Decline in Mobility and Balance in Persons with Post-COVID-19 Condition.

OBJECTIVES: Post-COVID-19 condition (PCC) may impact mobility and balance and affect physical function. The objectives of the study were to estimate the prevalence of decline in balance and mobility in individuals with PCC; explore the association between comorbidities and sociodemographic characteristics with decline in balance and mobility; and evaluate correlations between decline in mobility and balance with change in performance of usual activities, personal care, and global health perception. METHODS: The design was a cross sectional study of persons with a COVID-19 diagnosis that was confirmed at least 3 months before the study. Those with PCC, defined as those still troubled by symptoms, were evaluated for decline in mobility and balance and with associated clinical and demographic factors using bivariate analysis and multivariable logistic regression. Correlations between decline in mobility and balance were also examined with change in ability to perform usual activities, personal care, and global health perception. RESULTS: In 1031 persons with PCC, mobility deteriorated in 44.9% and balance deteriorated in 37.1%. Older age, hospitalization, comorbidities, and obesity were associated with decline in mobility, while decline in balance was associated with older age and comorbidities. Reduced mobility was associated with changes in ability to carry out usual activities (rp = 0.6), conduct personal care (rp = 0.6), and global health status (rp = 0.5). Correlations between decline in balance and these same outcomes were 0.5, 0.5, and 0.45, respectively. CONCLUSIONS: Almost half the participants with PCC had reduced mobility and over a third reported deterioration in balance, with associated difficulties with daily functioning. Factors associated with greater decline help identify those most at risk. IMPACT: Many people with PCC experience changes in mobility and balance, which can affect functional capacities and lead to physical therapist consultations. Further study should assess specific needs of these patients and determine effective physical therapist interventions to meet these needs.

Many persons with post­COVID-19 condition (PCC) experience symptoms resulting in functional problems, such as difficulties with personal care and performing usual activities. This study focused on difficulty in mobility and problems with balance. Almost half of persons with PCC in the study had declines in getting around and over a third had declines in balance. These problems were associated with older age and having other comorbid health conditions and were linked with decline in ability to perform personal care, carry out usual activities, and perceived global health status.

Long COVID in Persons With Self-Reported Arthritis: Symptoms, Associated Factors, and Functional Limitations.

OBJECTIVE: The aim is to describe both long COVID symptoms and associated factors in a cohort of individuals with a self-reported history of arthritis as well as change in function in persons with arthritis and long COVID compared to pre-COVID status. METHODS: Among 2,764 persons with a confirmed COVID-19 diagnosis who responded to an online survey at least 12 weeks post-infection, 171 reported a history of arthritis and formed our study sample. We calculated the frequency of long COVID defined as troubled by persistent symptoms and evaluated associated factors using bivariate analysis and multivariable logistic regression. Among those with long COVID, we describe limitations in activity and function in comparison to pre-COVID status. RESULTS: In our sample, 53.5% (n = 91) reported being troubled by ongoing symptoms at the time of completing the questionnaire (long COVID), with the most frequent symptoms as the following: fatigue, myalgia, weakness, breathlessness, low mood, anxiety, and sleep disturbance. Factors associated with long COVID were female sex, having been hospitalized for COVID, and having at least 1 other chronic disease. Persons with long COVID had substantial declines in function, notably in global health status, usual activities, mobility, personal care, and employment status. Also, 37% of those with long COVID reported moderate to severe increase in pain. CONCLUSION: Persons with arthritis who have long COVID have substantial limitations in function compared to their pre-COVID status. There is a need to implement effective interventions to improve functional status in persons with arthritis and long COVID.

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.

Do physical therapists follow evidence-based practices for treatment of inflammatory arthritis? Results from an online survey.

BACKGROUND: Physical therapists (PTs) should know how to best treat patients with inflammatory arthritis. OBJECTIVE: To document interventions chosen by PTs for patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) and whether choices follow evidence-based practice. METHODS: Licensed musculoskeletal PTs in Quebec, Canada responded to an online survey. Descriptive statistics illustrated proportions for each treatment choice and inferential statistics explored associations with demographic and practice-related factors. RESULTS: There were 298 PTs who responded to the survey. For both RA and AS respectively, most common interventions were mobility exercises (91.0%; 98.3%) and patient education (90.1%; 92.8%). For both cases, slightly >60% selected strengthening exercises. Passive forms of therapy were chosen by 36% of PTs for RA and 58% for AS. Aerobic exercise was rarely selected. PTs working in the public sector were less likely to use manual therapy for both RA (Odds Ratio (OR) 0.43, 95% confidence interval (CI) 0.22,0.86) and AS (OR 0.46, 95% CI 0.22,0.97). CONCLUSIONS: Most PTs chose mobility exercises and patient education, representing evidence-based approaches. Despite current recommendations, strengthening and especially aerobic exercises were not used as much. There is a need to increase awareness regarding the benefits of strengthening and aerobic exercise for these patients.

