Validez de contenido de un ECOE en el pregrado de fisioterapia para el razonamiento clínico / Validity of content of a ECOE in the physiotherapy undergraduate for clinical reasoning

Introducción: El Examen Clínico Objetivo Estructurado (ECOE) es una metodología de evaluación que permite medir de manera válida las competencias clínicas en estudiantes de fisioterapia a través de estaciones previamente estandarizadas. Objetivo: Determinar la validez de contenido del instrumento ECOE-LM 2017 para la medición de competencias clínicas en el examen, evaluación, diagnóstico, pronóstico e intervención de una persona con lumbalgia mecánica en fisioterapia. Métodos: Se diseñó un instrumento de seis estaciones evaluado con la técnica de juicio de expertos, para posteriormente calcular la confiabilidad interobservador a través de Fleiss’ Kappa, por medio del ReCal; adicionalmente se identificó el índice de aceptabilidad. Resultados: Se obtiene un índice kappa de 0,82 (casi perfecto) que da cuenta de una buena confiabilidad para el instrumento. Conclusiones: Se cuenta con un instrumento con una buena concordancia para su empleo en los procesos educativos. (AU)

Introduction: The Objective Structured Clinical Examination (ECOE) is an evaluation methodology that allows to validly measure clinical competencies in Physiotherapy students through previously standardized stations. Objective: To determine the content validity of the ECOE-LM 2017 instrument for the measurement of clinical competencies in the examination, evaluation, diagnosis, prognosis and intervention of a person with mechanical low back pain in Physiotherapy. Methods: An instrument of six stations evaluated with the expert judgment technique was designed to subsequently calculate the inter-observer reliability, through Fleiss’ Kappa, by means of the ReCal, additionally the acceptability index was identified. Results: A Kappa index of 0.82 (almost perfect) is obtained, which shows good reliability for the instrument. Conclusions: There is an instrument with good agreement for its use in educational processes. (AU)

Uso de la balneoterapia y el ejercicio terapéutico en la mejora física y psicosocial en adolescentes con lupus y artritis juvenil: un estudio de método mixto / Use of balneotherapy and therapeutic exercise in physical and psychosocial improvement in adolescents with lupus and juvenile arthritis: A mixed method study

Antecedentes y objetivo: Evaluar los cambios a nivel físico y psicosocial de una intervención combinada de balneoterapia y ejercicio terapéutico en grupo aplicado en jóvenes con lupus eritematoso sistémico y artritis idiopática juvenil. Materiales y métodos: Estudio longitudinal prospectivo pre y postintervención y cualitativo fenomenológico descriptivo. La intervención consistió en un programa combinado de balneoterapia, ejercicio terapéutico en grupo y terapia manual e instrumental. Se evaluaron el dolor percibido (Escala Visual Analógica), el estado funcional (Health Assessment Questionnaire) y la fatiga (Escala de Evaluación Funcional de Terapia de Enfermedades Crónicas-Fatiga). Las entrevistas se analizaron mediante análisis temático. Resultados: Quince adolescentes de 14,1±2,1 años participaron en el estudio. Se observó una mejoría significativa respecto al dolor máximo (p=0,006; TE=1,1), dolor medio (p=0,029; TE=0,5) y estado funcional (p=0,013; TE=0,7). Sin embargo, a pesar de que la fatiga disminuyó, no se encontraron diferencias estadísticamente significativas (p=0,415; TE=0,3). Los temas principales surgidos tras las entrevistas fueron «una experiencia de aprendizaje» y «desventajas», que describen la vivencia de la intervención. Discusión y conclusiones: Parece que la combinación de balneoterapia y el ejercicio terapéutico en grupo es útil para reducir el dolor y mejorar la función física. Ensayos clínicos en diferentes poblaciones reportan resultados similares, hallando una disminución del dolor. Se concluye que la realización de un programa de fisioterapia combinado de balneoterapia y ejercicio terapéutico en grupo produce beneficios con relación al dolor y al estado funcional, favoreciendo además la ampliación de conocimientos y el automanejo de la enfermedad.

