The Development of the Canadian Physiotherapy Assessment of Clinical Performance (ACP) 2.0 - Alignment with the 2017 Competency Profile.

Purpose: Clinical education and assessment of students' performance during clinical placements are key components of Canadian entry-to-practice physiotherapy curriculum and important in developing entry-level physiotherapy practitioners. The Canadian Physiotherapy Assessment of Clinical Performance (ACP) is the measure currently used to assess physiotherapy student performance on clinical placements in most of the entry-to-practice physiotherapy programmes across Canada. The release of the 2017 Competency Profile by the National Physiotherapy Advisory Group resulted in a revision of the existing ACP. The purpose of this study is to report the process used to develop a revised version of the ACP based on the 2017 Competency Profile, henceforth called the ACP 2.0. Method: Using a multistage process, we sought input from Canadian clinical education academics, an expert consultant panel, as well as physiotherapists across Canada using a questionnaire, meetings, and an online survey, respectively. Results: Twelve of 15 clinical education academics responded to a questionnaire. The expert consultant panel (n = 12) met three times. There were 144 physiotherapists who initiated the national, online, survey and met the inclusion criteria; 84 completed the survey. In the ACP 2.0, rating scales and comments boxes were grouped, and additional text was added to 12 items for further clarification. The ACP 2.0 came to have 18 items and 9 comment boxes in addition to summative comments, in contrast to the original ACP's 21 items and 9 comment boxes. Conclusions: In November 2020, Canadian clinical education academics reviewed the proposed draft ACP 2.0 and unanimously accepted it for implementation in Canadian physiotherapy university programmes.

Objectif: l'enseignement clinique et l'évaluation du rendement des étudiants pendant les stages cliniques sont des éléments clés du programme canadien d'entrée en pratique de la physiothérapie et sont importants pour former des praticiens de la physiothérapie prêts à entrer en pratique. L'évaluation du rendement clinique de la physiothérapie au Canada (ÉPC) est la mesure actuellement en usage pour évaluer le rendement des étudiants en physiothérapie lors de leur stage clinique dans la plupart des programmes d'entrée en pratique de la physiothérapie au Canada. La publication du Profil des compétences par le Groupe consultatif national en physiothérapie en 2017 a donné lieu à une révision de l'ÉPC. La présente étude vise à rendre compte du processus utilisé pour mettre au point une version révisée de l'ÉPC d'après le Profil des compétences de 2017, désormais appelée l'ÉPC 2.0. Méthodologie: au moyen d'un processus échelonné, les chercheurs ont demandé l'apport d'universitaires canadiens en enseignement clinique, d'un groupe d'experts consultants et de physiothérapeutes des diverses régions du Canada dans le cadre d'un questionnaire, de réunions et d'un sondage en ligne, respectivement. Résultats: au total, 12 des 15 universitaires en enseignement clinique ont répondu à un questionnaire. Le groupe d'experts consultants (n = 12) s'est réuni trois fois. Enfin, 144 physiothérapeutes qui respectaient les critères d'inclusion ont entrepris le sondage national en ligne, et 84 l'ont terminé. Dans l'ÉPC 2.0, les échelles d'évaluation et les encadrés de commentaires ont été regroupés et du texte a été ajouté à 12 des points afin de les clarifier. L'ÉPC 2.0 comporte finalement 18 points et neuf encadrés de commentaires en plus des commentaires sommatifs, par rapport aux 21 points et aux neuf encadrés de commentaires de l'ÉPC original. Conclusions: en novembre 2020, les universitaires en enseignement clinique canadiens ont révisé le projet d'ÉPC 2.0 et en ont adopté la mise en œuvre à l'unanimité au sein des programmes universitaires de physiothérapie du Canada.

How Community-Based Health and Social Care Professionals Support Unpaid Caregivers: Experiences From One Health Authority in Ontario, Canada.

In Ontario, Canada, rising rates of caregiver distress have been the 'canary in the coal mine' for a health system out of balance with the needs of an ageing population. Community-based health and social care professionals are well placed to play an important role in the caregiver support process; however, a gap has remained in the understanding of if and how caregiver support strategies are operationalized or experienced by community service providers (CSPs). The goal of this study was to describe how CSPs interpreted policy and how those interpretations may enable their work in supporting unpaid caregivers. Using a qualitative constructionist design, we interviewed 24 participants and reviewed 92 publicly available documents. Braun and Clarke's method of thematic analysis was used for analysis strategy. Four overarching themes were identified: (1) community care as a priority, (2) sidewalk accountability, (3) creative care planning through partnerships, and (4) challenges to care delivery. We found that the importance of caregivers to the health system was reflected in organizational policy and strategy. There is an opportunity to improve health outcome for caregivers and the population alike through strong leadership and a clear shared vision. Our findings also suggested that social capital was a significant factor in enabling providers in their work, leveraging long-standing relationships, and accumulated local knowledge to implement highly creative care plans.