Long COVID symptoms in a population-based sample of persons discharged home from hospital.

OBJECTIVES: The impact of long COVID among persons hospitalized and discharged home is unknown. We aimed to (1) report the prevalence of long COVID in persons hospitalized for COVID-19 and discharged home; (2) estimate the prevalence of physical, sensory, and psychological/mental health impairments; and (3) explore associated factors. METHODS: We conducted a telephone survey of adult residents in Laval, Quebec, who were discharged home ≥ 2 months post-hospitalization for COVID-19. Participants responded to a standard questionnaire regarding persistent symptoms. We calculated the prevalence of long COVID and of persistent types of symptoms and evaluated associated factors using bivariate analysis and multivariable logistic regression. RESULTS: In our sample (n = 398), 70% reported physical symptoms, 58% psychological problems, and 16% sensory impairments. 31.5% reported being troubled by persistent symptoms (long COVID). Factors associated with long COVID were a greater number of symptoms (odds ratio (OR) = 1.97, 95% confidence interval (CI) = 1.69-2.28) and increased hospital stay (OR = 1.03, 95% CI = 1.01-1.06). Other factors associated with physical and psychological symptoms were female sex (OR = 2.17, 95% CI = 1.27-3.71 and OR = 2.06, 95% CI = 1.25-3.39; respectively), higher education level (OR = 2.10, 95% CI = 1.20-3.68 and OR = 2.43, 95% CI = 1.44-4.14; respectively), and obesity (OR = 1.95, 95% CI = 1.15-3.34 and OR = 1.70, 95% CI = 1.05-2.77; respectively). CONCLUSION: In this population-based study of persons hospitalized for COVID-19 and discharged home, nearly one third were troubled by symptoms for 2 months or more post-discharge. There was a high proportion with persistent physical and psychological/mental health symptoms. Further research will assess the specific needs of these patients to inform health policy makers on service requirements for these persons.

RéSUMé: OBJECTIFS: L'impact de la présence de la COVID longue chez les personnes hospitalisées et lors de leur congé de l'hôpital est inconnu. Dans le cadre de cette étude, nous visions à 1) rapporter la prévalence de la présence de la COVID longue chez les personnes hospitalisées en raison de la COVID-19 et lors de leur congé à la maison; 2) estimer la prévalence des déficiences physiques, sensorielles et psychologiques/cognitives; et 3) explorer les facteurs associés. MéTHODES: Nous avons mené une enquête téléphonique auprès des résidents adultes de Laval, au Québec, qui ont reçu leur congé de l'hôpital plus de deux mois après avoir été hospitalisés en raison de la COVID-19. Les participants ont répondu à un questionnaire standard concernant leurs symptômes résiduels. Nous avons calculé la prévalence de la COVID longue et le type de symptômes résiduels et nous avons évalué les facteurs associés en utilisant une analyse bivariée et une régression logistique multivariable. RéSULTATS: Dans notre échantillon (n=398), 70 % ont déclaré des symptômes physiques, 58 % des problèmes psychologiques et 16 % des déficiences sensorielles. 31,5 % ont déclaré être perturbés par des symptômes résiduels (COVID longue). Les facteurs associés à la COVID longue étaient un plus grand nombre de symptômes (Rapport de cotes (OR)=1,97, intervalle de confiance à 95% (IC)=1,69-2,28) et une durée d'hospitalisation plus longue (OR=1,03, IC 95%=1,01-1,06). Les autres facteurs associés aux symptômes physiques et psychologiques étaient le sexe féminin (OR=2,17, IC 95%=1,27-3,71 et OR=2,06, IC 95%=1,25-3,39; respectivement), un niveau d'éducation plus élevé (OR=2,10, IC 95%=1,20-3,68 et OR=2,43, IC 95%=1,44-4,14; respectivement) et l'obésité (OR=1,95, IC 95%=1,15-3,34 et OR=1,70, IC 95%=1,05-2,77; respectivement). CONCLUSION: Dans cette étude effectuée sur une population de personnes hospitalisées pour la COVID-19 et lors de leur congé de l'hôpital, près d'un tiers ont été perturbées par la présence de symptômes résiduels présents pendant 2 mois ou plus après leur congé. Une forte proportion d'entre elles présentait des symptômes physiques et psychologiques/enjeux de santé mentale persistants. Des recherches futures permettront d'évaluer les besoins spécifiques de ces individus afin d'informer les décideurs politiques en santé de leurs besoins afin d'offrir des services adaptés à leur condition.

