) regression models were fitted. Results: The study population was 154 people (76.6% women). Perceived health was significantly better (P<.001) in the experimental group than in the control group, both at 3(7.4 versus 5.0, respectively) and at 6months of follow-up (7.1 versus 4.6, respectively). There was a strong association between perceived health and compliance (regression coefficient 3.0 [95% CI=2.5–3.4]). The strong association between MI and treatment adherence was maintained after multivariate adjustments (6-month OR=383.6 [95% CI 31.0–4742.4]). Conclusions: MI is a feasible and effective complement to physiotherapy treatments to improve compliance with home recommendations and subjective perception of health. (AU)

[Therapeutic healthcare professional staffing requirements in intensive care units]. / Stellenschlüssel für therapeutische Gesundheitsfachberufe auf Intensivstationen.

BACKGROUND: Therapeutic healthcare professionals in the multiprofessional intensive care unit (ICU) team are important for early mobilization, dysphagia therapy, and psychosocial care of critically ill patients. OBJECTIVE: Despite the high relevance of therapeutic healthcare professions for care in ICUs, there are no recommendations on the specific staffing of therapists in ICUs. RESULTS: Considering the main areas of activity of the individual professional groups and based on productivity time, a requirements analysis for staffing ICUs of different care levels with physiotherapists, occupational therapists, speech therapists, and psychologists was performed. For every 10 beds in the highest care level (LoC3), 1.28 full-time equivalent (FTE) physiotherapists, 0.91 FTE occupational therapists and speech therapists, and 0.80 FTE psychologists should be employed. CONCLUSION: In order to implement multiprofessional patient treatment and support for relatives in the ICU, it is essential to employ a proportionate number of therapeutic healthcare professionals.

Canadian Physiotherapists Integrate Virtual Care during the COVID-19 Pandemic.

Purpose: To examine Canadian physiotherapists' experiences in adapting their delivery of patient care during the COVID-19 pandemic. We examine the level of strain on the profession and barriers and enablers to virtual care and provide strategies to support future virtual care implementation. Methods: From May to October 2020, a series of eight cross-sectional survey cycles were distributed every 2-4 weeks through branches and divisions of the Canadian Physiotherapy Association, social media, and personal networks. Descriptive statistics summarized the main findings. Open ended questions were first analyzed inductively using thematic analysis, then deductively mapped to the Capability-Opportunity-Motivation Behavioural (COM-B) Model. Results: Between 1,820 (cycle 1) and 334 (cycle 7) physiotherapists responded. Median strain level was 5/5 (cycle 1) and dropped to median 3/5 (cycles 5-8). In cycle 1, 55% of physiotherapists had ceased in-person care, while 41% were providing modified in-person care. Of these physiotherapists, 79% were offering virtual care. As modified in-person care increased, virtual care continued as a substantial aspect of practice. Physiotherapists identified barriers (e.g., lack of hands-on care) and enabling factors (e.g., greater accessibility to patients) for virtual care. In-depth examination of the barriers and enablers through the COM-B lens identified potential interventions to support future virtual care implementation, including education and training resources for physiotherapists and communication and advocacy to patients and the public on the value of virtual care. Conclusions: Canadian physiotherapists exhibited high adaptability in response to COVID-19 through the rapid and widespread use of virtual care. By creating an in-depth understanding of the barriers and enablers to virtual care, along with potential interventions, this work will facilitate future opportunities to support and enhance physiotherapists' delivery of virtual care.

Objectif : examiner les expériences des physiothérapeutes canadiens qui ont adapté la prestation de leurs soins aux patients pendant la pandémie de COVID-19. Les auteurs ont examiné le degré de pression sur la profession de même que les obstacles et les incitations aux soins virtuels et ils proposent des stratégies pour appuyer la future mise en œuvre des soins virtuels. Méthodologie : de mai à octobre 2020, toutes les deux à quatre semaines, les auteurs ont distribué une série de huit cycles de sondages transversaux aux sections et divisions de l'Association canadienne de physiothérapie, aux réseaux sociaux et à leurs réseaux personnels. Ils ont utilisé des statistiques descriptives pour résumer leurs principales observations. Ils ont d'abord procédé à l'examen inductif des questions ouvertes par une analyse thématique, puis ont entrepris la cartographie déductive du modèle comportemental de capacité-possibilité-motivation (COM-B). Résultats : entre 1 820 (cycle 1) et 334 (cycle 7) physiothérapeutes ont répondu. Le degré médian de pression a atteint 5/5 (cycle 1), pour reculer à 3/5 (cycles 5 à 8). Au cours du cycle 1, 55 % des physiothérapeutes ont interrompu leurs soins en présentiel, tandis que 41 % ont fourni des soins modifiés en présentiel. Par ailleurs, 79 % de tous ces physiothérapeutes ont offert des soins virtuels. Alors que les soins modifiés en présentiel ont augmenté, les soins virtuels ont continué de représenter un volet substantiel de la pratique. Les physiothérapeutes ont relevé des obstacles (p. ex., absence de soins manuels) et des incitatifs (p. ex., plus grande accessibilité aux patients) aux soins virtuels. L'examen approfondi des obstacles et des incitatifs en fonction du modèle COM-B a permis d'extraire des interventions possibles pour appuyer la future mise en œuvre des soins virtuels, y compris des ressources d'éducation et de formation pour les physiothérapeutes et les communications et la promotion de la valeur des soins virtuels auprès des patients et du public. Conclusions : les physiothérapeutes canadiens ont fait preuve d'une grande adaptabilité en réponse à la COVID-19 grâce au recours rapide et généralisé aux soins virtuels. Par une compréhension approfondie des obstacles et des incitations aux soins virtuels et des interventions potentielles, la présente étude favorisera les futures occasions de soutenir et d'améliorer la prestation des soins virtuels par des physiothérapeutes.

