Physical and occupational therapists' learning needs and preferences for education on functional electrical stimulation: A qualitative descriptive study.

BACKGROUND: Functional electrical stimulation (FES) is an evidence-based intervention that is rarely used by Canadian physical therapists (PTs) and occupational therapists (OTs). A common barrier to FES implementation is a lack of knowledge and training. FES learning resources that meet therapists' learning needs and preferences may address this barrier. OBJECTIVE: To explore OTs' and PTs' perspectives on the utility of FES e-learning resources, including whether the resources met their learning needs and preferences. METHODS: Through this qualitative descriptive study, feedback on FES e-learning resources was solicited from 5 PTs and 18 OTs who work clinically, but do not use FES. Participants reviewed ≥3 prerecorded lectures on FES topics and then completed a semi-structured interview. Participants were asked about the lectures' content, delivery, ease of use and comprehensibility, and were asked to suggest modifications to facilitate self-directed learning about FES. Interviews were analyzed using conventional content analysis. RESULTS: Three themes were identified. (1) Feedback on FES e-learning: the content and delivery of the prerecorded lectures facilitated participants' learning, although opportunities to improve content and delivery were identified. (2) Factors influencing FES learning needs and preferences: Participants identified internal (i.e., baseline knowledge, learning style) and external (i.e., learning with colleagues, practice setting) factors that affected learning. Themes 1 and 2 impacted (3) the effects of FES e-learning: Participants described the outcomes of their FES e-learning, including increases in FES knowledge, confidence, and use in clinical practice. CONCLUSION: Therapists' perceived the FES e-learning resources to be useful and to address their learning needs and preferences.

Continuing Professional Development in Response to COVID-19: Knowledge Mobilization for Occupational Therapy and Physiotherapy via a Curated Web Site.

Purpose: Once the COVID-19 pandemic was declared, clinicians were redeployed to prepare for increased hospitalizations. This disruption necessitated rapid continuing professional development (CPD) resources for health care providers. This mixed-method study explored the experiences of occupational therapists and physiotherapists who accessed a CPD Web site that provided educational resources related to the pandemic to refresh their clinical knowledge and skills. Methods: Faculty from the Michener Institute of Education at the University Health Network and University of Toronto along with 60 collaborators created a Web site to support the need for rapid CPD. An occupational therapist and physiotherapist advisory group informed the evolving design of the occupational therapy and physiotherapy content. Results: In the occupational therapy profession 535 users created an account between April and November 2020 (236 practicing, 283 students, and 16 did not specify) and in the physiotherapy profession 829 created an account (532 practicing, 278 students and 19 did not specify). Each user viewed an average of 53 Web pages. Three themes emerged: (1)To prepare for practice changes, clinicians value a single repository of information; (2) Web site features can either facilitate or hinder access to the needed information; and (3) Participants described diverse learning needs. Conclusions: The Web site design features assisted participants in preparing for redeployment and patient care. Features to encourage self-directed learning, such as the grouping of relevant topics and self-check quizzes, can enhance the user experience.