Disability Among Persons With Chronic Severe Back Pain: Results From a Nationally Representative Population-based Sample.

We evaluated the association between the chronic severe back pain with disability and participation, in U.S. Adults using data from the US 2019 National Health Interview Survey. In our sample of 2,925 adults (weighted n: 20,468,134) who reported having chronic severe back pain, 60% reported mobility disability, 60% had work limitations, 34% were limited for social participation and 16% had self-care limitations. Older age (65+) was associated with mobility difficulties (OR 1.99, 95% CI 1.28,6.09) and work limitation (OR 2.21, 95% CI 1.61,3.05). Lower socioeconomic status was associated with increasing odds of disability across the 4 categories. Being obese was only associated with mobility difficulties (OR 1.95, 95% CI 1.41,2.71), while not working in the past week was associated with difficulties in mobility (OR 3.55, 95% CI 2.64,4.75), self-care (OR 3.34, 95% CI 2.20,5.08), and social participation (OR 3.20, 95% CI 2.13,4.80). Comorbidities were highly associated with limitations in all 4 categories. Those deeming their ability to manage their pain ineffective were twice as likely to have limitations in self-care, social and work participation but not mobility. Identifying factors associated with disability and limitation may help target appropriate management for persons with chronic pain at high risk for disability. PERSPECTIVE: We evaluated the association between the chronic severe back pain with disability and participation, in a representative sample of Americans. Identifying factors associated with a likelihood of disability may help target appropriate pain management for persons at high risk for disability due to chronic severe back pain.

Evaluating a new referral pathway from physical therapists to rheumatologists: A qualitative study.

Early referral to rheumatology of people with suspected inflammatory arthritis is associated with better outcomes. Typically, these individuals are seen by a family physician who would assess the need for rheumatology referral. However, some may first consult a physical therapist where no physician referral is required. New interprofessional referral pathways, such as direct referral from a physical therapist to a rheumatologist, could enhance early access to a rheumatologist. Our objective was to explore perceptions of clinicians and people with inflammatory arthritis regarding physical therapists referring directly to rheumatologists. We used purposive and snowball sampling to recruit participants for five focus groups: rheumatologists, family physicians, physical therapists, people with inflammatory arthritis, and a mixed group of physical therapists and people with inflammatory arthritis. Thematic analysis revealed four core themes: difficulties accessing care, reluctance of family physicians and rheumatologists toward the new pathway, interprofessional relationships (or lack thereof), and opportunities along the referral pathway. The conclusions are that care must be optimized by ensuring swift referral for those who require it; and that there is a need for knowledge translation to all actors on the advantages of this new pathway.

Use of IMMPACT Recommendations to Explore Pain Phenotypes in People with Knee Osteoarthritis.

OBJECTIVE: Knee osteoarthritis (OA) is a disease of multiple phenotypes of which a chronic pain phenotype (PP) is known. Previous PP studies have focused on one domain of pain and included heterogenous variables. We sought to identify multidimensional PPs using the IMMPACT recommendations and their relationship to clinical outcomes. METHODS: Participants >40 years of age with knee OA having a first-time orthopedic consultation at five university affiliated hospitals in Montreal, Quebec, and Hamilton (Canada) were recruited. Latent profile analysis was used to determine PPs (classes) using variables recommended by IMMPACT. This included pain variability, intensity and qualities, somatization, anxiodepressive symptoms, sleep, fatigue, pain catastrophizing, neuropathic pain, and quantitative sensory tests. We used MANOVA and χ2 tests to assess differences in participant characteristics across the classes and linear and Poisson regression to evaluate the association of classes to outcomes of physical performance tests, self-reported function and provincial healthcare data. RESULTS: In total, 343 participants were included (mean age 64 years, 64% female). Three classes were identified with increasing pain burden (class3 > class1), characterized by significant differences across most self-report measures and temporal summation, and differed in terms of female sex, younger age, lower optimism and pain self-efficacy. Participants in class2 and class3 had significantly worse self-reported function, stair climb and 40 m walk tests, and higher rates of healthcare usage compared to those in class1. CONCLUSIONS: Three distinct PPs guided by IMMPACT recommendations were identified, predominated by self-report measures and temporal summation. Using this standardized approach may improve PP study variability and comparison.