Background and objective: To evaluate the physical and psychosocial changes of a combined intervention of balneotherapy and therapeutic exercise applied in young people with systemic lupus erythematosus and juvenile idiopathic arthritis. Materials and methods: Pre- and post-intervention prospective longitudinal and descriptive phenomenological qualitative studies were conducted. The intervention consisted of a combined program of balneotherapy, therapeutic group exercise and physiotherapy techniques. Perceived pain (Visual Analogue Scale), functional status (Health Assessment Questionnaire), and fatigue (Chronic Disease Therapy-Fatigue Functional Assessment Scale) were assessed. The interviews were analysed using thematic analysis. Results: 15 adolescents aged 14.1±2.1 years participated in the study. A significant improvement was observed with respect to maximum pain (P=.006; ES=1.1), mean pain (P=.029; ES=0.5) and functional status (P=.013; ES=0.7). However, despite the decrease in fatigue, no statistically significant differences were found (P=.415; ES=0.3). The main themes that emerged after the interviews were “a learning experience” and “disadvantages of the intervention”. Discussion and conclusions: It seems that the combination of balneotherapy and therapeutic group exercise is effective in reducing pain and improving physical function. Randomized clinical trials performed in different populations report similar results, finding a decrease in pain. It is concluded that carrying out a physiotherapy program combined balneotherapy and therapeutic group exercise produces benefits in relation to pain and functional status, also favoring the expansion of knowledge and self-management of the disease.

Efectividad de la movilidad cervicodorsal con característica socializadora y lúdica con relación al riesgo de caídas en adultos mayores con anteposición de cabeza y cuello: un ensayo clínico aleatorizado / Effectiveness of cervicodorsal mobility testing with socialising and playful features of falls risk in older adults with forward head and neck posture: A randomised clinical trial

Objetivo: El propósito del estudio fue comprobar la efectividad de la movilidad cervicodorsal con característica socializadora y lúdica en relación con el riesgo de caídas en adultos mayores con anteposición de cabeza y cuello. Material y métodos: El presente estudio fue un ensayo clínico aleatorizado con un diseño experimental, longitudinal, basado en la evaluación del riesgo de caídas mediante el Timed Up and Go en 3 grupos de 44 participantes posterior a 16 semanas, divididos en: grupo movilidad cervicodorsal, grupo movilidad cervicodorsal con característica socializadora y lúdica y grupo control que no realizó intervención. Los 132 participantes cumplieron los criterios de inclusión y exclusión: adultos mayores>60 años, con anteposición de cabeza y cuello, índice de masa corporal con sobrepeso y obesidad tipo 1 y sin enfermedades neurológicas, reumatológicas, sistémicas, inmunodepresivas, infecciosas u osteomusculares. Resultados: Hubo cambios estadísticamente significativos en la disminución del riesgo de caídas en ambos grupos que recibieron tratamiento (p<0,05). El grupo movilidad cervicodorsal disminuyó en promedio 5,43 segundos, y el grupo movilidad cervicodorsal con característica socializadora y lúdica disminuyó en promedio 5,78 segundos. Conclusión: La movilidad cervicodorsal con característica socializadora y lúdica fue efectiva en relación con la disminución del riesgo de caídas en adultos mayores con anteposición de cabeza y cuello, no observándose diferencias estadísticamente significativas entre los 2 grupos experimentales.