Gender Issues in Physiotherapy in Quebec, Canada.

Purpose: This study examines gender differences in the physiotherapy (PT) profession in the province of Quebec regarding: (1) areas of practice; (2) roles associated with the advancement of the profession; (3) formal disciplinary complaints; and (4) interests and competency perceptions of PT students. Methods: We collected data from the Canadian Institute of Health Information, the Quebec Professional Order of Physiotherapy, Quebec university public Internet sites, and PT associations. We also surveyed PT students at the Université de Montréal. Results: The PT workforce in Quebec was 76.6% women. The presidents of the four main PT associations were men. In the five university programmes, the percentage of male and female physiotherapists in tenure track positions was 46% and 54%, respectively. There were more sanctioned complaints of sexual misconduct and not maintaining continuing education for male physiotherapists, while more women were sanctioned for problems with documentation and billing. Among students, men were more interested in becoming administrators, but neither men nor women had a strong interest in research. Conclusions: Male physiotherapists make up 23.4% of the PT workforce in Quebec but are more involved in leadership positions in the profession than women.

Objectif : examiner les différences de genre en physiothérapie au Québec à l'égard 1) des secteurs d'exercice, 2) des rôles associés à l'avancement de la profession, 3) des plaintes disciplinaires officielles et 4) des intérêts des étudiants en physiothérapie et de leurs perceptions à l'égard des compétences. Méthodologie : collecte de données auprès de l'Institut canadien d'information sur la santé, de l'Ordre professionnel de la physiothérapie du Québec, des sites Internet publics des universités québécoises et des associations de physiothérapie. Sondage auprès des étudiants en physiothérapie de l'Université de Montréal. Résultats : au Québec, la main-d'œuvre en physiothérapie était composée de 76,6 % de femmes. Ce sont des hommes qui présidaient les quatre principales associations de physiothérapie. Dans les cinq programmes universitaires, le pourcentage de physiothérapeutes de sexe masculin et féminin qui occupaient des postes menant à la permanence s'élevait à 46 % et à 54 %, respectivement. On dénombrait plus de plaintes sanctionnées d'inconduite sexuelle et de non-respect de la formation continue chez les physiothérapeutes de sexe masculin, tandis que plus de femmes étaient sanctionnées pour des problèmes de tenue de dossier et de facturation. Chez les étudiants, les hommes étaient plus intéressés à devenir administrateurs, mais ni les hommes ni les femmes ne témoignaient d'un intérêt marqué envers la recherche. Conclusions : les physiothérapeutes de sexe masculin représentent 23.4% de la main-d'œuvre en physiothérapie au Québec, mais occupent plus de postes de direction dans la profession que les femmes.

Neck pain repercussions in migraine - The role of physiotherapy.

INTRODUCTION: Migraine is a neurological and disabling disease whose peripheral manifestations can be addressed with physiotherapy. These manifestations can include pain and hypersensitivity to muscular and articular palpation in the neck and face region, a higher prevalence of myofascial trigger points, limitation in global cervical motion, especially in the upper segment (C1-C2), and forward head posture with worse muscular performance. Furthermore, patients with migraine can present cervical muscle weakness and greater co-activation of antagonists in maximum and submaximal tasks. In addition to musculoskeletal repercussions, these patients can also present balance impairment and a greater risk of falls, especially when chronicity of migraine frequency is present. The physiotherapist is a relevant player in the interdisciplinary team and can help these patients to control and manage their migraine attacks. PURPOSE: This position paper discusses the most relevant musculoskeletal repercussions of migraine in the craniocervical area under the perspective of sensitization and disease chronification, besides addressing physiotherapy as an important strategy for evaluating and treating these patients. IMPLICATIONS: Physiotherapy as a non-pharmacological treatment option in migraine treatment may potentially reduce musculoskeletal impairments related to neck pain in this population. Disseminating knowledge about the different types of headaches and the diagnostic criteria can support physiotherapists who compose a specialized interdisciplinary team. Furthermore, it is important to acquire competencies in neck pain assessment and treatment approaches according to the current evidence.

Sensory and muscular functions of the pelvic floor in women with endometriosis - cross-sectional study.

PURPOSE: The aim of this study was to analyze the sensory and muscle functions of the pelvic floor in women with endometriosis, trying to improve overall knowledge/findings regarding pelvic floor muscle functions in patients with endometriosis. METHODS: Sample size calculated as 92 patients with endometriosis, aged between 18 and 45 years, not virgin, without other causes of pain and could not be pregnant. Patients underwent the Pelvic Floor Sensorial and Muscle Function Exam (EFSMAP). Descriptive data were recorded with mean and standard deviation, median (range), and absolute and relative frequency. The Kolmogorov-Smirnov test was used to observe the normality of quantitative variables. The significance level adopted for this study was 5%. RESULTS: Of 92 women assessed, 93.3% had pain and 75% had increased tone in the levator ani muscle; 50.4% had impaired pelvic floor relaxation with median strength of 3 by the Oxford scale and endurance of 2 s. CONCLUSIONS: The patients had a high prevalence of pain and dysfunction of the pelvic floor muscles, such as low muscle endurance and difficulty to relax. It shows that these patients should be referred to a pelvic floor physiotherapist, as soon as they have the diagnosis of endometriosis, to be assessed to prevent and/or treat pelvic floor impairments.

Effectiveness of physical therapy in axillary web syndrome after breast cancer: a systematic review and meta-analysis.