Mitigating Caregiver Distress in South Western Ontario: Perspectives on Role, Community, and Care.

The former South West Local Health Integration Network (SW LHIN) of Ontario, which is in a predominantly rural region, regularly reports the lowest rates of caregiver distress in the province. Caregivers from rural communities regularly face challenges related to the access, applicability, and availability of supports and services, This qualitative case study describes perspectives of caregiving from the region, and explores how role construction and expectations of caregivers might both mitigate distress and influence service support use. Thematic analysis identified five themes: anticipated care, gendered caring, service support assumptions, confidence in community, and the "line in the sand": care decisions for evolving needs. Using the lens of caregiver identity theory, the findings suggest that these caregivers conceptualize identity as an extension of their primary role, to include caregiving obligations and responsibilities. We also noted a steadfast confidence in community and perceived service support assumptions across the region, with no notable rural-urban divide.

A Systematic Review and Meta-Analysis of Exercise Interventions and Use of Exercise Principles to Reduce Fear of Falling in Community-Dwelling Older Adults.

OBJECTIVE: Fear of falling (FOF) contributes to activity restriction and institutionalization among older adults, and exercise interventions are linked to reduction in FOF. Adhering to exercise principles and adapting optimal exercise parameters are fundamental to optimizing the effectiveness of exercise interventions. The purpose of this review was to describe FOF exercise interventions in community-dwelling older adults, evaluate the extent to which these interventions followed the exercise principles and reported exercise parameters, and quantify the effect of these interventions on reducing FOF. METHODS: Randomized controlled trials (RCTs) of FOF exercise interventions in older adults (≥65 years) were identified from 4 databases. The methodological quality of RCTs was assessed using the Physiotherapy Evidence Database scale. A random-effect model was used in the meta-analysis. RESULTS: Seventy-five RCTs were included in this review. With regard to reporting exercise principles, specificity was reported in 92% of trials, progression in 72%, reversibility in 32%, overload in 31%, diminished return in 21%, and initial value in 8%. For exercise parameters, 97% of RCTs reported exercise type; 89%, frequency; and 85%, time. Only 25% reported the intensity. The pooled effect of exercise interventions on FOF among all included studies was a standard mean difference of -0.34 (95% CI = -0.44 to -0.23). CONCLUSION: This study showed a significant small to moderate effect size of exercise interventions in reducing FOF among community-dwelling older adults. Most exercise principles and intensity of exercises were not adequately reported in included trials. IMPACT: These inadequate reports could undermine efforts to examine the optimal dosage for exercise prescription. More attention must be given to designing and reporting components of therapeutic exercise programs to facilitate evidence-based practice.

Moral distress experienced by community service providers of home health and social care in Ontario, Canada.

Moral distress occurs when one knows a morally correct action to take but feels powerless to act the way one believes is right. Moral distress has been studied in many contexts but there remains a gap in our understanding of the phenomenon as it manifests outside of hospital-based settings. The aim of this study was to explore the nature of the moral distress experience among community-based health and social care professionals working with older adults and their caregivers. Using a qualitative constructionist design, we interviewed 24 participants from a single health authority in southwestern Ontario, Canada. Participants were both urban and rurally based. Data were collected in the winter and summer of 2020 and analysed using Braun and Clarke's thematic analysis strategy. Three factors: reluctant clients, human resource shortages and system challenges, contributed to the creation of perceived morally precarious care plans, resulting in symptoms of moral distress. Study participants described frustration, guilt, anger, and grief at not being able to act consistently with their core values and provide the amount and/or quality of care their clients and unpaid caregivers deserved. We consider possible reasons for our finding that community service providers did not always respond to the consequences of moral distress symptoms in a manner similar to those in acute care contexts. Our findings suggest that study participants may have been able to cultivate moral resilience in the face of moral distress through the positive reframing of adversity and therefore maintain their overall sense of moral integrity.

Physiotherapy Students' Performance in Clinical Education: An Analysis of 1 Year of Canadian Cross-Sectional Data.

Purpose: This research examines 1 year of cross-sectional, Canada-wide ratings from clinical instructors using the Canadian Physiotherapy Assessment of Clinical Performance (ACP) and analyzes the performance profiles of physiotherapy students' performance ratings over the course of their entry-to-practice clinical placements. Method: Canadian physiotherapy programmes that use the ACP were invited to submit anonymized, cross-sectional data for placements completed during 2018. Descriptive analyses and summary statistics were completed. Mixed-effects modelling was used to create typical performance profiles for each evaluation criterion in the ACP. Stepwise ordered logistic regression was also completed. Results: Ten programmes contributed data on 3,290 placements. Profiles were generated for each ACP evaluative item by means of mixed-effects modelling; three profiles are presented. In all cases, the predicted typical performance by the end of 24 months of study was approximately the rating corresponding to entry level. Subtle differences among profiles were identified, including the rate at which a student may be predicted to receive a rating of "entry level." Conclusions: This analysis identified that, in 2018, the majority of Canadian physiotherapy students were successful on clinical placements and typically achieved a rating of "entry level" on ACP items at the end of 24 months.