Objective: The purpose of the study was to assess the effectiveness of cervicodorsal mobility testing with a socialising and playful features in relation to falls risk in older adults with forward head and neck posture. Material and methods: The present study was a randomised clinical trial with a longitudinal, experimental design, based on assessment of falls risk using the Timed Up and Go Test in three groups of 44 participants after 16 weeks, divided into: cervicodorsal mobility group, cervicodorsal mobility group with socialising and playful features and a control group that did not take part in the intervention. The 132 participants met the inclusion and exclusion criteria: older adults>60 years of age, with forward head and neck posture, overweight body mass index and type 1 obesity and with no neurological, rheumatological, systemic, immunosuppressive, infectious, or musculoskeletal diseases. Results: There were statistically significant changes in decrease in falls risk in both groups receiving treatment (p<.05). The cervicodorsal mobility group decreased in risk by an average of 5.43seconds and the cervicodorsal mobility group with socialising and playful features decreased by an average of 5.78seconds. Conclusion: Cervicodorsal mobility with socialising and playful features was effective in reducing the risk for falls in older adults with forward head and neck posture and forward neck posture, and no statistically significant differences were observed between the two experimental groups.

Comparing fly-in fly-out and telehealth models for delivering advanced-practice physiotherapy services in regional Queensland: An audit of outcomes and costs.

INTRODUCTION: Recruitment of advanced-practice physiotherapists to regional and rural healthcare facilities in Queensland, Australia remains a challenge. To overcome this barrier, two different service delivery models (Fly-In, Fly-Out (FIFO), Telehealth) were trialled by one regional facility. This study aims to describe the economic- and service-related outcomes of these two methods of service delivery. METHODS: A retrospective audit was conducted where two nine-week time periods were selected for each service delivery model. Outcomes of interests include patient demographics and case-mix, service utilisation, clinical actions, adverse events and costs. Net financial position for both models was calculated based upon costs incurred and revenue generated by service activity. RESULTS: A total of 33 appointment slots were recorded for each service delivery model. Patient case-mix was variable, where the Telehealth model predominately involved patients with musculoskeletal spinal conditions managed from a neurosurgical waiting list. Appointment slot utilisation and pattern of referral for further investigations were similar between models. No safety incidents occurred in either service delivery model. An estimated cost-savings of 13% for the Telehealth model could be achieved when compared to the FIFO model. DISCUSSION: Telehealth is a safe, efficient and viable option when compared to a traditional in-person outreach service, while providing cost-savings. Telehealth should be seen as a service delivery medium in which sustainable recruitment of advanced-practice physiotherapists to regional and rural healthcare facilities can be achieved.

Attitudes and beliefs on low back pain in physical therapy education: A cross-sectional study.

BACKGROUND: Prescription behavior in low back pain (LBP) differs between physical therapists with a biomedical versus a biopsychosocial belief, despite the presence of clinical guidelines. OBJECTIVE: To examine (1) the beliefs of physical therapy students and their adherence to clinical LBP guidelines in Belgium and the Netherlands; (2) whether the beliefs and attitudes of physical therapy students change during education; (3) whether beliefs are related to guideline adherence; (4) whether beliefs and attitudes differ with or without a personal history of LBP. METHODS: A cross-sectional design included students in the 2nd and 4th year of physical therapy education in 6 Belgian and 2 Dutch institutions. To quantify beliefs, the Pain Attitudes and Beliefs Scale, the Health Care Providers' Pain and Impairment Relationship Scale, and a clinical case vignette were used. RESULTS: In total, 1624 students participated. (1) Only 47% of physical therapy students provide clinical guidelines' consistent recommendations for activity and 16% for work. (2) 2nd year students score higher on the biomedical subscales and lower on the psychosocial subscale. 4th year students make more guideline consistent recommendations about work and activity. (3) Students with a more biopsychosocial belief give more guideline adherent recommendations. (4) Personal experience with LBP is not associated with different beliefs or attitudes. CONCLUSIONS: A positive shift occurs from a merely biomedical model towards a more biopsychosocial model from the 2nd to the 4th year of physical therapy education. However, guideline adherence concerning activity and work recommendations remains low.