BACKGROUND: The axillary web syndrome (AWS) is a surgical breast cancer sequel that limits the functionality of the patient and delays the protocol times of application of cancer treatments. This implies a long period of discomfort and limitations for the user. OBJECTIVE: To investigate the different physiotherapy treatments for the AWS and how effective they are. METHODS: A systematic review based on PRISMA protocol and registered in PROSPERO (CRD42021281354) was conducted. The research was performed using PubMed, Scopus, CINAHL, PEDro, and Web of Science databases during January 2022 and March 2022. All randomized controlled trials and controlled clinical trials were included in this review. RESULTS: A total of 188 articles were identified, with 9 studies selected for the systematic review. These studies basically propose treatments based on exercises and stretching, manual therapy, and the combination of manual therapy and exercises. CONCLUSIONS: Exercise and stretching are the most effective therapies within the field of physiotherapy for the rehabilitation of axillary web syndrome. They restore range of motion faster, reduce pain, improve quality of life, and reduce disabilities. Manual therapy, scar massage, and myofascial release could help improve outcomes but with worse results. The meta-analysis conclusion is that pain is the only outcome with a significant reduction after the application of physiotherapy treatments - 0.82 [- 1.67; 0.03]. This conclusion is drawn from the only three studies with small sample sizes.

Factores psicosociales y laborales asociados al agotamiento laboral en profesionales sanitarios de un hospital de alta complejidad de Bogotá, Colombia / Psychosocial and working conditions associated with burnout among health professionals of a highly complex hospital in Bogotá, Colombia

Objetivo Evaluar la asociación de los factores psicosociales y laborales frente a la presencia de agotamiento laboral en fisioterapeutas y terapeutas respiratorios de un hospital de alta complejidad de Bogotá, Colombia. Materiales y métodos Estudio transversal analítico. Se encuestaron a 31 fisioterapeutas y terapeutas respiratorios de un hospital de alta complejidad. La recolección de información se realizó a través de un cuestionario digital, incluyó variables psicosociales, demográficas y laborales. La prevalencia de burnout se evaluó mediante el Maslach Burnout Inventory para profesionales de la salud. Se realizaron análisis univariados y bivariados mediante SPSS versión 25.0. Resultados Se encontró que el 93,5% (n = 29) correspondió al sexo femenino, la media de edad fue de 36±8,7 años, con un tipo de vinculación laboral a término fijo del 96,8% (n = 30). El 38,7% (n = 12) de profesionales atiende más de 15 pacientes por turno. Frente a la presencia de burnout, el 38,7% (n = 12) presentan agotamiento laboral, ya sea por cansancio emocional, despersonalización o baja realización personal. Finalmente, un 64,5% (n = 20) y un 74,2% (n = 23) considera que su salud mental o física se ha deteriorado por las condiciones laborales dada la actual pandemia por SARS-CoV-2, respectivamente. Conclusiones Un porcentaje considerable de profesionales presenta agotamiento laboral. Se resaltan algunas condiciones psicosociales y laborales (insuficiente personal, jornada agotadora, falta colaboración, pérdida de información) asociadas a la presencia de burnout. Existe deterioro de la salud física y mental de los profesionales por la pandemia SARS-CoV-2 (AU)

Objective To evaluate the association of psychosocial and work factors in the presence of job exhaustion in physiotherapists and respiratory therapists of a highly complex hospital in Bogotá, Colombia. Materials and method An analytical cross-sectional study. 31 physiotherapists and respiratory therapists from a high complexity hospital were surveyed. The data collection was carried out through a virtual questionnaire, it included psychosocial, demographic and labor variables; the prevalence of burnout was assessed using the Maslach Burnout Inventory for health professionals. Univariate and bivariate analyses were performed using SPSS version 25.0. Results It was found that 93.5% (n = 29) corresponded to female, the mean age was 36±8.7 years old, with a type of fixed-term employment relationship of 96.8% (n = 30). Number of patients seen per shift of more than 15 patients in 38.7% (n = 12) of the cases. The 38.7% (n = 12) of the professionals presented job exhaustion, either due to emotional exhaustion, depersonalization, or low personal fulfillment. Finally, 64.5% (n = 20) and 74.2% (n = 23) considered that their mental or physical health has deteriorated due to working conditions given the current SARS-CoV-2 pandemic. Conclusion A considerable percentage of professionals presented job exhaustion. Some psychosocial and working conditions are highlighted (insufficient staff, exhausting workday, lack of collaboration, loss of information) associated with the presence of burnout. There is deterioration in the physical and mental health of professionals due to the SARS-CoV-2 pandemic (AU)

Análisis documental de los perfiles de egreso vigentes de las carreras de Fisioterapia en Chile / Documentary analysis of competency-based exit profile of Physiotherapy entry-level programs in Chile

Introducción El perfil de egreso corresponde a una declaración formal de los aprendizajes terminales de una profesión, comprometiendo la formación de una identidad profesional, especificando los principales ámbitos de acción profesional y sus atributos clave asociados a la formación universitaria, los cuales deben describirse para transparentar los compromisos que hacen las instituciones con sus egresados y la sociedad. En Chile no existen actualmente directrices para la formación profesional en Fisioterapia, y es necesario avanzar hacia ese objetivo comenzando con un análisis de lo ofrecido por las universidades actualmente. Objetivo Analizar los perfiles de egreso, sus principales ámbitos de desempeño y competencias declarados en las carreras de Fisioterapia que se imparten en 2021 en Chile. Material y método Se realizó una investigación documental cualitativa de los perfiles de egreso publicados en las páginas web de 41 instituciones de Educación Superior en Chile que imparten la carrera universitaria de Fisioterapia durante el año 2021. Se realizó un análisis de contenido temático asistido por el programa NVivo 12 pro. Resultados Se obtuvieron siete categorías principales que caracterizan los ámbitos de competencias de los perfiles de egreso de Fisioterapia en Chile: intervención; razonamiento clínico; promoción y prevención en salud; investigación; gestión y administración en salud; educación, y emprendimiento e innovación. Conclusiones Los principales ámbitos de desempeño presentes en los perfiles de egreso en los planes de formación de los programas universitarios de Fisioterapia en Chile en el presente estudio permitirán promover una reflexión acerca de los significados prácticos para la formación profesional, y así responder a las demandas profesionales presentes y futuras con una identidad centrada en el movimiento humano como eje de acción profesional (AU)

