Primary care occupational, physical, and respiratory therapy role adaptation in the first year of the COVID-19 pandemic.

BACKGROUND: Occupational, physical and respiratory therapists are relatively new to primary care settings, and thus their roles are still emerging. The COVID-19 pandemic was a time of abrupt changes in professional roles. Professional role adaptations are integral to the ability of health care teams to respond to day-to-day care delivery challenges, such as the current physician and nurse shortage, as well as disaster situations. This study explored the role adaptation of occupational, physical, and respiratory therapists in Canadian primary care settings throughout the first year of the COVID-19 pandemic, as well as barriers and facilitators to adaptation. METHODS: This longitudinal interpretative descriptive study purposively sampled primary care occupational, physical, and respiratory therapists from two Canadian provinces (Manitoba and Ontario). We asked participants to prepare at least 10 semi-structured audio-diary entries during a 12-week period (April - Oct 2020), followed by two semi-structured interviews (Dec 2020, Apr 2021). Questions focused on changes happening in their practice over time. Analysis was iterative, including developing a individual summaries and coding data using both inductive and pre-determined codes. We then entered an immersion/crystallization process to develop key themes related to role adaptation. RESULTS: We represent our findings with the metaphor of the game of Role Adaptation Snakes and Ladders (aka Chutes and Ladders). The pandemic was certainly not a game, but this metaphor represents the tension of being a pawn to circumstance while also being expected to take control of one's professional and personal life during a disaster. The object of the game is to move through three phases of role adaptation, from Disorienting, through Coping and Waiting, to Adapting. In the Adapting phase, the therapists creatively found ways to provide vital services for the pandemic response. The therapists were influenced both negatively and positively (snakes and ladders) by their personal circumstances, and professional meso and macro contexts. Each therapist moved across the board in a unique trajectory and timeline based on these contexts. CONCLUSIONS: Rehabilitation professionals, with adequate meso and macro system supports, can maximize their role on primary care teams by adapting their services to work to their full scope of practice.

Strategies to Increase Access to Outpatient Physiotherapy Services: A Scoping Review.

Purpose: Multiple Canadian jurisdictions have curtailed public funding for outpatient physiotherapy services, impacting access and potentially creating or worsening inequities in access. We sought to identify evaluated organizational strategies that aimed to improve access to physiotherapy services for community-dwelling persons. Method: We used Arksey and O'Malley's scoping review methods, including a systematic search of CINAHL, MEDLINE, and Embase for relevant peer-reviewed texts published in English, French, or German, and we performed a qualitative content analysis of included articles. Results: Fifty-one peer-reviewed articles met inclusion criteria. Most studies of interventions or system changes to improve access took place in the United Kingdom (17), the United States (12), Australia (9), and Canada (8). Twenty-nine studies aimed to improve access for patients with musculoskeletal conditions; only five studies examined interventions to improve equitable access for underserved populations. The most common interventions and system changes studied were expanded physiotherapy roles, direct access, rapid access systems, telerehabilitation, and new community settings. Conclusions: Studies evaluating interventions and health system changes to improve access to physiotherapy services have been limited in focus, and most have neglected to address inequities in access. To improve equitable access to physiotherapy services in Canada, physiotherapy providers in local settings can implement and evaluate transferable patient-centred access strategies, particularly telerehabilitation and primary care integration.

Objectif : de multiples régions sociosanitaires canadiennes ont limité le financement des services de physiothérapie ambulatoires, ce qui a des conséquences sur l'accès et qui risque de créer ou d'aggraver les inégalités en matière d'accès. Les chercheurs ont cherché à définir les stratégies organisationnelles évaluées afin d'améliorer l'accès aux services de physiothérapie pour les personnes qui vivent dans la communauté. Méthodologie : les chercheurs ont utilisé les méthodologies d'étude de portée, y compris des recherches systématiques dans les bases de données CINAHL, MEDLINE et Embase pour en extraire les textes révisés par un comité de lecture publiés en anglais, en français ou en allemand, et ont effectué une analyse qualitative du contenu des articles extraits. Résultats : au total, 51 articles révisés par un comité de lecture respectaient les critères d'inclusion. La plupart des études sur les interventions ou les changements systémiques visant à améliorer l'accès ont été réalisées au Royaume-Uni (17), aux États-Unis (12), en Australie (9) et au Canada (8). Ainsi, 29 études ont visé à améliorer l'accès aux patients atteints d'affections musculosquelettiques; seulement cinq ont porté sur des interventions pour améliorer l'accès équitable aux populations mal desservies. Les interventions et les changements systémiques les plus courants étudiés dans le présent article ont entraîné un élargissement des rôles physiothérapiques, des systèmes d'accès direct, de la téléréadaptation et de nouveaux milieux communautaires. Conclusions :les études sur les interventions et les changements aux systèmes de santé pour améliorer l'accès aux services physiothérapiques ont eu une portée limitée, et la plupart ont négligé d'aborder les inégalités en matière d'accès. Pour améliorer un accès équitable aux services physiothérapiques au Canada, les dispensateurs de soins physiothérapiques locaux peuvent adopter et évaluer des stratégies d'accès transférables axées sur les patients, notamment la téléréadaptation et l'intégration des soins de première ligne.