Papel de las distintas modalidades de fisioterapia en mujeres con dispareunia: una revisión bibliográfica / Role of the different physiotherapy modalities in women with dyspareunia: a literature review

El objetivo de este trabajo es evaluar la literatura científica actual sobre el papel de las modalidades de fisioterapia en mujeres con dispareunia, independientemente de su causa. La búsqueda se realizó en las bases de datos Medline, Pubmed, Cinahl, Scopus y Web of Science. Después de tener en cuenta los criterios de inclusión y exclusión fueron seleccionados 12 artículos para la realización de la revisión. El tratamiento se lleva a cabo con dilatadores, biofeedback, ejercicios de fortalecimiento, técnicas de relajación y estiramientos entre otros. Dichas intervenciones, tienen períodos de tiempo variables y utilizan múltiples escalas y cuestionarios. La fisioterapia del suelo pélvico se utiliza como herramienta para el tratamiento de la dispareunia pero los resultados se deben tomar con precaución. Se necesitan ensayos clínicos controlados aleatorizados con tamaños muestrales más grandes que aumenten la calidad de la literatura científica

A review of the current scientific literature was performed on the role of physiotherapy modalities in women with dyspareunia, regardless of the cause. The search for article was carried out in Medline, PubMed, Cinahl, Scopus, and Web of Science databases. After taking into account the inclusion and exclusion criteria, 12 articles were selected for the creation of the literature review. The reviewed articles describe different interventions, such as the use of vaginal dilators, biofeedback, strengthening exercises, relaxation techniques, and stretching exercises, among others. Furthermore, these interventions were carried out during varying periods of time, and multiple scales and questionnaires were used. Pelvic floor physiotherapy is used as a tool for the treatment of dyspareunia but the results should be taken with caution. Randomised controlled clinical trials with larger sample sizes that increase the quality of the scientific literature are needed

Fisioterapia para las personas con Parkinson durante la pandemia de COVID-19 y después de esta / Physiotherapy for people with Parkinson around and after the COVID-19 outbreak

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Validity and reliability of the Australian Therapy Outcome Measures - Physiotherapy, for podiatry (AusTOMs-PT for use in podiatry).

BACKGROUND: Valid and reliable outcome measure enable measurement of health care service impact. There are limited valid and reliable outcome measures for use in podiatry practice to measure the impact of treatment. This research aimed to test the face validity of the AusTOMs for Physiotherapy (AusTOMs-PT), it's adaptability to podiatry clinical practice and the reliability of its use with podiatrists. METHODS: Stage 1 used a nominal group technique with podiatrists who worked in public and/or private settings. All podiatrists underwent self-directed training in the AusTOMs framework and measures prior to interviews or focus group discussion. Discussion was centred about transferability of the core scales of the AusTOMs-PT and an adjunct measure, AusTOMs for Occupational Therapy (AusTOMs-OT) to podiatry practice. Stage 2 used 10 case studies representative of people who had foot or ankle concerns. Podiatrists were recruited and trained in the use of the relevant AusTOMs-PT scales. Podiatrists individually scored the cases at two timepoints (1 month apart) using the six scales from the AusTOMs-PT deemed by stage 1 as relevant to podiatry. Intra and inter-rater reliability of scales were determined using intraclass correlation coefficients (ICCs). RESULTS: Thirteen podiatrists participated in individual or focus group interviews in Stage 1. Consensus was gained on six of the nine core scales adopted from the AusTOMs-PT. These were 1. Balance and Postural Control, 3. Musculoskeletal Movement Related Functions, 4. Neurological Movement Related Functions, 5. Pain, 7. Sensory Functions, 8. Skin Functions. Each core scale rated the functional domains of Impairment, Activity Limitation, Participation Restriction and Wellbeing/Distress relating to that presentation of goals of the person in the case study. There were 22 podiatrists complete training and scored two rounds of case studies using the six scales in Stage 2. There were 91%(n = 20) participants with an intra-rater ICC > 0.5 (moderate or greater). Each domain had an inter-rater reliability of > 0.9 (excellent) during the first round. CONCLUSIONS: The AusTOMs-PT for use in podiatry may be implemented to record change in impairment, function, participation and wellbeing of people receiving podiatry treatment. Podiatry specific training and mentoring, together with repeated use could be expected to improve intra-reliability.