Introduction The entry-level profile corresponds to a formal statement of an institution about the intended learning outcomes of a profession. This commitment includes developing a professional identity, specifying the main areas of professional activity and its key attributes. Besides, universities’ training must transparentize institutions’ commitments to their graduates and society. There is currently no standard for professional training in Physiotherapy in Chile, and it is necessary to move toward this purpose by starting with an analysis of what universities offer today. Purpose To analyze the main areas of performance and competencies declared in the competency-based exit profile of Physiotherapy entry-level programs delivered in 2021 in Chile. Material and method Qualitative documentary research was carried out of the competency-based exit profile, published on the web sites of 41 Higher Education institutions in Chile that delivered Physiotherapy entry-level University Programs during the 2021. A thematic content analysis was carried out assisted by CAQDAS NVivo 12 pro. Results Seven main categories were obtained that characterize competence areas of the current competency-based exit profile in Physiotherapy entry-level programs in Chile: physiotherapist intervention; clinical reasoning in physiotherapy; promotion and prevention in health; research; health management and administration; education; and entrepreneurship and innovation. Conclusions The main areas of performance present in the exit profiles of the university programs of Physiotherapy in Chile were identified. A reflection would be made about the practical meanings for university professional training in Physiotherapy in Chile to respond to the present and future professionals requirements with the identity centered on the human movement as the axis of professional action (AU)

Validez de contenido de un ECOE en el pregrado de fisioterapia para el razonamiento clínico / Validity of content of a ECOE in the physiotherapy undergraduate for clinical reasoning

Introducción: El Examen Clínico Objetivo Estructurado (ECOE) es una metodología de evaluación que permite medir de manera válida las competencias clínicas en estudiantes de fisioterapia a través de estaciones previamente estandarizadas. Objetivo: Determinar la validez de contenido del instrumento ECOE-LM 2017 para la medición de competencias clínicas en el examen, evaluación, diagnóstico, pronóstico e intervención de una persona con lumbalgia mecánica en fisioterapia. Métodos: Se diseñó un instrumento de seis estaciones evaluado con la técnica de juicio de expertos, para posteriormente calcular la confiabilidad interobservador a través de Fleiss’ Kappa, por medio del ReCal; adicionalmente se identificó el índice de aceptabilidad. Resultados: Se obtiene un índice kappa de 0,82 (casi perfecto) que da cuenta de una buena confiabilidad para el instrumento. Conclusiones: Se cuenta con un instrumento con una buena concordancia para su empleo en los procesos educativos. (AU)

Introduction: The Objective Structured Clinical Examination (ECOE) is an evaluation methodology that allows to validly measure clinical competencies in Physiotherapy students through previously standardized stations. Objective: To determine the content validity of the ECOE-LM 2017 instrument for the measurement of clinical competencies in the examination, evaluation, diagnosis, prognosis and intervention of a person with mechanical low back pain in Physiotherapy. Methods: An instrument of six stations evaluated with the expert judgment technique was designed to subsequently calculate the inter-observer reliability, through Fleiss’ Kappa, by means of the ReCal, additionally the acceptability index was identified. Results: A Kappa index of 0.82 (almost perfect) is obtained, which shows good reliability for the instrument. Conclusions: There is an instrument with good agreement for its use in educational processes. (AU)

Higher quality of care in emergency departments with physiotherapy service models.

OBJECTIVE: To investigate the quality of care provided by EDs with physiotherapy services compared to those without, using established musculoskeletal process and outcome quality indicators (QIs). METHODS: An analysis was undertaken of prospective observational and chart audit data collected from 628 patients who presented with a musculoskeletal injury in any of the eight participating EDs in Queensland in 2016-2017. The care provided was scored against 46 musculoskeletal QIs. Quality of care was first compared between EDs with physiotherapists to EDs with a limited physiotherapy service, and second between EDs with primary contact physiotherapists to EDs without. χ2 and Fisher's exact tests were used to identify significant results. RESULTS: In the first comparison, EDs with physiotherapists performed significantly higher on 15 QIs and EDs with only limited physiotherapy performed higher on two QIs. In the second comparison, EDs with primary contact physiotherapists performed significantly higher on 17 QIs when compared to EDs without and three QIs demonstrated significance in favour of EDs without primary contact physiotherapists. Performance differences occurred across both process and outcome QIs, including musculoskeletal assessment, diagnostics, pain assessment and management, fracture management, medication safety, mobility, patient information, referrals and follow-up, re-presentations and patient experience. CONCLUSIONS: EDs with physiotherapists provide at least equivalent or higher quality of care for patients with musculoskeletal injuries than those EDs with limited access to physiotherapists. This may be because of their specialised training in musculoskeletal diagnosis and treatment, as well as the impact of teaching and mentoring for other ED clinicians.

Implementing a Virtual Care Clinical Placement for a Physiotherapy Student in a Hospital-Based Chronic Pain Programme.

Purpose: The aim of this case report was to determine the experiences and outcomes of implementing a part-time virtual care clinical placement for a physiotherapy student in a hospital-based chronic pain programme. Client Description: Three participants were involved in this clinical placement: an entry-level physiotherapy student, a physiotherapy clinical instructor, and an academic coordinator of clinical education from a Master of Science in Physical Therapy (MScPT) programme. Intervention: We implemented a part-time 40-hour virtual care clinical placement (10 h/wk for 4 wk) in a publicly funded chronic pain programme at Kingston Health Sciences Centre for an MScPT student from Queen's University in Kingston, Ontario. Measures and Outcome: The student's performance was evaluated by the clinical instructor using learning goals and the Canadian Physiotherapy Assessment of Clinical Performance. The participants also provided reflections on their experiences in their respective roles. The student achieved the learning goals and demonstrated competency at the level required for a senior-level placement. Overall reflections on the virtual care clinical placement were positive, with a few key challenges. Implications: Novel clinical placement opportunities can help prepare physiotherapy students for emerging practice experiences. This case report provides insight into one such experience.