Objectif : étude transversale d'un an des évaluations canadiennes des moniteurs cliniques au moyen de l'Évaluation physiothérapique canadienne de la performance clinique (ÉPC) pour analyser les profils de performance des étudiants en physiothérapie pendant la durée de leurs stages cliniques débutants. Méthodologie : les programmes de physiothérapie canadiens qui font appel à l'ÉPC ont été invités à soumettre des données transversales anonymisées sur les stages effectués en 2018. Les chercheurs ont procédé à des analyses descriptives et des statistiques sommaires. Ils ont utilisé des modèles non linéaires à effets mixtes pour créer des profils de performance types pour chaque critère d'évaluation de l'ÉPC. Ils ont également procédé à la régression logistique séquentielle. Résultats : dix programmes ont fourni des données sur 3 290 stages. Les chercheurs ont produit des profils pour chaque point d'évaluation de l'ÉPC au moyen du modèle non linéaire à effets mixtes et en ont retenu trois. Dans tous les cas, la performance type anticipée à la fin des 24 mois d'étude correspondait environ au classement de premier échelon. Les chercheurs ont constaté des différences discrètes entre les profils, y compris la vitesse à laquelle il est possible d'anticiper qu'un étudiant recevra un classement de premier échelon. Conclusions : cette analyse a déterminé qu'en 2018, la majorité des étudiants en physiothérapie canadiens réussissaient leur stage clinique, et ils obtenaient habituellement une note de premier échelon aux points de l'ÉPC à la fin des 24 mois.

How Do I Choose a Job? Factors Influencing the Career and Employment Decisions of Physiotherapy Graduates in Canada.

Purpose: Physiotherapy is a diverse profession: there are many areas in which physiotherapists can practise. New graduates must decide in which area of physiotherapy they would like to work and with which organizations to seek employment. The purpose of this study was to describe the factors that influenced the career (area of practice, practice setting) and employment (organization) decisions of recent physiotherapy graduates. Method: Given Canada's vast expanse, we used survey methodology. We invited English-speaking physiotherapists who had completed their physiotherapy education between October 2015 and December 2017 to participate in this study. The survey was emailed to 1,442 physiotherapists in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, and Nova Scotia. Results: We collected 351 responses (24%). Almost all respondents reported currently working as a physiotherapist, and the majority worked with patients with musculoskeletal conditions. Clinical education experiences were most influential in determining career decisions. Area of practice, practice setting, and mentorship were the most influential factors contributing to employment decisions. Conclusions: Clinical education experiences are influential in shaping physiotherapy students' career and employment decisions. Employers who want to recruit physiotherapy graduates may consider partnering with physiotherapy programmes to offer clinical placement experiences and develop mentorship programmes that help build novice physiotherapists' competence and confidence.

Objectif : la physiothérapie est une profession diversifiée : les physiothérapeutes peuvent exercer dans divers domaines. Les nouveaux diplômés doivent décider celui dans lequel ils désirent travailler et dans quelles organisations solliciter un emploi. La présente étude visait à décrire les facteurs qui avaient influé sur les décisions des récents diplômés en physiothérapie pour leur choix de carrière (domaine et milieu d'exercice) et d'emploi (organisations). Méthodologie : étant donné l'immensité du Canada, les chercheurs ont opté pour la méthodologie du sondage. Ils ont invité les physiothérapeutes anglophones qui avaient terminé leurs études entre octobre 2015 et décembre 2017 à participer. Ils ont posté le sondage à 1 442 physiothérapeutes de la Colombie-Britannique, de l'Alberta, de la Saskatchewan, du Manitoba, de l'Ontario et de la Nouvelle-Écosse. Résultats : les chercheurs ont colligé 351 réponses (24 %). Presque tous les répondants ont déclaré travailler comme physiothérapeutes, la majorité auprès de patients ayant des troubles musculosquelettiques. Les expériences cliniques pendant leurs études avaient été déterminantes dans leur choix de carrière. Le domaine et le milieu d'exercice et le mentorat étaient les facteurs qui avaient le plus influencé leurs décisions en matière d'emploi. Conclusions : les expériences cliniques pendant les études contribuent à orienter les décisions des étudiants en matière de carrière et d'emploi. Les employeurs qui souhaitent recruter des diplômés en physiothérapie peuvent envisager de s'associer à des programmes de physiothérapie pour offrir des expériences de stage clinique et créer des programmes de mentorat qui contribueront à accroître les compétences et la confiance des physiothérapeutes novices.

Clinical Instructors' Perceptions of Internationally Educated Physical Therapists' Readiness to Practise during Supervised Clinical Internships in a Bridging Programme.