Objectif: lorsque la pandémie de COVID-19 s'est déclarée, les cliniciens ont été redéployés pour se préparer à une recrudescence d'hospitalisations. Ce bouleversement a exigé la prestation rapide de ressources de perfectionnement professionnel continu (PPC) aux dispensateurs de soins. La présente étude à méthodologie mixte a exploré les expériences des ergothérapeutes et des physiothérapeutes qui ont accédé à un site Web de PPC contenant des ressources de formation liées à la pandémie pour mettre leurs connaissances et habiletés cliniques à niveau. Méthodologie: les professeurs du Michener Institute of Education du Réseau universitaire de santé et de l'Université de Toronto et 60 collaborateurs ont créé un site Web pour répondre au besoin de PPC rapide. Un groupe consultatif d'ergothérapeutes et de physiothérapeutes a éclairé la conception évolutive de la matière en ergothérapie et en physiothérapie. Résultats: En ergothérapie, 535 utilisateurs ont créé un compte entre avril et novembre 2020 (236 en exercice, 283 étudiants et 16 ne l'ont pas précisé) et en physiothérapie, ce chiffre est passé à 829 (532 en exercice, 278 étudiants et 19 ne l'ont pas précisé). Chaque utilisateur a visualisé une moyenne de 53 pages Web. Trois thèmes ont émergé : 1) pour se préparer aux changements de pratique, les cliniciens préfèrent un seul centre d'information; 2) les caractéristiques du site Web peuvent soit faciliter, soit freiner l'accès à l'information nécessaire et 3) les participants ont décrit des besoins d'apprentissage diversifiés. Conclusions: les caractéristiques de conception du site Web ont aidé les participants à se préparer au redéploiement et aux soins des patients. Des caractéristiques visant à encourager l'apprentissage autonome, comme le regroupement des sujets pertinents et les questionnaires d'autoévaluation, peuvent optimiser l'expérience de l'utilisateur.

The 3D muscle morphology and intramuscular innervation of the digital bellies of flexor digitorum profundus: Clinical implications for botulinum toxin injection sites.

Spasticity of flexor digitorum profundus is frequently managed with botulinum toxin injections. Knowledge of the 3D morphology and intramuscular innervation of the digital bellies of flexor digitorum profundus is necessary to optimize the injections. The purpose of this study was to digitize and model in 3D the contractile and connective tissue elements of flexor digitorum profundus to determine muscle morphology, model and map the intramuscular innervation and propose sites for botulinum toxin injection. Fiber bundles (FBs)/aponeuroses and intramuscular nerve branches were dissected and digitized in 12 formalin embalmed cadaveric specimens. Cartesian coordinate data were reconstructed into 3D models as in situ to visualize and compare the muscle morphology and intramuscular innervation patterns of the bellies of flexor digitorum profundus. The 3rd, 4th and 5th digital bellies were superficial to the 2nd digital belly and located adjacent to each other in all specimens. Each digital belly had distinct intramuscular innervation patterns. The 2nd digital belly received intramuscular branches from the anterior interosseus nerve (AIN). The superior half of the 3rd digital belly was innervated intramuscularly by the ulnar nerve (n = 4) or by both the anterior interosseus and ulnar nerves (n = 1). The inferior half of the belly received dual innervation from the anterior interosseus and ulnar nerves in 2 specimens, or exclusively from the AIN (n = 2) or the ulnar nerve (n = 1). The 4th digital belly was innervated by intramuscular branches of the ulnar nerve. One main branch, after coursing through the 4th digital belly, entered the lateral aspect of the 5th digital belly and arborized intramuscularly. The morphology of the FBs, aponeuroses and intramuscular innervation of the digital bellies of FDP were mapped and modelled volumetrically in 3D as in situ. Previous studies were not volumetric nor identified the course of the intramuscular nerve branches within each digital belly. Based on the intramuscular innervation of each of the digital bellies, one possible optimized botulinum toxin injection location was proposed. This injection location, at the junction of the superior and middle thirds of the forearm, would be located in dense nerve terminal zones of the anterior interosseus and ulnar nerves. Future anatomical and clinical investigations are necessary to evaluate the efficacy of these anatomical findings in the management of spasticity.

Reliability and Validity of Shoulder and Handgrip Strength Testing.