Objectif : déterminer les expériences et les résultats découlant de l'adoption d'un stage clinique virtuel à temps partiel dans un programme de douleur chronique en milieu hospitalier pour un étudiant en physiothérapie. Description du client : trois participants ont fait ce stage clinique : un étudiant au premier échelon en physiothérapie, un moniteur clinique en physiothérapie et un coordonnateur universitaire de l'enseignement clinique dans un programme de maîtrise en physiothérapie (M. pht.). Intervention : les auteurs ont mis sur pied un stage clinique en soins virtuels à temps partiel de 40 heures (dix heures par semaine pendant quatre semaines) dans un programme de douleur chronique public du Kingston Health Sciences Centre pour un étudiant à la maîtrise en physiothérapie de l'Université Queen's à Kingston, en Ontario. Mesures et résultats : le moniteur clinique a évalué la performance de l'étudiant au moyen d'objectifs d'apprentissage et de l'Évaluation physiothérapique canadienne de la performance clinique. Les participants ont également fait part de leurs réflexions sur leur expérience dans leurs rôles respectifs. L'étudiant a réalisé ses objectifs d'apprentissage et fait preuve de la compétence requise pour un stage avancé. Les réflexions générales sur le stage clinique en soins virtuels ont été positives, malgré quelques difficultés essentielles. Conséquences : de nouvelles possibilités de stage clinique peuvent contribuer à préparer les étudiants en physiothérapie pour ces expériences de pratique émergentes. Le présent rapport de cas donne un aperçu de cette expérience.

High Patient Satisfaction with Examination by Advanced Practice Physiotherapists in an Orthopaedic Outpatient Shoulder Clinic: A Cross-Sectional Study Using Quantitative and Qualitative Methods.

Purpose: To evaluate patients' satisfaction with being examined and diagnosed in an orthopaedic outpatient shoulder clinic, determine whether a difference exists between levels of satisfaction among patients examined by advanced practice physiotherapists (APPs) and orthopaedic surgeons (OSs), and explore patients' experiences with being examined by APPs. Method: One hundred and thirty-three patients participated in a cross-sectional questionnaire study using the Visit-Specific Satisfaction Instrument (VSQ-9). Primary outcome was satisfaction with "The visit overall" (item 9). Nine patients participated in semi-structured interviews, which were thematically analyzed. Results:There was no significant difference in satisfaction with "The visit overall" between patients examined by an OS (median: 75, 1st-3rd quartiles: 75-100) and an APP (median: 100, 1st-3rd quartiles: 75-100). The VSQ-9 total score was not significantly different between groups, but some items regarding direct interaction with the health provider were scored significantly higher in the APP group. Patients were particularly satisfied with APPs' ability to explain during the consultation. Conclusions: The results showed high levels of satisfaction with examinations performed by both OSs and APPs with no difference between groups concerning "The visit overall." From a patient perspective, the results support the use of APPs to examine and diagnose selected patients in an orthopaedic outpatient shoulder clinic.

Objectif : évaluer la satisfaction des patients après un examen et un diagnostic dans une clinique orthopédique ambulatoire de l'épaule, déterminer s'il y a une différence entre les taux de satisfaction chez les patients examinés par des physiothérapeutes en pratique avancée (PPA) et les chirurgiens orthopédiques (CO) et explorer les expériences des patients examinées par des PPA. Méthodologie : au total, 133 patients ont participé à un questionnaire transversal faisant appel à l'instrument de satisfaction lors de la visite (VSQ-9). Le résultat primaire était la satisfaction à l'égard de « l'ensemble de la visite ¼ (point 9). Neuf patients ont participé à des entrevues semi-structurées, analysées par thème. Résultats : il n'y avait pas de différence significative sur le plan de la satisfaction à l'égard de « l'ensemble de la visite ¼ entre les patients examinés par un CO (médiane : 75, premier au troisième quartiles : 75 à 100) et un PPA (médiane : 100, premier au troisième quartiles :75 à 100). Le score total du VSQ-9 n'était pas significativement différent entre les groupes, mais certains points relatifs à l'interaction directe avec le professionnel de la santé obtenaient un pointage beaucoup plus élevé dans le groupe des PPA. Les patients étaient particulièrement satisfaits par la capacité des PPA à donner des explications pendant la consultation. Conclusions : les résultats ont démontré un taux élevé de satisfaction à l'égard des examens effectués à la fois par des CO et des PPA, sans différence entre les groupes au sujet de « l'ensemble de la visite ¼. De l'avis des patients, les résultats soutiennent le recours au PPA pour examiner et diagnostiquer certains patients dans une clinique orthopédique ambulatoire de l'épaule.

Signs of Inequitable Access: Users of Private Physiotherapy Services Do Not Reflect the Urban Population in Winnipeg, Manitoba.

Purpose: Both private and public funding cover outpatient physiotherapy (PT) in Canada. Knowledge is lacking in who does and does not access PT services, which limits the ability to identify health/access inequities created by current financing structures. This study characterizes the individuals accessing private PT in Winnipeg to better understand whether inequities exist, given the very limited publicly financed PT. Methods: Patients attending PT in 32 private businesses, sampled for geographic variation, completed a survey online or on paper. We compared the sample's demographic characteristics with Winnipeg population data using chi-square goodness-of-fit tests. Results: In total, 665 adults accessing PT participated. Respondents were older and had higher levels of income and education compared to Winnipeg census data (p < 0.001). Our sample included higher proportions of female and White individuals, and lower proportions of Indigenous persons, newcomers, and people from visible minorities (p < 0.001). Conclusions: There are signs that inequities exist in access to PT in Winnipeg; the cohort who access private PT services does not reflect the wider population, which suggests that some segments of the population are not receiving care.