Purpose: The purpose of this study was to describe clinical instructors' (CIs) comments on the Canadian Physiotherapy Assessment of Clinical Performance (ACP) that reflect areas of strength and areas requiring improvement among internationally educated physical therapists (IEPTs) during supervised clinical internships in a bridging programme. Method: We reviewed the assessment records of 100 IEPTs' clinical performance during two internships each for three successive cohorts of learners in a Canadian bridging programme. We extracted the CIs' text from 385 comment sections of the ACP completed during these internships and analyzed them using qualitative content analysis. Results: The iterative deductive coding process resulted in 36 subcategories: 14 for areas of strength and 22 for areas requiring improvement. We merged the 36 subcategories to produce nine categories: four areas of strength (subjective assessment, treatment, patient confidentiality, and professionalism) and five areas for improvement (objective assessment, clinical reasoning, establishment of treatment goals, communication, confidence, and time management). We then grouped these categories into two broad themes: professional practice and professional conduct. Conclusions: The CIs commended the IEPTs for their clinical competence in subjective assessment, treatment, patient confidentiality, and professionalism. The areas requiring improvement typically required more complex clinical decision-making skills, which may have been challenging for these IEPTs to demonstrate as competently during a short internship.

Objectif : décrire les commentaires des moniteurs cliniques (MC) dans l'évaluation clinique de la performance (ÉCP) en physiothérapie au Canada, qui reflètent les points forts et les points à améliorer chez les physiothérapeutes formés à l'étranger (PTFÉ) pendant les stages cliniques supervisés d'un programme de transition. Méthodologie : les chercheurs ont analysé les dossiers d'évaluation de la performance clinique de 100 PTFÉ faisant partie de trois cohortes successives d'un programme de transition canadien, qui ont toutes participé à deux stages. Ils ont extrait les textes de 385 sections de commentaires des MC dans l'ÉCP remplie lors de ces stages et ont procédé à une analyse qualitative du contenu. Résultats : le processus itératif de codage déductif s'est traduit par 36 sous-catégories : 14 dans les points forts et 22 dans les points à améliorer. Les chercheurs ont fusionné les 36 sous-catégories en neuf points : quatre points forts (évaluation subjective, traitement, confidentialité des patients et professionnalisme) et cinq points à améliorer (évaluation objective, raisonnement clinique, établissement des objectifs thérapeutiques, communication, confiance et gestion du temps). Ils ont ensuite regroupé ces catégories en deux grands thèmes : pratique professionnelle et conduite professionnelle. Conclusion : Les MC ont félicité les PTFÉ pour leur compétence clinique dans l'évaluation subjective, le traitement, la confidentialité des patients et le professionnalisme. Les points à améliorer exigent habituellement des aptitudes décisionnelles cliniques plus complexes, à l'égard desquelles les PTFÉ ont peut-être eu plus de difficulté à démontrer leur compétence dans le cadre d'un court stage.

Improving Cultural Knowledge to Facilitate Cultural Adaptation of Pain Management in a Culturally and Linguistically Diverse Community.

Purpose: Health care disparities exist for people from culturally and linguistically diverse (CALD) communities. Addressing the cultural competence of health care providers could limit these disparities. The aim of this study was to improve cultural knowledge of and humility regarding pain in a CALD community. Method: This interpretive description qualitative study used focus group discussions (FGDs) to generate ideas about how South Asian culture could influence how health care providers manage pain. A total of 14 people with pain and of South Asian background (6 women and 8 men, aged 28-70 y) participated. Two investigators independently analyzed the data. This process involved repeatedly reading the transcripts, then manually sorting the key messages into categories. The investigators compared their categorizations and resolved differences through discussion. Next, similar categories and concepts were grouped into ideas (potential themes). These ideas, along with supporting categories and verbatim quotes, were presented to the full research team for feedback. After compiling the feedback, the ideas formed the thematic representation of the data. Results: The data from the FGDs revealed how pain management could be culturally adapted. The FGDs generated four themes about South Asian cultural perspectives that could influence the pain management experience for people living with pain: (1) cultural and linguistic impediments to communication, (2) understanding of pain in terms of the extent to which it interferes with function and work, (3) nurturing or personal attention as a marker of good care, and (4) value attributed to traditional ideas of illness and treatment. Conclusion: This study demonstrates how engaging with CALD people living with pain can lead to improved cultural knowledge and humility that can form the basis for adapting pain management. Through this process, it is more likely that a meaningful and client-centred pain management plan can be developed.