Scoping Review of Pain and Patient Characteristics and Physical Function Associated with Intermittent and Constant Pain in People with Knee Osteoarthritis.

Purpose: We identified the pain and patient characteristics and physical function associated with intermittent and constant pain in people with knee osteoarthritis (OA). Method: The search strategy was conducted in MEDLINE, CINAHL, Embase, SPORTDiscus, Cochrane, and the Physiotherapy Evidence Database for articles published up to October 2018. We included observational studies, randomized controlled trials, reviews, qualitative studies, and case reports in English and French of adults with knee OA. Articles were screened by two independent reviewers, and disagreements were resolved by a third researcher. Results: Our search yielded 1,232 articles, and 4 articles were included in the review. Constant pain was related to limitations in daily activities, a higher Kellgren and Lawrence grade, a higher prevalence of comorbidities, and symptomatic knee OA and depressive symptoms. Intermittent pain was associated with limitations in high-impact activities, but greater time spent in moderate activities was reported. The evidence is contradictory as to whether intermittent or constant pain has a greater average severity. Conclusions: There was limited evidence available to determine the association of pain and patient characteristics and physical function with constant and intermittent pain in people with knee OA. Future research will help improve our understanding of these two pain patterns by examining their associations across a variety of pain and functional outcomes in people with knee OA.

Objectif : déterminer les caratéristique de la douleur et des patients ainsi que la fonction physique associées à une douleur intermittente et constante chez les personnes atteintes d'arthrose du genou. Méthodologie : les chercheurs ont fouillé les bases de données MEDLINE, CINAHL, Embase, SPORTDiscus, Cochrane et Physiotherapy Evidence Database jusqu'en octobre 2018. Ils ont inclus des études d'observation, des essais aléatoires et contrôlés, des analyses, des études qualitatives et des rapports de cas d'adultes atteints d'arthrose du genou, en anglais et en français. Deux réviseurs indépendants ont parcouru les articles et un troisième chercheur a résolu les désaccords. Résultats : la recherche a permis d'extraire 1 232 articles, dont quatre ont été retenus. La douleur chronique suscitait des limitations aux activités quotidiennes, un score de Kellgren et Lawrence plus élevé, une prévalence de morbidité plus élevée, une arthrose du genou symptomatique et des symptômes de dépression. La douleur intermittente était liée à des limitations lors d'activités à fort impact, mais à plus de temps consacré aux activités modérées. Les données sont contradictoires quant à la gravité moyenne accrue de la douleur constante ou intermittente. Conclusions : les données probantes sont limitées pour déterminer l'association entre, d'une part, les caractéristiques la douleur et des patients et la fonction physique et, d'autre part, les douleurs constantes et intermittentes causées par l'arthrose du genou. Pour mieux comprendre ces deux profils de douleur, de prochaines recherches porteront sur leur association avec divers résultats cliniques sur le plan de la douleur et de la fonction chez les personnes atteintes d'arthrose du genou.

Specialty Differences in Initial Evaluation of Patients With Non-Acute Musculoskeletal Pain.

PURPOSE: To explore medical diagnostic testing of new cases of musculoskeletal (MSK) conditions associated with chronic pain. METHODS: We analyzed nationally representative cross-sectional data of people having visits with a new likely chronic MSK pain condition. We documented depression screening and prescribing of diagnostic imaging and blood tests and explored associations between patient and provider factors for each. RESULTS: Over the 9 years of the survey, there were 11,994 initial visits for chronic MSK pain, an average of 36.8 million weighted visits per year or approximately 11.8% of the population. Proportions for depression screening, prescribed imaging, and blood tests were 1.79%, 36.34%, and 9.70%, respectively. People on any public health insurance had twice the increased relative odds to be screened for depression. Orthopedists had 3 times increased relative odds to prescribe imaging compared with family physicians; oncologists had 4 times increased relative odds to prescribe blood tests. Survey year was significantly associated with depression screening and ordering any type of imaging. CONCLUSIONS: Observed rates of depression screening and nonindicated imaging for patients with chronic MSK pain have fluctuated over time. The impact of these fluctuations on clinical practice is as yet unknown. The type of nonrecommended actions varied by specialty of physician.