Objectif : un financement tant public que privé couvre les services ambulatoires de physiothérapie au Canada. On ne sait pas qui y a accès ou non, ce qui limite la possibilité de déterminer les iniquités en matière de santé et d'accès attribuables aux structures actuelles de financement. La présente étude caractérise les personnes qui accèdent à des services de physiothérapie privés à Winnipeg, afin de mieux comprendre s'il existe des iniquités, compte tenu des services de physiothérapie très limités qui sont financés par le secteur public. Méthodologie : des patients recevant des services de physiothérapie dans 32 entreprises privées, échantillonnées d'après leur variation géographique, ont rempli un sondage en ligne ou sur papier. Les chercheurs ont comparé les caractéristiques démographiques de l'échantillon aux données populationnelles de Winnipeg au moyen de tests du chi carré pour la qualité de l'ajustement. Résultats : au total, 665 adultes qui avaient accès à des services de physiothérapie ont participé. Ils étaient plus âgés et avaient un revenu et une scolarisation supérieurs aux données du recensement de Winnipeg (p < 0,001). L'échantillon contenait une plus forte proportion de femmes et de personnes blanches, et une plus faible proportion de personnes autochtones, de nouveaux arrivants et de membres des minorités visibles (p < 0,001). Conclusions : il y a des signes d'iniquité d'accès aux services de physiothérapie à Winnipeg. La cohorte qui a accès aux services de physiothérapie privés ne reflète pas l'ensemble de la population, ce qui indique que certains segments de la population ne reçoivent pas de soins.

Experiences of Physiotherapy Students, Health Care Providers, and Patients with a Role-Emerging Student Clinical Placement in an Emergency Department: A Qualitative Study.

Purpose: To understand the experiences and perspectives of physiotherapy (PT) students, their clinical instructor, nurses, physicians, and patients with a role-emerging student clinical placement in an emergency department (ED) and to identify barriers and facilitators in implementing this placement model. Method: We conducted qualitative semi-structured interviews with 6 PT students, 1 PT clinical instructor, 15 nurses, 12 physicians, and 17 patients. Five researchers independently coded the transcribed interviews and performed thematic analysis in an interpretive description tradition with frequent peer debriefing and reflexive discussions. Results: Students and their clinical instructor reported that the placement setting provided a unique learning opportunity. Patients and ED staff noted that involving the PT students in patient care delivery improved the musculoskeletal assessments and self-management advice provided to patients. Identified barriers included students' inability to chart in the electronic medical record, lack of bed space, and lack of clarity about students' scope and abilities. Reported facilitators included positive perceptions of the students' supervision and a perceived positive impact on patient care and the health care team. Conclusions: Participants reported positive experiences with the student ED placement and recommended similar placements in the future. Understanding barriers and facilitators in implementing PT student clinical placements in an ED can inform future placements.

Objectif : comprendre les expériences et les perspectives des étudiants en physiothérapie, de leur moniteur clinique, des infirmières, des médecins et des patients à l'égard d'un stage clinique émergent en physiothérapie à l'urgence et déterminer les obstacles et les incitatifs à l'adoption de ce modèle de stage. Méthodologie : entrevues qualitatives semi-structurées auprès de six étudiants en physiothérapie, un moniteur clinique en physiothérapie, 15 infirmières, 12 médecins et 17 patients. Cinq chercheurs ont codé la transcription des entrevues de manière indépendante et ont procédé à une analyse thématique dans la tradition de la description interprétative accompagnée de fréquents bilans avec les collègues et de fréquentes discussions réflexives. Résultats : selon les étudiants et leur moniteur clinique, le milieu de stage fournissait une occasion d'apprentissage unique. Les patients et le personnel de l'urgence ont remarqué que les étudiants amélioraient les évaluations musculosquelettiques et les conseils d'autoévaluation fournis aux patients. Les obstacles perçus étaient l'incapacité des étudiants à consigner l'information dans les dossiers médicaux électroniques, le manque de lits et le manque de clarté quant à la portée de pratiques et aux capacités des étudiants. Les incitatifs constatés incluaient les perceptions positives à l'égard de la supervision des étudiants et la perception de conséquences positives sur les soins pour les patients et l'équipe soignante. Conclusions : les participants ont fait état d'expériences positives dans le cadre des stages des étudiants à l'urgence et ont recommandé des stages semblables à l'avenir. Le fait de comprendre les obstacles et les incitatifs à la mise en œuvre de stages cliniques pour les physiothérapeutes à l'urgence pourra éclairer les futurs stages.

Physiotherapy services in patient care in Bhutan.

Physiotherapy and rehabilitative services are an integral part of patient care, but in many developing countries they are not considered a priority and are either not available or not easily accessible to those who need them. Bhutan is one such country where healthcare is provided free of cost to all, but as of 2021 physiotherapy services were available only in 26 of 48 hospitals and 19 of 20 districts. The number of physiotherapy professionals per 10,000 population is 1.4 with significant rates of attrition. There is lack of awareness among patients and other health professionals about physiotherapy and rehabilitation services. The country needs to integrate physiotherapy and rehabilitation services into the overall health policy framework and develop proper planning of human resources and infrastructure to meet the current and future demands.