Objectif : les membres de communautés linguistiques et culturelles diversifiées (CLCD) font face à des disparités en matière de soins. Si les dispensateurs de soins acquéraient des compétences culturelles, il serait possible d'atténuer ces disparités. La présente étude visait à améliorer les connaissances et l'humilité culturelle au sujet de la douleur dans les CLCD. Méthodologie : étude qualitative descriptive et interprétative faisant appel à des entrevues de groupe pour générer des idées sur la manière dont la culture sud-asiatique peut influencer les modes de gestion de la douleur par les dispensateurs de soins. Au total, 14 personnes d'origine sud-asiatique qui souffrent de douleur y ont participé (six femmes et huit hommes de 28 à 70 ans). Deux chercheurs ont analysé les données de manière indépendante. Ce processus incluait la lecture répétée des comptes rendus, puis la catégorisation manuelle des principaux messages. Les chercheurs ont comparé les catégories et résolu leurs différends par des discussions. Ils ont ensuite regroupé les catégories et les concepts semblables en idées (thèmes potentiels). Les idées, de même que les catégories et les citations textuelles qui les appuyaient, ont ensuite été présentées à l'ensemble de l'équipe de recherche pour qu'elle y réagisse. Une fois les réactions compilées, les idées ont formé la représentation thématique des données. Résultats : les données tirées des entrevues de groupe ont révélé des manières d'adapter la gestion de la douleur à la culture. Les entrevues ont produit quatre thèmes sur les points de vue de la culture sud-asiatique qui pourraient influer sur l'expérience de gestion de la douleur des personnes qui vivent avec la douleur : 1) les obstacles culturels et linguistiques à la communication, 2) la compréhension de l'importance de l'entrave que représente la douleur pour le fonctionnement et le travail, 3) l'accompagnement ou l'attention personnelle comme marqueur de bons soins et 4) la valeur attribuée aux idées traditionnelles de la maladie et du traitement. Conclusion : la présente étude démontre que le fait d'engager un dialogue avec des personnes de CLCD qui vivent avec la douleur peut améliorer les connaissances et l'humilité culturelles sur lesquelles reposeront les mesures d'adaptation. Grâce à ce processus, il est plus probable d'établir un plan concret de gestion de la douleur, axé sur le client.

Evaluation of the Predictive Accuracy of the interRAI Falls Clinical Assessment Protocol, Scott Fall Risk Screen, and a Supplementary Falls Risk Assessment Tool Used in Residential Long-Term Care: A Retrospective Cohort Study.

Falls in residential long-term care (LTC) facilities continue to be a leading cause of injury for residents and cost for the health care system. Interdisciplinary clinical teams are responsible for assessing risk levels for their residents and developing appropriate care plans and interventions in response. This study compares the predictive accuracy of three separate fall risk assessment tools: the interRAI Falls Clinical Assessment Protocol (CAP), derived from the LTC Facility (LTCF) or Minimum Data Set (MDS) 2.0 assessments; the Scott Fall Risk Screen; and a modified Fall Risk Tool that was implemented as part of a provincial Fall Reduction Strategy in Nova Scotia. To conduct this retrospective cohort study, secondary data were collected from 1,553 LTC residents with interRAI assessments completed between March 1, 2015 and September 29, 2016, across Nova Scotia and New Brunswick. For each resident, data were collected regarding the three fall risk assessments, along with fall incident data for use in sensitivity, specificity, and logistic regression analyses. This study found that although all three tools had limitations with sensitivity or specificity thresholds, the interRAI Falls CAP delivered the highest accuracy with a c-statistic of 0.673, compared with the Scott Fall Risk Screen at 0.529 and the modified Fall Risk Tool at 0.609. When diseases that have been established to be a risk factor for falls were added to the model, the overall accuracy of the interRAI Falls CAP combined with those covariates increased to 0.749. These results suggest that the best practice guidelines for fall risk assessment be revisited, and that the interRAI Falls CAP could potentially be updated to include certain diseases and controls for optimal predictive ability.

"I've found it's very meaningful work": Perspectives of physiotherapists providing palliative care in Ontario.

OBJECTIVES: This study aimed to describe insights from interviews about the experience of physiotherapists providing palliative care in Ontario and their perceptions of the role and value of physiotherapists' involvement in palliative care. METHODS: We conducted interviews with physiotherapists in Ontario, Canada (n = 14), and received emailed submissions from two others (one physiotherapist and one physiotherapy student) with current or recent practice experience in palliative care. We conducted inductive thematic analysis of the interview data and emailed submissions. RESULTS: Participants' reflections were categorized into three major themes: perceived value of the contribution of physiotherapists in palliative care; the experience of providing physiotherapy in palliative care; and reflections on the palliative care system. Participants described their role in palliative care as diverse, driven by patient goals and focused on the experience of patients and families. Participants perceived a high value in collaborative networks for supporting them to fulfill their role in palliative care settings. Participants also recommended efforts to increase awareness of the potential for physiotherapists to contribute to palliative care. CONCLUSIONS: The findings confirm those of research in other jurisdictions and extend our understanding of the value and meaningfulness of physiotherapy in palliative care, to patients, families, and physiotherapists themselves.

Clinical Performance Scores of Internationally Educated Physical Therapists during Clinical Education in a Bridging Programme.