National Estimates of Chronic Musculoskeletal Pain and Its Treatment in Children, Adolescents, and Young Adults in the United States: Data From the 2007-2015 National Ambulatory Medical Care Survey.

OBJECTIVES: To portray physician office visits by young Americans with chronic musculoskeletal pain; to describe clinical management in this group; and to explore factors associated with prescribed treatments. STUDY DESIGN: Using nationally representative data of ambulatory physician office visits (2007-2015 United States National Ambulatory Medical Care Survey), we identified and cross-sectionally analyzed visits by persons <25 years of age diagnosed with a chronic musculoskeletal pain condition. RESULTS: There were 28.6 million visits over the 9-year period for chronic musculoskeletal pain for persons <25 years of age, (average 3.2 million visits/year). There were more visits among older age groups, female persons, non-Hispanic White ethnicity/race, and those with more medical visits in the past year. Nonopioid medications were the most frequent treatments in all age groups (range 38.5%-48.8%). Opioids were rarely prescribed for children and adolescents but were prescribed in 23% of visits among young adults (18-24 years of age). Health education and counseling were consistently prescribed at 20% of visits and physical therapy (range 9.5%-23.7%) and other treatments were less frequently prescribed. Age, sex, payment source, and physician specialty were associated with various treatments. CONCLUSION: There were over 3 million annual visits for chronic musculoskeletal pain in young Americans; these increased with age. Pharmacologic treatment is used more than nonpharmacologic approaches, and opioid prescribing in the 18- to 24-year-old age group approaches estimates in adults with musculoskeletal pain.

Making Decisions about Service Provision for Clients with Low Back Pain: Perspectives of Canadian Physiotherapy Professionals.

Purpose: This study identified the individuals responsible for making decisions about physiotherapy (PT) wait time, frequency of treatment, and treatment duration for persons with low back pain and determined which factors guided these decisions. Method: A cross-sectional survey was sent to Canadian PT professionals treating adult patients with musculoskeletal problems. It included a clinical vignette describing a patient with low back pain. Respondents were asked who made decisions about wait time, treatment frequency, and treatment duration as well as on which factors they based these decisions. Results: Clinicians were most often responsible for making decisions about treatment frequency and duration. Although clinicians and managers or coordinators were mainly responsible for making decisions about wait time, there was more variability depending on sector of care: in the private sector, administrative assistants played a much larger role. Clinical judgment, clinical guidelines, and patients' demands were the predominant factors influencing wait time and frequency decisions. Treatment duration was related to patients' goals, clinical progression, patients' motivation, and patients' return to work. Conclusions: Decisions about service provision for wait times are made by a range of stakeholders, and a wide variety of factors guide Canadian PT professionals' decision making. Identifying these factors is essential for informing a discussion of decisions about evidence-based and equitable service delivery so that the actors involved can reach a consensus.

Objectif : établir quelles sont les personnes responsables de prendre des décisions au sujet des temps d'attente et de la fréquence et de la durée des traitements en physiothérapie pour les personnes souffrant de douleurs lombaires, et déterminer quels facteurs orientent ces décisions. Méthodologie : les professionnels canadiens en physiothérapie qui traitaient des patients adultes atteints de problèmes musculosquelettiques ont reçu un sondage transversal, qui comprenait une mise en situation clinique décrivant un patient souffrant de douleurs lombaires. Les répondants devaient indiquer qui prenait les décisions au sujet des temps d'attente et de la durée et de la fréquence des traitements et sur quels facteurs reposaient ces décisions. Résultats : la plupart du temps, les cliniciens étaient responsables de prendre les décisions relatives à la fréquence et la durée des traitements. Même si la prise de décision sur les temps d'attente incombait surtout aux cliniciens et aux gestionnaires ou aux coordonnateurs, les responsabilités étaient plus variables en fonction du secteur de soins. En effet, dans le secteur privé, les adjoints administratifs jouaient un rôle beaucoup plus important à cet égard. Le jugement clinique, les directives cliniques et les demandes des patients étaient les principaux facteurs qui influaient sur les décisions en matière de temps d'attente et de fréquence. La durée des traitements dépendait des objectifs des patients, de leur progression clinique, de leur motivation et de leur retour au travail. Conclusions : de nombreux intervenants prennent les décisions sur le temps d'attente avant l'obtention des services, et toute une série de facteurs oriente les décisions des professionnels canadiens en physiothérapie. Il est essentiel de connaître ces facteurs pour éclairer les échanges sur les décisions relatives à une prestation de services équitable et fondée sur des données probantes, afin que toutes les personnes visées parviennent à un consensus.