Spinal Muscle Atrophy: Clinical Cases / Atrofia Muscular Espinhal: Casos Clínicos

Spinal muscular atrophy (EBF) is an autosomal recessive neuromuscular disease with genetic inheritance. EBF is classified into: type I - patients have symptoms up to 6 months of age; type II - after 6 months of age, symptoms begin; type III - it starts after 18 months of age. The objective of this study was to clinically characterize two brothers diagnosed with EBF. It is a clinical case study of two individuals, male gender, attended at Clínica Escola de Fisioterapia, at Universidade Estadual do Centro Oeste do Paraná UNICENTRO, Campus CEDETEG. Selected by eligibility both were diagnosed with spinal muscular atrophy. The physiotherapy stages evaluation was carried out, which consist of anamnesis, functional examination, physical examination and respiratory evaluation. Patient 1, was diagnosed with EBF type IIIb at 16 years old, with reports of falls and weakness mainly in lower limbs, in the evaluation positive Gowers sign, anserine gait, hypotonic, MMSS areflexia and lower limb hyporeflexia, breathing pattern apical were found. Patient 2 was diagnosed with EBF type IIIa at 1 year of age, currently using a wheelchair for locomotion, on physical examination he had scoliosis with right convexity, deformities in the costal grid, decreased muscle strength in the upper limbs and lower limbs, mixed respiratory pattern. From the physical therapy evaluation performed on these patients, it could be noted that the weakness of the respiratory muscles is directly related to the clinical sign presented by both. (AU)

A atrofia muscular espinhal (AME) é uma doença neuromuscular autossômica recessiva com herança genética. A AME é classificada em: tipo I ­ pacientes apresentam sintomas até 6 meses de idade; tipo II ­ após os 6 meses de idade inicia-se os sintomas; tipo III ­ inicia-se após 18 meses de idade. O objetivo desse trabalho foi caracterizar clinicamente dois irmãos com diagnóstico de AME. É um estudo de casos clínicos de dois indivíduos, do gênero masculino, atendidos na Clínica Escola de Fisioterapia, da Universidade Estadual do Centro Oeste do Paraná ­ UNICENTRO, Campus CEDETEG. Selecionados por elegibilidade ambos diagnosticados com atrofia muscular espinhal. Foram realizadas as etapas da avaliação fisioterapêutica que consistem em anamnese, exame funcional, exame físico e avaliação respiratória. O paciente 1, foi diagnosticado com AME tipo IIIb aos 16 anos, com relatos de quedas e fraqueza principalmente em MMII, na avaliação constatou-se, sinal de Gowers positivo, marcha anserina, hipotônico, arreflexia de MMSS e hiporeflexia de MMII, padrão respiratório apical. O paciente 2 recebeu o diagnóstico de AME tipo IIIa com 01 ano de idade, atualmente utiliza cadeira de rodas para locomoção, no exame físico apresenta escoliose com convexidade a direita, deformidades no gradil costal, força muscular diminuída em MMSS e MMII, padrão respiratório misto. A partir da avaliação fisioterapêutica realizada nesses pacientes, pode-se notar que a fraqueza dos músculos respiratórios está diretamente relacionada com o quadro clinico apresentado por ambos. (AU)

Convergência e discrepância em documentos norteadores dos estágios supervisionados obrigatórios em fisioterapia: uma revisão integrativa / Convergence and discrepancies in guiding documents of the mandatory supervised practice in physiotherapy: an integrative review

INTRODUÇÃO: O estágio supervisionado obrigatório constitui-se em um componente curricular que integra o processo formativo do graduando em Fisioterapia. Todavia, a despeito de sua relevância como construto legal e normativo, os documentos oficiais não dão suporte suficiente à unificação dos critérios de sua realização, o que pode ocasionar a ocorrência de práticas irregulares. OBJETIVO: Identificar as discrepâncias e pontos de convergência existentes nos documentos oficiais e relatos de pesquisas que norteiam os estágios supervisionados obrigatórios em Fisioterapia. MÉTODOS: Revisão integrativa da literatura com consulta às bases de dados PubMed, SciELO, Biblioteca Virtual em Saúde e Periódicos Capes, e aos documentos oficiais do Conselho Federal de Fisioterapia, Conselho Nacional de Saúde, Ministério da Educação e Associação Brasileira de Ensino em Fisioterapia. RESULTADOS: Foram analisados 15 artigos publicados entre os anos de 2002 e 2017 e sete documentos oficiais que abordam os estágios, a práxis pedagógica e as normas legais no contexto da Fisioterapia. CONCLUSÃO: Existem discrepâncias em relação ao número de estudantes por supervisor de estágio e por turno de prática, à identidade do profissional, sua presença durante o treinamento e intervalo temporal entre a teoria e o estágio curricular obrigatório. Já como pontos de convergência podem ser pontuados o reconhecimento do estágio enquanto uma prática curricular obrigatória e didático-pedagógica e o momento em que o estudante deverá ser estimulado a desenvolver autonomia e responsabilidade profissional, interação com a equipe multiprofissional e habilidade no manejo dos pacientes.

INTRODUCTION: The mandatory supervised practice is a curricular component that integrates the training process of the undergraduate student in Physiotherapy, however, despite its relevance as a legal and normative construct, the official documents do not provide sufficient support for the unification of the criteria for its completion, which can cause irregular practices to occur. OBJECTIVE: Identify the discrepancies and points of convergence in existing official documents and research reports that guide the mandatory supervised internships in Physiotherapy. METHODS: Integrative literature review with a consultation to the databases PubMed, SciELO, Virtual Health Library, and Capes Periodicals, and to the official documents of the Federal Council of Physiotherapy, National Council of Health, Ministry of Education, and the Brazilian Association of Teaching in Physiotherapy. RESULTS: 15 articles published between 2002 and 2017 were analyzed, as well as seven official documents that address internships, pedagogical praxis, and legal norms in the context of Physiotherapy. CONCLUSION: There are discrepancies concerning the number of students per internship supervisor and practice shift, the professional identity, their presence during training, and the time interval between theory and the mandatory curricular internship. As points of convergence, the recognition of the internship as a mandatory and didactic-pedagogical curricular practice and the moment when the student should be encouraged to develop autonomy and professional responsibility, interaction with the multidisciplinary team, and ability to manage patients can be scored.