Purpose: We describe the numerical ratings assigned by clinical instructors to the performance of internationally educated physical therapists (IEPTs) during their clinical internships while enrolled in a bridging programme. Method: We conducted a secondary analysis of the quantitative data for IEPT learners attending the Ontario Internationally Educated Physical Therapist Bridging Program using the Canadian Physiotherapy Assessment of Clinical Performance (ACP) tool. We extracted the scores from each IEPT's ACP form at the midterm and final evaluations for two internships and conducted a descriptive analysis. Results: We obtained 318 data sets for 61 IEPTs. By the final point of the second internship, (1) items about communication pertaining to ethical professional relationships, conducting oneself within legal and ethical requirements, and respecting the individuality and autonomy of the client had high mean ratings; (2) most items rated achieved advanced intermediate performance and many indicated entry-level performance; and (3) most IEPTs (84%) either had high scores throughout or improved from lower scores to at least advanced intermediate performance. Conclusions: Items relating to professional conduct and effective communication in professional relationships were relatively high among the IEPTs. By the end of the second internship, most IEPTs in this bridging programme had improved their clinical performance toward or up to the entry-level standard for Canadian physiotherapists.

Objectif : décrire les cotes numériques que les moniteurs cliniques attribuent au rendement des physiothérapeutes formés à l'étranger (PFÉ) pendant les stages cliniques de leur programme de transition. Méthodologie : les chercheurs ont procédé à une analyse secondaire des données quantitatives des apprenants PFÉ qui participent au programme ontarien de transition des PFÉ. Pour ce faire, ils ont utilisé l'outil d'évaluation du rendement clinique (ÉRC) en physiothérapie au Canada. Ils ont extrait les cotes de chaque formulaire d'ÉRC des PFÉ à l'évaluation de mi-session et à l'évaluation finale de deux stages et réalisé une analyse descriptive. Résultats : les chercheurs ont obtenu 318 ensembles de données sur 61 PFÉ. À la fin du deuxième stage, a) les points sur la communication relative aux relations professionnelles éthiques, le comportement respectueux des exigences légales et éthiques et le respect de l'individualité et de l'autonomie du client ont obtenu des cotes élevées; b) la plupart des points cotés ont obtenu un rendement intermédiaire avancé, et bon nombre, un rendement de physiothérapeute débutant et c) la plupart des PFÉ (84 %) ont obtenu des cotes élevées tout au long de leurs stages ou sont passés de scores faibles à un rendement au moins intermédiaire avancé. Conclusion : les points relatifs au comportement professionnel et à des communications efficaces étaient relativement élevés chez les PFÉ. À la fin de leur deuxième stage, la plupart des PFÉ de ce programme de transition avaient amélioré leur rendement clinique pour qu'il avoisine ou atteigne la norme exigée des physiothérapeutes canadiens débutants.

Heterogeneity and Its Impact on Rehabilitation Outcomes and Interventions for Community Reintegration in People With Spinal Cord Injuries: An Integrative Review.

Background: Various injury characteristics such as cause, level, severity, and time since injury divide individuals with spinal cord injury (SCI) into many subgroups. The heterogeneity among individuals' injuries and personal characteristics has significant implications for SCI rehabilitation practice, specifically directed toward community reintegration, which is a key goal of rehabilitation interventions for people with disabilities. Purpose: This study aims to summarize the evidence on attributes that make the SCI population heterogeneous, the impact of these attributes on community reintegration, and the implications of heterogeneity for rehabilitation interventions directed toward optimizing community reintegration. Methods: We used an integrative review approach to conduct this study. MEDLINE, PubMed, CINAHL, EMBASE, Google Scholar, and PsycINFO were searched from inception until May 2017. Out of 670 articles retrieved, 49 provided evidence on the impact of various attributes that make SCI heterogeneous on rehabilitation outcomes related to community reintegration. Results: An array of injury-related, personal, social, and environmental factors are associated with various rehabilitation outcomes that affect community reintegration of people with SCI. There is level 1 evidence that social support, self-efficacy, and self-esteem facilitate community reintegration among people with SCI while there is level 5 evidence that presence of psychological or medical complications decreases it. There is lack of clarity on the impact of injury-related factors on community reintegration. Conclusion: This integrative review found that social support and individuals' self-efficacy can improve community reintegration of people with SCI. However, evidence regarding the impact of injury characteristics on community reintegration is still underdeveloped. Approaches directed at community reintegration should involve components of psychosocial, physical, and vocational rehabilitation while considering personal and societal aspects of an individual's life.

Imaging use for low back pain by Ontario primary care clinicians: protocol for a mixed methods study - the Back ON study.