Purpose: This study aimed to estimate the intra- and inter-rater reliability of the JTECH computerized, wireless apparatus and its validity (compared to established devices) for measurements of maximal shoulder isometric strength and handgrip strength among healthy adults with no shoulder pathology. Methods: Twenty healthy young adults had shoulder strength tested with JTECH and Micro-FET2 hand-held dynamometers, and the handgrip strength was tested using JTECH and Jamar handgrip dynamometers. Assessments were performed by the same rater to determine intra-rater reliability and convergent validity, at least two days apart, while on a third visit, the other rater performed measures to determine inter-rater reliability. Results: The JTECH computerized, wireless devices demonstrated good to excellent intra-rater reliability (ICCs (2,1) = 0.78-0.97) and inter-rater reliability for strength measures (ICCs (2,1) = 0.76-0.95). The JTECH computerized device compared to the Micro-FET2 hand-held dynamometer showed substantial concurrent validity for shoulder flexion (R2 = 0.87), extension (R2 = 0.87), abduction (R2 = 0.88), and adduction (R2 = 0.85). Substantial concurrent validity was shown for the JTECH computerized device and Jamar handgrip dynamometers (R2 = 0.92). Conclusions: The JTECH computerized, wireless devices demonstrated high intra- and inter-rater reliability and substantial concurrent validity for shoulder isometric strength and handgrip strength in healthy adults.

Objectif : évaluer la fiabilité intraévaluateur et interévaluateur et la validité (par rapport à des appareils éprouvés) du dispositif informatisé sans fil JTECH pour mesurer la force isométrique de l'épaule et la force de préhension maximales chez des adultes en santé sans pathologie de l'épaule. Méthodologie : vingt jeunes adultes en bonne santé ont fait vérifier la force de leur épaule à l'aide des dynamomètres manuels JTECH et Micro-FET2, et leur force de préhension à l'aide des dynamomètres à poignée JTECH et Jamar. Le même évaluateur a procédé aux évaluations pour déterminer la fiabilité intraévaluateur et la validité convergente, à au moins deux jours d'intervalle, tandis qu'à un troisième rendez-vous, l'autre évaluateur a effectué des mesures pour établir la fiabilité interévaluateur. Résultats : les dispositifs informatisés sans fil JTECH possèdent une fiabilité intraévaluateur (coefficient de corrélation intraclasse, ou CCI [2,1] = 0,78 à 0,97) et une fiabilité interévaluateur pour mesurer la force (CCI [2,1] = 0,76 à 0,95) bonnes à excellentes. Par rapport au dynamomètre manuel Micro-FET2, le dispositif informatisé sans fil JTECH a démontré une validité convergente importante à l'égard de la flexion (R2 = 0,87), de l'extension (R2 = 0,87), de l'abduction (R2 = 0,88) et de l'adduction (R2 = 0,85) de l'épaule. Le dispositif informatisé JTECH et le dynamomètre manuel Jamar ont également démontré une validité convergente importante (R2 = 0,92). Conclusions : les dispositifs informatisés sans fil JTECH ont démontré une fiabilité intraévaluateur et interévaluateur élevée et une validité convergente importante pour la force isométrique de l'épaule et la force de préhension chez des adultes en santé.

Intramuscular aponeuroses and fiber bundle morphology of the five bellies of flexor digitorum superficialis: A three-dimensional modeling study.

Restoring balanced function of the five bellies of flexor digitorum superficialis (FDS) following injury requires knowledge of the muscle architecture and the arrangement of the contractile and connective tissue elements. No three-dimensional (3D) studies of FDS architecture were found in the literature. The purpose was to (1) digitize/model in 3D the contractile/connective tissue elements of FDS, (2) quantify/compare architectural parameters of the bellies and (3) assess functional implications. The fiber bundles (FBs)/aponeuroses of the bellies of FDS were dissected and digitized (MicroScribe® Digitizer) in 10 embalmed specimens. Data were used to construct 3D models of FDS to determine/compare the morphology of each digital belly and quantify architectural parameters to assess functional implications. FDS consists of five morphologically and architecturally distinct bellies, a proximal belly, and four digital bellies. FBs of each belly have unique attachment sites to one or more of the three aponeuroses (proximal/distal/median). The proximal belly is connected through the median aponeurosis to the bellies of the second and fifth digits. The third belly exhibited the longest mean FB length (72.84 ± 16.26 mm) and the proximal belly the shortest (30.49 ± 6.45 mm). The third belly also had the greatest mean physiological cross-sectional area, followed by proximal/second/fourth/fifth. Each belly was found to have distinct excursion and force-generating capabilities based on their 3D morphology and architectural parameters. Results of this study provide the basis for the development of in vivo ultrasound protocols to study activation patterns of FDS during functional activities in normal and pathologic states.