Evaluation of learning approaches in physiotherapy students: A valuable insight.

INTRODUCTION: Every individual has different learning approaches in acquisition and processing of knowledge. Physiotherapy, an evolving allied health science profession, is developing rapidly. Exploration of learning approaches among physiotherapy students will help the academicians to enrich the quality of learning. This study aimed to analyze the learning approaches among physiotherapy students. MATERIALS AND METHODS: A cross-sectional study was carried out among 435 physiotherapy students. The Approaches and Study Skills Inventory for Students questionnaire was used to evaluate learning approaches in both preclinical and clinical students. Data were analyzed using the Statistical Package for the Social Sciences software version 21. Statistical significance was set at P < 0.05. RESULTS: A total of 435 participants, 233 (53.56%) in preclinical phase and 202 (46.44%) in clinical phase with a mean age of 19.01 ± 1.01 and 22.03 ± 1.43 years, respectively, participated in the study. Among the 435 students, 411 (94.49%) adopted the deep approach, while only 21 (4.83%) and 3 (0.69%) adopted strategic approach and surface approach, respectively. Preclinical students had significantly higher mean scores for strategic and surface approaches than clinical (P = 0.000) and (P = 0.000) using independent t-test, respectively. Out of the 435 students, 50 (11.45%) were male and 385 (88.51%) were female. Male students appeared less likely to adopt the deep learning approach than female students (P = 0.013). CONCLUSIONS: Assessment of learning approaches will assist the academicians to develop teaching and learning strategies and effective curriculum depending on the perspectives of students. Multiple methodologies focused on interactive student-centric approach should be utilized to enhance positive learning outcomes.

USE OF COMPRESSION GARMENT IN THE TREATMENT OF MALIGNANT LYMPHEDEMA IN A PATIENT WITH RECURRENT BREAST CANCER: CASE REPORT / Utilização de vestimenta compressiva no tratamento do linfedema maligno em paciente com câncer de mama recidivado: relato de caso

Introduction: Malignant lymphedema is a rapidly progressive condition, and its treatment is a major challenge. Objective: To demonstrate the benefit of using compression garments in reducing limb volume and improving the symptoms of a patient with malignant lymphedema with recurrent breast cancer. Case report: A 67-year-old woman, diagnosed with a 2.3 cm, triple negative, invasive ductal carcinoma in the left breast, submitted to quadrantectomy with axillary dissection (T2aN1bM0). The patient developed benign lymphedema after eight years of surgery, but only started complex decongestive physiotherapy three years after the diagnosis, presenting an important improvement. The following year, the patient returned with complaints of worsening lymphedema. At the examination, there was an expressive volume increase and areas of vascular alteration in the left upper limb (LUL) and in the anterior quadrant of the thorax. The exams confirmed axillary vein thrombosis due to tumor obstruction. Lymphoscintigraphy showed unsatisfactory lymphatic drainage. As a last treatment option, the use of LUL low elastic compression garment was adopted, after poor success after the use of multi-layered compression bandages. LUL volume was 6,158.1 mL prior to using the garment. After ten days of continuous use, the volume decreased to 5,174.2 mL. In the last evaluation, the volume was 4,510.8 mL, presenting a reduction of 1,647.3 mL (26.7%). The patient developed acute respiratory failure caused by pleural metastasis, and died. Conclusion: The compression garment provided benefits such as significant improvement in the feeling of heaviness in the limb due to the reduction of volume and in the ease of putting on and taking off the garment in or make the hygiene, when compared to the multilayer compression bandages. Other advantages were the reduction of costs and the promotion of well-being.

Introdução: O linfedema maligno é uma condição com rápida progressão, e seu tratamento é um grande desafio. Objetivo: Demonstrar o benefício do uso de vestimenta compressiva na redução do volume do membro e na melhora dos sintomas de uma paciente com linfedema maligno após câncer de mama recidivado. Relato de caso: Colocar paciente de 67 anos, sexo feminino, com diagnóstico de carcinoma ductal invasor em mama esquerda com 2,3 cm e triplo negativo, submetida a quadrantectomia com esvaziamento axilar (T2aN1bM0). A paciente desenvolveu linfedema benigno após oito anos de cirurgia, porém só iniciou tratamento fisioterapêutico com terapia física complexa descongestiva três anos após o diagnóstico, apresentando melhora importante. No ano seguinte, retornou ao consultório com queixa de piora do linfedema. Ao exame, apresentava aumento de volume expressivo e áreas de alteração vascular no membro superior esquerdo (MSE) e no quadrante anterior do tórax. Os exames confirmaram trombose de veia axilar por obstrução tumoral. A linfocintilografia demonstrou ausência de drenagem linfática satisfatória. Adotou-se, como última opção de tratamento, o uso da vestimenta compressiva de baixa elasticidade de MSE, após baixa resposta do enfaixamento compressivo multicamadas. O volume do MSE era de 6.158,1 mL antes do uso da vestimenta. Após dez dias contínuos de uso, o volume diminuiu para 5.174,2 mL. Na última avaliação, o volume era de 4.510,8 mL, apresentando redução de 1.647,3 mL (26,7%). A paciente evoluiu com insuficiência respiratória aguda ocasionada por metástase pleural à direita, vindo a falecer. Conclusão: A vestimenta proporcionou benefícios como melhora importante da sensação de peso no membro devido à redução de volume e facilidade em colocar e retirar a vestimenta para fazer a higiene, quando comparada ao enfaixamento compressivo multicamadas. Outras vantagens foram a redução de custos e a promoção do bem-estar.