BACKGROUND: At any one time, one in every five Canadians has low back pain (LBP), and LBP is one of the most common health problems in primary care. Guidelines recommend that imaging not be routinely performed in patients presenting with LBP without signs or symptoms indicating a potential pathological cause. Yet imaging rates remain high for many patients who present without such indications. Inappropriate imaging can lead to inappropriate treatments, results in worse health outcomes and causes harm from unnecessary radiation. There is a need to understand the extent of, and factors contributing to, inappropriate imaging for LBP, and to develop effective strategies that target modifiable barriers and facilitators. The primary study objectives are to determine: 1) The rate of, and factors associated with, inappropriate lumbar spine imaging (x-ray, CT scan and MRI) for people with non-specific LBP presenting to primary care clinicians in Ontario; 2) The barriers and facilitators to reduce inappropriate imaging for LBP in primary care settings. METHODS: The project will comprise an inception cohort study and a concurrent qualitative study. For the cohort study, we will recruit 175 primary care clinicians (50 each from physiotherapy and chiropractic; 75 from family medicine), and 3750 patients with a new episode of LBP who present to these clinicians. Clinicians will collect data in the clinic, and each participant will be tracked for 12 months using Ontario health administrative and self-reported data to measure diagnostic imaging use and other health outcomes. We will assess characteristics of the clinicians, patients and encounters to identify variables associated with inappropriate imaging. In the qualitative study we will conduct in-depth interviews with primary care clinicians and patients. DISCUSSION: This will be the first Canadian study to accurately document the extent of the overuse of imaging for LBP, and the first worldwide to include data from the main healthcare professions offering primary care for people with LBP. This study will provide robust information about rates of inappropriate imaging for LBP, along with factors associated with, and an understanding of, potential reasons for inappropriate imaging.

Socially Valued Roles, Self-Determination, and Community Participation among Individuals Living with Serious Mental Illnesses.

Decades after deinstitutionalization, individuals living with serious mental illnesses remain isolated, socially disengaged, and devalued members of communities. Burgeoning research and services need conceptual clarity to improve such social conditions. This qualitative inquiry used grounded theory and participatory approaches to conduct an in-depth exploration of community participation for individuals living with serious mental illnesses based on key stakeholder perspectives (n = 45). Results revealed that community participation is a multifaceted construct with layers of meaning for individuals living with serious mental illnesses. Overarching themes are contextualized in Self-Determination Theory and presented with deidentified illustrations. Implications for services, research, and policy are discussed.

Knowledge about risk factors for falls and practice about fall prevention in older adults among physiotherapists in Nigeria.

BACKGROUND AND OBJECTIVE: Falling is a major health concern that has contributed significantly to older people's injury and loss of life worldwide, warranting the development of fall-prevention strategies, the success of which has been attributed to the levels of knowledge and practice about fall prevention among physiotherapists and other health professionals. The objective of this study was to determine the self-reported levels of knowledge on risk factors of fall and practices about fall prevention in older adults among physiotherapists in Nigeria. METHODS: Physiotherapists (N = 237) recruited from the six geopolitical zones of Nigeria completed a three-part structured questionnaire that asked questions about risk factors for fall and common practices for fall prevention using a 5-point-rated Likert scale. Data were analysed using descriptive analysis, chi-square, and Kruskal-Wallis tests. RESULTS: Among physiotherapists in Nigeria, 89% rated their level of knowledge about preventing falls among older adults as high, and 64% of them rated their level of practice on this topic as high. Among the individual items that measured knowledge, 40% of the participants reported a moderate level of knowledge about multiple medications as a risk factor for falls. Fifty percent of the participants reported a low level of practice of referral to other health care professionals, whereas 40% and 41% reported a moderate level of practice on documenting risk factors and treatment plans, respectively. There was no association between age, gender, or years of practice with levels of knowledge or practice. CONCLUSION: This study suggests that physiotherapists in Nigeria have adequate knowledge and practice for fall prevention in older adults. However, there are potential gaps in knowledge of risk factors, documentation, and referrals to other professions that may be addressed through developing context-specific fall-prevention clinical guidelines for practice in Nigeria.

Let's Talk about the Talk: Exploring the Experience of Discussing Student Performance at the Mid- and Final Points of the Clinical Internship.

Purpose: The purpose of this study was to explore the experiences of physiotherapy students and clinical instructors (CIs) when discussing student clinical performance at the mid- and final points of clinical internships. The objectives were to identify why performance assessment discussions are valuable, explore the role of each participant throughout the discussion, identify the challenges associated with these discussions, and explore the effect of the standardized assessment tool on the discussion. Methods: This study used a qualitative descriptive design, consisting of student and CI focus groups in the Greater Toronto Area from January to June 2016. Results: All participants (N=29) recognized the importance of having face-to-face performance assessment discussions in a quiet and private space. Students and CIs agreed that the Canadian Physiotherapy Assessment of Clinical Performance helped to structure and focus the discussions. Valuable discussions occurred when students were open minded and self-reflected on their performance and when CIs were honest and used their expertise to guide learning. Other key features included mutual preparedness, two-way feedback that was constructive and tangible, and a goal-setting process. Students described the emotional component of these discussions as being challenging, and CIs found it difficult when a student took a more passive role in the discussion. Conclusions: Our findings indicate that valuable discussions can provide meaningful feedback, strengthen the student-CI relationship, and engage the learner in an ongoing and cumulative learning process that contributes to professional development.