What is 'disability'? Exploring the conceptions of internationally educated learners in a Canadian physical therapy bridging program.

BACKGROUND: Physiotherapists' understanding of disability has direct relevance for their practices and work with disabled people. PURPOSE: To explore how physiotherapists from diverse backgrounds, cultures and social locations conceptualize disability. Understanding their conceptualizations will provide insight to determine future directions regarding disability education, in healthcare education, to optimize the quality of care and life for individuals with disabilities. METHODS: Six internationally educated physiotherapists enrolled in a Canadian physical therapy bridging program were interviewed and data were analyzed for themes. RESULTS: Participants' conceptualizations of disability were complex and a dynamic process that reflected what was 'thinkable' in relation to experience, such as with social location and in personal, professional and educational domains. This primary theme was reflected in three subthemes: 1) Professional PT acculturation shaped disability conceptualization in particular ways; 2) Medical model as the dominant way of thinking; and 3) Social model thinking was more feasible in resource rich contexts. CONCLUSION: These results reinforce the benefits of a wide exposure to different ways of conceptualizing and addressing disability within PT education to counter the dominance of the medical model and reinforce the importance of advocacy and allyship with disabled people.

Development and Initial Evaluation of Psychometric Properties of a Pain Competence Assessment Tool (PCAT).

Competency-based education is now considered the best approach for pain educational programs provided for pre and postgraduate healthcare providers (HCPs). To demonstrate learners' progression, an assessment tool that aligns with this educational approach and targets different HCPs is needed. A Pain Competence Assessment Tool (PCAT) was developed based on the pain management core competencies that align with the International Association for the Study of Pain interprofessional pain curriculum. The PCAT is an online competency-based assessment tool for HCPs that consists of 5 case scenarios followed by 17 key-feature questions. HCPs and trainees completed the PCAT through a series of studies to assess its psychometric properties. The preliminary evaluation suggested that the PCAT had adequate content validity. Apart from 6 questions, the PCAT questions demonstrated homogeneity and acceptable reliability, and substantial stability. No ceiling or floor effect was found. A significant difference was detected between the HCPs' and trainees' scores. The PCAT scores strongly correlated with other variables reflecting different competence levels. The PCAT scores showed significant changes in the baseline scores compared to scores after attending an educational intervention. The PCAT offers a first-of-its-kind tool for assessing HCPs' competence (ie, knowledge and its application) in managing chronic pain. Future research is needed for further validation and adaptation of the PCAT. PERSPECTIVE: The Pain Competence Assessment Tool (PCAT) offers a first-of-its-kind tool for assessing clinicians' core competencies that overlap between different professions and support the clinicians' capacity to successfully manage chronic pain in the real world focusing on the patient-centered perspective rather than the profession-specific perspective.

Overview of Innervation of Shoulder and Acromioclavicular Joints.

Detailed understanding of the course and location of articular nerves supplying the shoulder joint is paramount to the successful utilization of image-guided radiofrequency ablation to manage chronic shoulder pain. In this article, the origin, course, and relationship to anatomic landmarks of articular nerves supplying the shoulder and acromioclavicular joints are discussed. The shoulder joint capsule was consistently reported to receive innervation from multiple sources including the suprascapular, axillary, subscapular, and lateral pectoral nerves. The acromioclavicular joint received innervation from suprascapular and lateral pectoral nerves. The consistent relationship of articular branches to anatomic landmarks provides the basis for specific image-guided targeting.

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.

Simulation Experiences in Canadian Physiotherapy Programmes: A Description of Current Practices.