Rheumatologists' Acceptance of Patient Referrals from Physical Therapists.

We surveyed Canadian rheumatologists regarding beliefs about physical therapists' (PTs) ability to refer patients appropriately to rheumatologists and whether they would accept such referrals. Most (86.9%) believed that PTs can appropriately refer to rheumatologists. However, only 48.2% of rheumatologists would be very or extremely likely to accept a referral from a PT they knew, and 23.5% would accept a referral from a PT they did not know. Conversely, 90.5% would accept a referral from a PT if they could bill it as a full consult. We conclude that being able to bill PT referrals as full consults may potentially enhance the acceptance of PT referrals.

Referral Prioritization in Home Care Occupational Therapy: A Matter of Perspective.

BACKGROUND.: Prioritizing referrals for home care occupational therapy is somewhat subjective, and public and patient perspectives on waiting list priorities are unknown. PURPOSE.: To explore the views of home care occupational therapists (OTs), older persons (OPs) and adults with disabilities on waiting list priorities, as well as issues and challenges underlying these priorities. METHOD.: We conducted in-depth interviews with 11 OTs, 10 OPs and 9 adults with disabilities. Participants were asked to prioritize referral scenarios while explaining their choices. Directed and conventional content analysis allowed the identification of themes for each group of participants. FINDINGS.: OTs experienced conflicts of values but mainly prioritized referrals based on client safety. OPs sought to maximize client's independence, and persons with disabilities aimed to improve clients' social participation. IMPLICATIONS.: OTs should seek the perspectives of their target clientele on referral prioritization criteria and strive to adjust prioritization practices accordingly.

Do Quebec Physiotherapists Follow Evidence-Based Guidelines for Treating Knee Osteoarthritis?

Purpose: The aim of this study was to document the types of treatment that Quebec physiotherapists use for knee osteoarthritis (OA), to assess whether treatment choices are consistent with current practice guidelines, and to explore the factors associated with using certain treatments. Method: Physiotherapists in Quebec answered a cross-sectional survey that was sent through licensing bodies and social media contacts. The respondents were asked which treatments they would use for a typical case of knee OA. We used descriptive statistics to determine the proportions of physiotherapists who chose each treatment and explored the associations between the use of treatments and demographic factors. Results: A total of 195 Quebec physiotherapists participated in this study, 74.9% of whom were women. The most common treatment choices were mobility exercises (96.4%), followed by education (93.8%), strengthening exercises (85.1%), thermotherapy and cryotherapy (72.3%), manual therapy (53.3%), and electrotherapy (42.1%). Selecting either manual or electrotherapy was significantly associated with working in private practice. Conclusions: The great majority of physiotherapists included mobility and strengthening exercises, both of which are the recommended approaches for treating knee OA. Physiotherapists in private practice were more likely to select manual therapy and electrotherapy.

Objectif : exposer les types de traitements qu'utilisent les physiothérapeutes du Québec pour l'arthrose du genou, afin d'évaluer si leurs choix respectent les directives cliniques actuelles, et explorer les facteurs associés à l'utilisation de certains traitements. Méthodologie : les physiothérapeutes du Québec ont participé à un sondage transversal qui leur a été transmis par leurs organismes de réglementation et les médias sociaux. Les répondants ont été invités à indiquer quel type de traitement ils utiliseraient dans un cas typique d'arthrose du genou. Les chercheurs ont utilisé des statistiques descriptives pour déterminer les proportions de physiothérapeutes choisissant chaque traitement et ont exploré les associations entre des traitements sélectionnés et des facteurs démographiques. Résultats : au total, 195 physiothérapeutes du Québec, dont 74,9 % de femmes, ont participé à la présente étude. Les traitements les plus choisis étaient les exercices de mobilité (96,4 %), l'éducation (93,8 %), les exercices de renforcement (85,1 %), la thermothérapie et la cryothérapie (72,3 %), la thérapie manuelle (53,3 %) et l'électrothérapie (42,1 %). Le choix de la thérapie manuelle ou de l'électrothérapie était significativement associé au travail en pratique privée. Conclusion : la grande majorité des physiothérapeutes ont sélectionné les exercices de mobilité et de renforcement, qui représentent les approches recommandées pour le traitement de l'arthrose du genou. Les physiothérapeutes en pratique privée étaient plus susceptibles de sélectionner la thérapie manuelle et l'électrothérapie.