Objectif : la présente étude visait à explorer les expériences d'étudiants en physiothérapie et de moniteurs cliniques (MC) lors des discussions sur le rendement clinique des étudiants au milieu et à la fin de leur stage clinique. Les objectifs consistaient à déterminer l'intérêt des discussions sur l'évaluation de rendement, à explorer le rôle de chaque participant à la discussion, à cerner les défis associés à ces discussions et à explorer l'effet de l'outil d'évaluation normalisé sur la discussion. Méthodologie : la présente étude faisait appel à une méthodologie descriptive qualitative, composée de groupes de travail d'étudiants et de MC du Grand Toronto entre janvier et juin 2016. Résultats : tous les participants (n=29) ont convenu de l'importance des discussions d'évaluation du rendement en tête à tête, dans un lieu calme et privé. Les étudiants et les MC conviennent également que l'évaluation de rendement clinique de l'Association canadienne de physiothérapie contribuait à structurer et à orienter les discussions. Des discussions intéressantes avaient lieu lorsque les étudiants étaient ouverts et prêts à tenir une autoréflexion sur leur rendement et lorsque les MC étaient honnêtes et utilisaient leurs compétences pour orienter l'apprentissage. Parmi les autres caractéristiques clés, soulignons une préparation mutuelle, des commentaires bidirectionnels constructifs et tangibles et un processus d'établissement d'objectifs. Les étudiants trouvaient les aspects émotifs de ces discussions exigeants, alors que les MC éprouvaient de la difficulté lorsqu'un étudiant adoptait un rôle plus passif dans la discussion. Conclusions : selon nos observations, des discussions intéressantes peuvent favoriser des commentaires significatifs, renforcer la relation entre l'étudiant et le MC et faire participer l'étudiant à un processus d'apprentissage continu et cumulatif qui contribue à son perfectionnement professionnel.

Determining the impact of a new physiotherapist-led primary care model for back pain: protocol for a pilot cluster randomized controlled trial.

BACKGROUND: Back pain is a leading contributor to disability, healthcare costs, and lost work. Family physicians are the most common first point of contact in the healthcare system for people with back pain, but physiotherapists (PTs) may be able to support the primary care team through evidence-based primary care. A cluster randomized trial is needed to determine the clinical, health system, and societal impact of a primary care model that integrates physiotherapists at the first visit for people with back pain. Prior to conducting a future fully powered cluster randomized trial, we need to demonstrate feasibility of the methods. Therefore, the purpose of this pilot study will be to: 1) Determine feasibility of patient recruitment, assessment procedures, and retention. 2) Determine the feasibility of training and implementation of a new PT-led primary care model for low back pain (LBP) 3) Explore the perspectives of patients and healthcare providers (HCPs) related to their experiences and attitudes towards the new service delivery model, barriers/facilitators to implementation, perceived satisfaction, perceived value, and impact on clinic processes and patient outcomes. METHODS: This pilot cluster randomized controlled trial will enroll four sites and randomize them to implement a new PT-led primary care model for back pain or a usual physician-led primary care model. All adults booking a primary care visit for back pain will be invited to participate. Feasibility outcomes will include: recruitment and retention rates, completeness of assessment data, PT training participation and confidence after training, and PT treatment fidelity. Secondary outcomes will include the clinical, health system, cost, and process outcomes planned for the future fully powered cluster trial. Results will be analyzed and reported descriptively and qualitatively. To explore perspectives of both HCPs and patients, we will conduct semi-structured qualitative interviews with patients and focus groups with HCPs from participants in the PT-led primary care sites. DISCUSSION: If this pilot demonstrates feasibility, a fully powered trial will provide evidence that has the potential to transform primary care for back pain. The full trial will inform future service design, whether these models should be more widely implemented, and training agendas. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03320148 . Submitted for registration on 17 September 2017.

Photovoice and Persons With Physical Disabilities: A Scoping Review of the Literature.

Photovoice is a group analysis method often affiliated with participatory action research (PAR). It has become increasingly popular in qualitative research with people with physical disabilities. This article details the results of a study that sought to understand the scope of the literature related to how photovoice is conducted with people with physical disabilities. We performed a scoping review related to use of photovoice in physical disabilities research. We identified 20 articles that featured diverse participants with physical disabilities and demonstrated a range of approaches to data collection, analysis, and dissemination. Nearly all of the articles identified used photovoice to study physical accessibility/navigation of space. Although a majority of selected articles purported to use PAR approaches, many articles demonstrated research that may not be as participatory as presumed. Based on the findings, we provide suggestions for photovoice studies that will ensure full and meaningful participation of members involved.