Purpose: Although health care professional education programmes around the world are increasingly using sophisticated simulation technology, the scope of simulation use in Canadian physiotherapy programmes is currently undefined. The current study explores the definitions of simulation, its current use, and the perceived benefits and barriers in Canadian entry-to-practice physiotherapy programmes. Method: Using a qualitative, descriptive study approach, we contacted Canadian physiotherapy programmes to identify faculty members with simulation experience. Using a semi-structured interview format, we asked participants to discuss their perspectives of simulation in their physiotherapy programmes. Interviews were audio recorded, transcribed, and analyzed for themes. Results: Of 13 eligible Canadian physiotherapy programmes, participants from 8 were interviewed. The interviews revealed three major themes: (1) variability in the definition of fidelity in simulation, (2) variability in simulation use, and (3) the benefits of and barriers to the use of simulation. Conclusions: Variability in the definition of fidelity in simulation among Canadian physiotherapy programmes is consistent with the current literature, highlighting a spectrum of complexity from low fidelity to high fidelity. Physiotherapy programmes are using a variety of simulations, with the aim of creating a bridge from theoretical knowledge to clinical practice. This study describes the starting point for characterizing simulation implementation in Canadian physiotherapy programmes and reflects the diversity that exists across the country.

Objectif : autour du monde, les programmes de formation des professionnels de la santé font de plus en plus appel à une technologie de simulation raffinée. On ne connaît pas l'ampleur de l'utilisation de la simulation dans les programmes canadiens de physiothérapie. La présente étude porte sur les définitions de la simulation, son utilisation actuelle et les avantages et obstacles perçus à son utilisation dans les programmes canadiens de physiothérapie de base. Méthodologie : les chercheurs ont utilisé une approche descriptive et qualitative. Ils ont pris contact avec les programmes canadiens de physiothérapie pour savoir quels professeurs avaient de l'expérience en simulation. Au moyen d'entrevues semi-structurées, ils ont demandé aux participants de parler de leurs perspectives de la simulation au sein de leurs programmes de physiothérapie. Ils ont enregistré les entrevues sur bande sonore, les ont transcrites et analysées pour en dégager les thèmes. Résultats : au sein des treize programmes canadiens de physiothérapie admissibles, les participants de huit d'entre eux ont été interviewés. Les entrevues ont fait ressortir trois thèmes majeurs : 1) la variabilité de la définition de fidélité de la simulation, 2) la variabilité dans l'utilisation de la simulation et 3) les bienfaits et les obstacles liés à l'utilisation de la simulation. Conclusions : la variabilité de la définition de fidélité de la simulation dans les programmes canadiens de physiothérapie correspond aux constatations des publications actuelles, ce qui fait ressortir un spectre de complexité qui passe de la faible fidélité à la haute fidélité. Les programmes de physiothérapie font appel à diverses simulations afin de créer un pont entre les connaissances théoriques et la pratique clinique. La présente étude décrit le point de départ pour caractériser l'adoption de la simulation dans les programmes canadiens de la physiothérapie et reflète la diversité au pays.

Clinical Instructors' Perspectives on the Clinical Education of Internationally Educated Physical Therapists: Diversity's Impact on the Experience.

Purpose: The aim of this study was to understand the nature and extent of clinical instructors' (CIs') involvement in the clinical education of internationally educated physical therapists (IEPTs) while exploring CIs' perceptions of the similarities among and differences between IEPTs and Canadian-trained students. Method: In this qualitative descriptive study, 13 semi-structured interviews were conducted with CIs who were involved in a bridging programme for IEPTs. Data were coded using NVivo version 10, and common themes emerged through qualitative thematic analysis. Results: The majority of CIs perceived IEPTs' backgrounds to be diverse as a result of their varied previous clinical experience, physiotherapy scope of practice, and life stressors. Their diverse backgrounds contributed to the similarities and differences found in their skills, their personal motivation, and the education process, leading to successes and challenges in the clinical environment. Conclusions: Differences between IEPTs and Canadian-trained students stem from IEPTs' diverse backgrounds. Recognizing this diversity while demonstrating cultural competence will promote a successful clinical experience for both IEPT learners and CIs, which will ultimately facilitate the integration of IEPTs into the Canadian health care system.

