Integration of behavioral medicine competencies into physiotherapy curriculum in an exemplary Swedish program: rationale, process, and review.

In 2004, Mälardalen University, Sweden, introduced a new undergraduate entry-level physiotherapy program. Program developers constructed the curriculum with behavioral medicine content that reflected the contemporary definition and values of the physiotherapy profession aligning it with current best practices, evidence, and the International Classification of Functioning, Disability, and Health (ICF). The new curriculum conceptualized movement and function as modifiable behaviors in that they reflect behavioral contingencies, perceptions, beliefs, and lifestyle factors as well as pathophysiology and environmental factors. The purpose of this article is to describe how one university accordingly structured its new curriculum and its review. We describe the rationale for the curriculum's behavioral medicine content and competencies, its development and implementation, challenges, long-term outcomes, and its related research enterprise. We conclude that physiotherapy practiced by our graduates augments that taught in other programs based on accreditation reviews. With their expanded practice scope, graduates are systematically practicing within the constructs of health and function conceptualized within the ICF. Our intent in sharing our experience is to exemplify one university's initiative to best prepare students with respect to maximizing physiotherapy outcomes as well as establish a dialogue regarding minimum standards of behavioral medicine competencies in physiotherapy education and practice.

Physiotherapy: How to work with evidence in daily practice.

RATIONALE, AIMS, AND OBJECTIVES: The concept of evidence-based health care has gained increasing currency over the past decades; however, questions persist regarding how to overcome the gap between research and health care practice. The question arises whether this gap derives from a true knowledge deficit or from physiotherapists' perception of working with evidence. The aim of the current study was to illuminate changes to the meaning of working with evidence experienced by a cohort of physiotherapists following an education program. METHODS: A phenomenological hermeneutic design with open-ended group interviews was carried out with physiotherapists who had participated in an education program about evidence and how to implement evidence-based practice (EBP) in day-to-day practice. FINDINGS: The interviews provided descriptions of working with evidence according to three major themes: "Confidence with the concept of evidence in relation to a way of working"; "Experience of EBP as a duty to seek evidence for individual patients"; and "EBP experienced as an integrated and patient-oriented activity". CONCLUSIONS: The physiotherapists' lived experiences demonstrated that the participants' perception of the concept of evidence mainly concerned a broadening of the definition of evidence, and this altered perception of evidence could interpreted as the physiotherapists viewing EBP as a more integrated and patient-oriented activity than before.

Neurologists dealing with sickness certification: Experiences of problems and need of competence.

Rationale and Aims: Most studies on physicians' sickness certification practices include general practitioners (GP) while there hardly is any knowledge on this regarding neurologists although neurological diseases often involve work incapacity and need of sick leave. Aim: The aim was to describe experiences among neurologists in Sweden concerning their work with sickness certification of patients. Method: A cross-sectional study of 265 neurologists' responses in a nationwide survey regarding their work with sickness certification of patients was conducted. Results: The majority (81.5%) had sickness certification consultations at least once a week and a third experienced problems every week in handling sickness certification. Among the 251 who at least sometimes had sickness certification consultations, the following two aspects were experienced as very or fairly problematic: "assess the degree to which the reduced functional capacity limits a patient's capacity to perform his/her work assignments" (67.3%) and "make a long-term prognosis about the future work capacity of patients on sick leave" (60.5%). At least once a week, 78.7% experienced lack of time regarding managing patient-related aspects of the sickness certification task. Moreover, 21.8% considered sickness certification to be a work environmental problem, at least once a week. In all, 84% stated that they had a large or fairly large need for more competence concerning sickness certification tasks. Conclusions: Sickness certification is a common task among neurologists, involving several problematic aspects related to, e.g., lack of competence in assessing function and work capacity and of time. There is a need for improvement.

The diverging perception among physiotherapists of how to work with the concept of evidence: a phenomenographic analysis.

RATIONALE, AIMS AND OBJECTIVES: Changes in Sweden's municipal care have impacted the situation of physiotherapists by the adoption of practice based on research evidence. Even if physiotherapists appear to be in favour of the idea of evidence-based practice, barriers still exist that prevent many from keeping up with current research. The aim of this study was to identify and describe the different ways in which physiotherapists in municipal care perceive the concept of evidence in rehabilitation. METHODS: A phenomenographic design with semi-structured interviews was carried out with physiotherapists working with frail older people in three municipal care units in two neighbouring municipalities in Sweden. The physiotherapists' perceptions of evidence were explored in 12 interviews. RESULTS: Distinct perceptions of the concept of evidence are identified in three categories: 'Confidence with the concept of evidence in relation to measurement instruments'; 'Perception of evidence-based practice as a duty, condition and demand of the profession'; and 'Evidence-based work as a separate rather than directly patient-oriented activity'. CONCLUSIONS: Physiotherapists take full responsibility to comply with what they perceive to be the demands of their profession. However, what evidence actually meant, and therefore what the practical element of this responsibility consisted of, was not as clear.

Aspects of nursing with evidence-base when nursing frail older adults: a phenomenographic analysis of interviews with nurses in municipal care.

INTRODUCTION: In earlier research as well as in political discussion and documents, the topic of evidence has been highlighted as one of the most important concerns in nursing care. This study focuses on understanding what lies behind nurses' ways of acting regarding evidence-based nursing through an illumination of the way they perceive the phenomena. AIM: The aim was to identify and describe the different ways municipal care nurses perceive aspects of working with evidence when nursing frail older adults. METHODS: An explorative design with a phenomenographic approach based on interviews with nurses working with home-based care within the municipality was used in order to gain understanding of nurse's perceptions of the phenomena. RESULTS: Findings revealed that the nurses perceived a variety of aspects when working with evidence when nursing frail older people. Aspects with a spectra of different perceptions shown in the analysis were as follows: Evidence-based nursing as a desired intention/mission, lack of practical supporting structures to apply evidence, lack of confidence in own capacity to apply evidence and a belief that it will work anyway. CONCLUSIONS: Findings reveal that it is a challenge to implement research both on an individual as well as on an organisational level. Understanding the contextual perceptions of evidence by nurses can cast light on the barriers as well as the prerequisites of working with evidence while caring for frail older adults in municipal care.