Conclusiones XVI congreso nacional asociación española de fisioterapeutas / Conclusions XVI national congress spanish association of physiotherapists

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Epilepsy: knowledge and attitudes of physiotherapists, occupational therapists, and speech therapists.

Physiotherapists, occupational therapists, and speech therapists play a key role in the treatment of children with epilepsy. We performed a survey of therapists' knowledge of and attitudes towards epilepsy in two regions of Germany, the city of Leipzig and the rural district of Zwickau. Therapists of 29/68 (43%) outpatient practices and 4/9 (44%) hospitals took part. In total, 195 therapists participated: 63 (32%) physiotherapists, 74 (38%) occupational therapists, and 58 (30%) speech therapist. In 65%, epilepsy was subject of vocational training. Of all therapists, 8% claimed they had not treated epilepsy patients so far. During professional life, 43% had witnessed a seizure. Of all therapists, 44% correctly assumed a seizure could result in death. During a seizure, 42% would perform the obsolete measure of placing something solid in the patient's mouth, and 41% would administer a prescribed rescue medication. More information on epilepsy was requested by 92%.Conclusion: Most therapists treat patients with epilepsy, and almost half have already witnessed a seizure. Often, however, epilepsy is not subject of vocational training. The risk of a fatal outcome of a seizure is underestimated, and many therapists would perform obsolete measures. Knowledge of seizure management should be transmitted to therapists especially during vocational training.

Effects of Exercise Training on Cardiovascular and Autonomic Parameters in Stroke Survivors: A Systematic Review

Negative changes in cardiovascular and autonomic variables in stroke survivors have encouraged the global scientific community to focus on investigating therapeutic strategies to mitigate stroke damage. The objective of the present study was to describe the effects of exercise training on cardiovascular and autonomic variables in stroke survivors. We used the PICO (population, intervention, control/comparison, and outcome variables) model for the search of articles in PubMed and Physiotherapy Evidence Databases from 2009 to December 2018. The following data were also recorded: type of study, author, year of publication, participants (time after stroke, sample size, and age) and benefits of exercise training. A total of 544 articles were initially selected, of which nine peer-reviewed articles met the search criteria. These nine studies enrolled 611 participants (middle-aged or elderly), and pointed to positive effects of training on maximal oxygen uptake, peak aerobic capacity, 6-minute walk test and resting heart rate. However, more well-controlled studies are needed to confirm the benefits of exercise training on cardiovascular and autonomic variables in this population

Tratamento de ferida em Coendou prehensilis (Rodentia: Erethizontidae) com laserterapia e ozonioterapia: relato de caso / Wound treatment of Coendou prehensilis (Rodentia: Erethizontidae) with laser and ozone therapy: case report

O emprego conjunto da laserterapia e da ozonioterapia em feridas apresenta alto potencial benéfico para os pacientes, uma vez que contribui para o manejo da dor, tem ação anti-inflamatória e acelera o processo de cicatrização. Este relato de caso tem como objetivo apresentar o uso de terapias alternativas na cicatrização de ferida em exemplar de Coendou prehensilis. Um ouriço-cacheiro, fêmea, adulto, com peso de 4kg foi encaminhado para atendimento médico veterinário com histórico de ter sido atacado por um cão. Inicialmente o ouriço passou pelo procedimento de higienização e desbridamento da ferida, para a retirada das bordas necróticas. Adicionalmente, foram administrados clindamicina (10mg/kg), por via intramuscular (IM), uma vez por dia (SID), tramadol (4mg/kg, IM, SID), flunixin (0,3mg/kg, SID), por via subcutânea (SC), e ferrodextrano (25mg/kg, IM, SID). Apesar da terapia instituída, observou-se reincidência de crescimento necrótico tecidual, o que levou à eleição do tratamento da ferida com as técnicas de laserterapia e ozonioterapia. O emprego das terapias alternativas como adjuvante promoveu uma cicatrização satisfatória da ferida, com ausência de sinais de sensibilidade local e de infecção, bem como ausência de crescimento de bordas necróticas. O tratamento adjuvante foi eficaz e pode ser empregado em outras situações para cicatrização de ferida em mamíferos silvestres.(AU)