Objectif : comprendre la nature et la portée de la participation des enseignants cliniques (EC) à la qualification clinique des physiothérapeutes formés à l'étranger (PTFÉ) tout en examinant leurs perceptions des similarités et des différences entre leur formation et celle des étudiants canadiens. Méthodologie : dans la présente étude descriptive et qualitative, les chercheurs ont effectué 13 entrevues semi-structurées auprès d'EC qui participaient à un programme de qualification destiné aux PTFÉ. Ils ont codé les données au moyen de la version 10 de NVivo et regroupé les thèmes communs à l'aide d'une analyse thématique qualitative. Résultats : la majorité des EC trouvaient le parcours des PTFÉ diversifié en raison de l'hétérogénéité de leurs expériences cliniques antérieures, de la portée de leur pratique et des éléments stressants de la vie. La diversité de ces parcours contribuait à des similarités et à des différences sur le plan des compétences, de la motivation personnelle et du processus de qualification, qui s'associaient à des réussites et des difficultés en milieu clinique. Conclusions : les différences entre les PTFÉ et les étudiants formés au Canada proviennent de l'hétérogénéité des parcours des PTFÉ. La prise de conscience de cette diversité, conjuguée à la compétence culturelle, favorisera une expérience clinique positive, tant pour les PTFÉ que pour les EC. Au bout du compte, elle facilitera l'intégration des PFTÉ au système de santé canadien.

Hand-arm vibration syndrome: Workers' experience with functional impairment and disability.

STUDY DESIGN: Qualitative and descriptive study. INTRODUCTION: Hand-arm vibration syndrome (HAVS) is a prevalent disease in Canada. There is little work on the perspectives of HAVS patients. PURPOSE OF THE STUDY: Explore perceptions of disability and functional compromise in patients with HAVS. METHODS: Semi-structured telephone interviews were conducted with HAVS patients and analysed using content analysis. RESULTS: The 11 participants reported numbness, pain, and reduced dexterity, strength, and sensation. Participants noted that HAVS was an inevitable aspect of their work. They indicated frustration with their condition and viewed it as a disability. To overcome impairments risky strategies are often used. Participants reported lack of support to manage symptoms and overcome work disability. DISCUSSION: HAVS related impairment is disabling. Workers require improved resources and support to address symptom management and safe strategies to minimize work disability. CONCLUSION: HAVS patients experience functional, social, emotional, and psychological disability. LEVEL OF EVIDENCE: Not applicable.

Glove Use and Glove Education in Workers with Hand Dermatitis.

BACKGROUND: Occupational skin diseases are common. The occurrence of occupational skin diseases represents a failure of primary prevention strategies that may include the use of personal protective equipment, most commonly gloves. OBJECTIVE: The objective of this study was to describe current glove use and education practices related to gloves in workers being assessed for possible work-related hand dermatitis. METHODS: Participants included consecutive patients being assessed for possible work-related hand dermatitis. A self-administered questionnaire obtained information on demographics, workplace characteristics and exposures, glove use, and education regarding gloves. RESULTS: Ninety percent of the 105 participants reported using gloves. Only 44% had received training related to glove use in the workplace. Major gaps in training content included skin care when using gloves, warning signs of skin problems, and glove size. If the worker indicated no glove training received, the majority reported they would have used gloves if such training was provided. CONCLUSIONS: Although the majority of workers being assessed wore gloves, the minority had received training related to glove use. Particular gaps in training content were identified. Those who had not received training noted they would likely have used gloves if training had been provided.

An Innovative Program to Support Internationally Educated Health Professionals and Their Instructors: Role of the Clinical Practice Facilitator.