Management of Patients with a Musculoskeletal Pain Condition that is Likely Chronic: Results from a National Cross Sectional Survey.

The purpose of the study was to explore clinical management for new cases of musculoskeletal pain that are likely chronic. We used data from the National Ambulatory Medical Care Survey, 2007-2015, identifying visits with a new chronic musculoskeletal pain condition using predetermined ICD-9 codes. We documented prescribing of nonopioid pain medication, opioids, physical therapy (PT), counseling, and other nonpharmacologic treatments and explored associations between patient and provider factors for each of these treatments. There were 11,994 visits over the 9-year period for a new case of chronic musculoskeletal pain, representing an average of 36.8 million weighted visits per year or approximately 11.8% of the population. Proportions that were prescribed nonopioid medication, opioids, PT, counseling and other nonpharmacologic treatments were: 40.2, 21.5, 10.0, 15.2 and 14.3 respectively. Patient age was associated with type of treatment with a young to old gradient for other nonpharmacologic treatments, PT, opioids, counseling and other medications. Orthopedists were less likely to prescribe pharmacological treatments than family practice physicians and more likely to prescribe PT. Physicians who used the electronic medical record were more likely to prescribe opioids. Contrary to practice guidelines for managing musculoskeletal pain, many patients are prescribed opioids for a new chronic musculoskeletal problem. PERSPECTIVE: We outlined in a representative sample of Americans what treatments are being prescribed for new cases of likely chronic musculoskeletal pain. Opioid prescription was double that of physical therapy. Using the electronic medical record was associated with more opioid prescription- a novel finding that should be corroborated by future research.

Trajectories of pain severity in juvenile idiopathic arthritis: results from the Research in Arthritis in Canadian Children Emphasizing Outcomes cohort.

We studied children enrolled within 90 days of juvenile idiopathic arthritis diagnosis in the Research in Arthritis in Canadian Children Emphasizing Outcomes (ReACCh-Out) prospective inception cohort to identify longitudinal trajectories of pain severity and features that may predict pain trajectory at diagnosis. A total of 1062 participants were followed a median of 24.3 months (interquartile range = 16.0-37.1 months). Latent trajectory analysis of pain severity, measured in a 100-mm visual analogue scale, identified 5 distinct trajectories: (1) mild-decreasing pain (56.2% of the cohort); (2) moderate-decreasing pain (28.6%); (3) chronically moderate pain (7.4%); (4) minimal pain (4.0%); and (5) mild-increasing pain (3.7%). Mean disability and quality of life scores roughly paralleled the pain severity trajectories. At baseline, children with chronically moderate pain, compared to those with moderate-decreasing pain, were older (mean 10.0 vs 8.5 years, P = 0.01) and had higher active joint counts (mean 10.0 vs 7.2 joints, P = 0.06). Children with mild-increasing pain had lower joint counts than children with mild-decreasing pain (2.3 vs 5.2 joints, P < 0.001). Although most children with juvenile idiopathic arthritis in this cohort had mild or moderate initial levels of pain that decreased quickly, about 1 in 10 children had concerning pain trajectories (chronically moderate pain and mild-increasing pain). Systematic periodic assessment of pain severity in the months after diagnosis may help identify these concerning pain trajectories early and lay out appropriate pain management plans. Focused research into the factors leading to these concerning trajectories may help prevent them.

Differences in Waiting List Prioritization Preferences of Occupational Therapists, Elderly People, and Persons With Disabilities: A Discrete Choice Experiment.