The use of therapy with laser beam and ozone in wounds has a high beneficial potential for patients, since it contributes to the management of pain, has an anti-inflammatory action and accelerates the cicatricial process. Due to this casuistry importance, the case report aims to present alternative therapy use for wound healing on a Coendou prehensilis. Thus, a female of C. prehensilis weighing 4kg, was sent to veterinary care. At first there was a hygiene process and debridement for necrotic edge removal. Furthermore, injected clindamycin (10mg/kg) was administered intramuscularly (IM), once a day (SID), tramadol (4mg/kg, IM, SID), flunixin (0.3mg/kg, SID), administered subcutaneously (SC) and iron dextran (25mg/kg, IM, SID). In spite of the established therapy, tissue necrotic growth was observed, which lead the wound treatment as healing by second intention, initiating an alternative therapy with laser beam and ozone. As a result, the healing was satisfactory due to the elected techniques, without signs of pain and infection. The adjuvant treatment with physiotherapy had advantageous effect and could be applied to wound healing in wild mammal animals.(AU)

Educating undergraduate occupational therapy and physiotherapy students in motivational interviewing: the student perspective.

BACKGROUND: Motivational Interviewing (MI) is an evidenced based talking therapy designed to affect client Health Behaviour Change. Previous research indicates that Allied Health Professionals (AHP) can effectively use the approach and training at pre-registration level has been piloted. However, student experiences of training is underexplored. AIM: To explore Physiotherapy and Occupational Therapy students' experiences of training in and implementation of Motivational Interviewing. METHODS: Four focus groups including 24 undergraduates (14 OT and 10 PT) were conducted at the completion of the training and a subsequent clinical placement. Transcribed texts were analysed thematically. Data were triangulated with student written post-it notes and open questions in a post training questionnaire. RESULTS: Two overarching themes were developed from the data. Learning different ways to interact and the challenge of transformation illuminates specific aspects of the training which enabled learning as well as areas of contention. Using the spirit of MI, but not every contact counts highlights the facilitators and challenges of implementation on placements. CONCLUSIONS: Motivational interviewing is a useful addition to training neophyte health students. Key skills were adopted and in some cases transferred into practice. The process of learning indicates areas of potential improvement to enhance relevance of practice scenarios. The transfer to practice is more complex illustrating a need to negotiate professional and institutional expectations which should be considered in training.

Implementation of Questionnaire-Based Risk Profiling for Clients in a Workers' Compensation Environment: An Example in Australian Physiotherapy Practice.

Purpose This study investigated the implementation of a risk profiling process for physiotherapy clients with a compensable musculoskeletal problem. Implementation targeted personal (clinician) and external (organisational) factors to facilitate behavioural change with regard to the use of formal, questionnaire-based risk profiling. Methods A theoretical construct was developed for formal questionnaire-based screening to be implemented across 12 private, metropolitan physiotherapy clinics. To target personal (clinician) factors, a multimodal educational procedure was developed focused on use of the ten-item Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ-10). To target external (organisational) factors, an administrative process was enacted to ensure routine completion of the OMPSQ-10 by compensable clients. Global practice behaviour with regard to the use of formal risk profiling was complete pre- and post-implementation. Results Pre-implementation physiotherapists understood the potential usefulness of formal risk profiling, but the large majority did not routinely have clients complete these types of questionnaires. Post-implementation there was a significant positive shift in behaviour to more frequent use the OMPSQ-10 for new compensable clients. Conclusions The results provide initial support for the use of a framework to develop an implementation strategy to increase physiotherapist adherence to the use of guideline recommended risk profiling questionnaires in clinical practice.