INTRODUCTION: Internationally educated health professionals immigrating to other countries may experience difficulty in clinical practice, due to linguistic and cultural factors. An important element of bridging is the opportunity for internationally educated health professionals to practice in a clinical environment. To support these health professionals and their clinical instructors, a Clinical Practice Facilitator (CPF) role was created. This study aimed to examine the CPF from internationally educated health professionals and clinical instructors' perspective. METHODS: A quantitative survey was conducted with two cohorts (2013 and 2015) of internationally educated physical therapists and clinical instructors who were asked about the nature of interaction with CPFs, mentor, and education roles and the benefits and challenges of the role. RESULTS: Thirty-five internationally educated physical therapists and 37 clinical instructors participated and were satisfied with the interaction with CPFs via face-to-face or e-mail communication. There was strong agreement (>80%) that the CPF educator role was to facilitate learner's reflection on clinical practice while the mentor role (>70%) was to answer questions, provide feedback, and investigate clinical concerns and conflicts. There was insufficient time for access to CPFs and resolution of learners' learning needs. There were differences (P = 0.04) in perspective on the benefit of the CPF in assisting with cultural differences. DISCUSSION: An innovative CPF role provided support encouragement, clinical, and professional advice. There were discordant views regarding the benefits of the CPF role in addressing cultural issues, which requires further examination.

Attitudes toward Adults with Intellectual Disability: A Survey of Ontario Occupational and Physical Therapy Students.

PURPOSE: To examine attitudes of students in Ontario master's degree programmes in occupational therapy (MScOT) and physical therapy (MScPT) toward adults with intellectual disability (ID). METHODS: A quantitative cross-sectional survey study was conducted. An electronic questionnaire was distributed to 1,255 MScOT/PT students at five Ontario universities via email, using a modified Dillman approach. Descriptive statistics were used to describe experiences, attitudes, willingness, and preparedness. RESULTS: Overall response rate was 17.9%. A total of 96.0% of respondents felt "quite" or "very willing" to deliver rehabilitation to adults with ID; however, 50.7% of respondents felt "not at all prepared" or "a little prepared" to interact with this population in a clinical setting. Of those who felt unprepared, 75.4% reported it to be due to inadequate knowledge. In addition, Ontario MScOT/PT students have neutral attitudes toward adults with ID. CONCLUSIONS: While many MScOT/PT students are willing to deliver rehabilitation to adults with ID, a large proportion do not feel adequately prepared to interact with this population in a clinical setting. These findings could inform future research and curricular reform in the rehabilitation professions so that future clinicians are better prepared to provide support for this population.

Objectif : Analyser les attitudes des étudiants des programmes de maîtrise en ergothérapie (MScOT) et en physiothérapie (MScPT) face aux adultes qui ont une déficience intellectuelle (DI). Méthodes : Dans le cadre d'une étude transversale quantitative, on a distribué par courriel un questionnaire électronique à 1 255 étudiants à la MScOT/PT de cinq universités de l'Ontario en suivant une stratégie Dillman modifiée. On a utilisé des statistiques descriptives pour décrire les expériences, les attitudes, la volonté et la préparation. Résultats : Le taux de réponse global s'est établi à 17,9 %. Au total, 96,0 % des répondants se sentaient « assez ¼ ou « très disposés ¼ à fournir des services de réadaptation aux adultes ayant une DI, mais 50,7 % des répondants ne se sentaient « pas préparés du tout ¼ ou « un peu préparés ¼ à interagir avec cette population en contexte clinique. Parmi ceux qui ne se sentaient pas préparés, 75,4 % ont déclaré que c'était attribuable à un manque de connaissances. En outre, les étudiants à la MScOT/PT de l'Ontario ont des attitudes neutres à l'égard des adultes qui ont une DI. Conclusions : Même si beaucoup d'étudiants à la MScOT/PT sont prêts à fournir des services de réadaptation aux adultes qui ont une DI, un pourcentage important d'entre eux ne se sent pas bien préparé pour interagir avec cette population en contexte clinique. Ces constatations pourraient éclairer des recherches futures et une réforme du cursus des professions de la réadaptation afin que les futurs cliniciens soient mieux préparés à aider cette population.