OBJECTIVE: To compare the preferences of occupational therapists, elderly people, and adults with disabilities regarding prioritization criteria for occupational therapy waiting lists in home care. DESIGN: Discrete choice experiment survey. SETTING: Survey mailed to occupational therapists working in home care and community-dwelling elderly or disabled persons. PARTICIPANTS: A sample (N=714) of home-based occupational therapists (n=241), elderly persons from a bank of research participants (n=226), and adults with physical disabilities recruited through community organizations (n=247). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The dependent variable was whether the referral scenario was prioritized or not in each question. The results were analyzed through logistic regression using conditional logit models. RESULTS: Prioritization preferences differed between groups (P<.001). Occupational therapists most strongly prioritized people who had a few falls (odds ratio vs no falls, 48.7), whereas elderly people and adults with disabilities most strongly prioritized people who were unable to enter and exit the home (odds ratio vs no difficulty entering and exiting the home, 30.8 for elderly people and 16.8 for persons with disabilities.) CONCLUSIONS: Our results highlight the gap between the priorities of home-based occupational therapists and their target clientele. Although further inquiry is needed to inform priority setting, the findings emphasize the importance of public or patient involvement in decisions on waiting list prioritization.

Low Back Pain: Investigation of Biases in Outpatient Canadian Physical Therapy.

BACKGROUND: Previous research suggested that physical therapy services can be influenced by patient characteristics (age, sex, socioeconomic status) or insurance status rather than their clinical need. OBJECTIVE: The aim of this study was to determine whether patient-related factors (age, sex, SES) and the source of reimbursement for physical therapy services (insurance status) influence wait time for, frequency of, and duration of physical therapy for low back pain. DESIGN: This study was an empirical cross-sectional online survey of Canadian physical therapy professionals (defined as including physical therapists and physical rehabilitation specialists). METHODS: A total of 846 physical therapy professionals received 1 of 24 different (and randomly selected) clinical vignettes (ie, patient case scenarios) and completed a 40-item questionnaire about how they would treat the fictional patient in the vignette as well as their professional clinical practice. Each vignette described a patient with low back pain but with variations in patient characteristics (age, sex, socioeconomic status) and insurance status (no insurance, private insurance, Workers' Compensation Board insurance). RESULTS: The age, sex, and socioeconomic status of the fictional vignette patients did not affect how participants would provide service. However, vignette patients with Workers' Compensation Board insurance would be seen more frequently than those with private insurance or no insurance. When asked explicitly, study participants stated that insurance status, age, and chronicity of the condition were not factors associated with wait time for, frequency of, or duration of treatment. LIMITATIONS: This study used a standardized vignette patient and may not accurately represent physical therapy professionals' actual clinical practice. CONCLUSIONS: There appears to be an implicit professional bias in relation to patients' insurance status; the resulting inequity in service provision highlights the need for further research as a basis for national guidelines to promote equity in access to and provision of quality physical therapy services.

Ottawa Panel Evidence-Based Clinical Practice Guidelines for Structured Physical Activity in the Management of Juvenile Idiopathic Arthritis.

OBJECTIVE: To create guidelines focused on the use of structured physical activity (PA) in the management of juvenile idiopathic arthritis (JIA). DATA SOURCES: A systematic literature search was conducted using the electronic databases Cochrane Central Register of Controlled Trials, MEDLINE (Ovid), EMBASE (Ovid), and Physiotherapy Evidence Database for all studies related to PA programs for JIA from January 1966 until December 2014, and was updated in May 2015. STUDY SELECTION: Study selection was completed independently by 2 reviewers. Studies were included if they involved individuals aged ≤21 years diagnosed with JIA who were taking part in therapeutic exercise or other PA interventions for which effects of various disease-related outcomes were compared with a control group (eg, no PA program or activity of lower intensity). DATA EXTRACTION: Two reviewers independently extracted information on interventions, comparators, outcomes, time period, and study design. The statistical analysis was reported using the Cochrane Collaboration methods. The quality of the included studies was assessed according to the Physiotherapy Evidence Database Scale. DATA SYNTHESIS: Five randomized controlled trials (RCTs) fit the selection criteria; of these, 4 were high-quality RCTs. The following recommendations were developed: (1) Pilates for improving quality of life, pain, functional ability, and range of motion (ROM) (grade A); (2) home exercise program for improving quality of life and functional ability (grade A); (3) aquatic aerobic fitness for decreasing the number of active joints (grade A); and (4) and cardio-karate aerobic exercise for improving ROM and number of active joints (grade C+). CONCLUSIONS: The Ottawa Panel recommends the following structured exercises and physical activities for the management of JIA: Pilates, cardio-karate, home and aquatic exercises. Pilates showed improvement in a higher number of outcomes.