Hand and upper extremity function in workers with hand dermatitis.

BACKGROUND: Traditional methods of assessing impairment associated with skin conditions focus on clinical severity, medication usage, activities of daily living, and quality of life. Assessment of function and ability to work may provide important additional information when determining readiness to work. OBJECTIVES: The objective was to gain an understanding of the functional impairment of the hand and upper extremity associated with hand dermatitis and the impact of hand dermatitis on quality of life, work instability, and productivity. METHODS: Sixty-two patients with suspected contact dermatitis of the hands participated in physical and functional assessments of the upper extremity and patient-reported questionnaires including Dermatology Life Quality Index, Short Form 36 Health Survey, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Work Instability Scale, and Work Limitations Questionnaire. RESULTS: Numbness and finger joint restrictions were moderate to severe in 29% and 30% of the workers, respectively. Positive Tinel and/or Phalen signs occurred in 25%. Forty-eight percent reported moderate-to-high work instability, and 31% reported a greater than 10% decrease in work productivity. Thirty-five percent missed work in the past year, 19% were doing a different job, and 9% were not working. CONCLUSIONS: Patients with hand dermatitis demonstrate significant functional compromise of the hand and a decrease in ability to work.

Upper extremity disability in workers with hand-arm vibration syndrome.

BACKGROUND: Hand-arm vibration syndrome (HAVS) is a common occupational problem and it is important to understand the disability associated with this condition. AIMS: To measure upper extremity disability using the disabilities of the arm, shoulder and hand (DASH) questionnaire in workers with HAVS and to determine how this disability is affected by the vascular and neurological components of HAVS and other factors, in particular musculoskeletal variables. METHODS: Subjects were recruited from HAVS patients assessed at St Michael's Hospital, Toronto, Canada, over a 2-year period. All participants were assessed by an occupational medicine specialist to determine the specific components of HAVS and musculoskeletal variables including upper extremity pain score measured by the Borg scale. The DASH questionnaire was completed on the same day as the clinical assessment and before any feedback had been given about the clinical findings. RESULTS: A total of 141 workers with HAVS were recruited and 139 agreed to participate in the study. This study group had a statistically significantly higher mean DASH score than the US population (P < 0.001). The multiple linear regression analysis indicated that upper extremity pain score (P < 0.001), the Stockholm sensorineural scale (P < 0.01) and the number of fingers blanching (P < 0.05) had a statistically significant association with an increase in the DASH score. The highest partial R(2) value was for the upper extremity pain score. CONCLUSIONS: Workers with HAVS have significant upper extremity disability and musculoskeletal factors appear to make an important contribution to this disability.

Clinical specialists and advanced practitioners in physical therapy: a survey of physical therapists and employers of physical therapists in ontario, Canada.

PURPOSE: Opportunities to expand the role of physical therapists (PTs) have evolved to include clinical specialists and advanced practitioners, although the literature on these roles is limited. We examined perceptions of PTs and PT employers in Ontario regarding clinical specialization and advanced practice. METHODS: Using a modified Dillman approach, a cross-sectional survey was conducted with 500 PTs and 500 PT employers in Ontario. Questionnaires were tailored to address specific issues related to each cohort. RESULTS: Sixty percent of PTs and 53% of PT employers responded to the survey. Thirty-three percent of PT respondents already considered themselves "clinical specialists" (CS), and 8% considered themselves "advanced practitioners" (AP), although neither role is yet formally recognized in Canada. Both groups had substantial interest in pursuing formal recognition of CS and AP status. Respondents indicated that their primary motivation to pursue such roles was to enhance clinical reasoning skills with the goal of improving client outcomes (82% for the role of CS, 71% for the role of AP). Respondents supported the involvement of academic institutions in the process (60% for CS, 70% for AP). CONCLUSION: PTs and PT employers are supportive of the roles of the CS and AP within the profession, even though there is currently no formal recognition of either role in Canada.