Estrategias de problematización e intervención de Kinesiología / Fisioterapia para un paciente con una afección ventilatoria crónica reagudizada / Problematizing strategies and intervention of Kinesiology / Physiotherapy for a patient with aggravated chronic ventilatory condition

La Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF), permite organizar la información mediante un lenguaje trans-disciplinario. Al respecto, es fundamental complementarlo con una epistemología propia para generar prácticas clínicas eficientes. La enfermedad pulmonar obstructiva crónica (EPOC), se ha convertido en una condicionante negativa de función, movimiento y salud en la población. Proponemos un modelo de razonamiento en kinesiología/fisioterapia para disfunciones del movimiento humano aplicado a una fase crónica ventilatoria irreversible. Paciente de 74 años con EPOC. Plantea como necesidad, la "mínima asistencia para realizar su aseo personal", lo que se estableció como contexto funcional crítico (CFC). Se entrenó progresivamente, según velocidad, por 36 sesiones, de 30 minutos. La espirometría no presentó cambios. Mejoró la capacidad de trabajo físico, calidad de vida y el CFC se hizo independiente. La intervención derivada del diagnóstico mediante estrategias de problematización permitió una mejora clínica eficiente de los indicadores evaluados.

The International Classification of Functioning, Disability and Health (CIF), make it possible to organize information through a trans-disciplinary language. In this regard, it is essential to complement it with an own epistemology to generate efficient clinical practices. Chronic obstructive pulmonary disease (COPD) has become a negative condition of function, movement and health in the population. We propose a model of reasoning in kinesiology/ physiotherapy for dysfunctions of human movement applied to an irreversible chronic ventilatory phase. Patient of 74 years old patient with COPD. As a necessity, it poses the "minimum assistance to perform personal hygiene", which was established as a critical functional context (CFC). He trained progressively, according to speed, for 36 sessions of 30 min. The spirometry did not change. The capacity for physical work, quality of life improved, and the CFC became independent. The intervention derived from the diagnosis by problematizing strategies allowed an efficient clinical improvement of the evaluated indicators.

Motivational interviewing training for physiotherapy and occupational therapy students: Effect on confidence, knowledge and skills.

OBJECTIVE: To examine the effectiveness of a three-day training programme on knowledge, confidence and fidelity to Motivational Interviewing (MI) delivery in an undergraduate occupational therapy and physiotherapy cohort (n = 25). METHODS: Training outcomes were assessed pre-training, post-training and following a subsequent clinical placement. The Motivational Interviewing Knowledge and Attitudes Test (MIKAT) and an 8-item survey assessed knowledge, attitudes and confidence respectively. MI fidelity was evaluated by a simulated patient interview rated with the Motivational Interviewing Treatment Integrity scale (MITI). Analysis was by one-way repeated measures ANOVA. RESULTS: Self-report measurements indicated increased confidence but no effect on knowledge or attitude. MITI analysis showed superior performance in all four global criteria and an increased frequency of MI adherent behaviours post-training. Positive changes were maintained following clinical placement. MITI summary scores indicated an improvement in question to reflection ratio in line with beginner competency. CONCLUSION(S): Participation in a three-day MI training programme significantly improved student confidence and MI skilfulness. PRACTICE IMPLICATIONS: Where feasible, MI training should be embedded within the curriculum. Further research is needed elucidate the best practices to incorporate teaching this skill set within the curriculum in order to best prepare students to counsel clients in behaviour change in their applied settings.

Evidence-Based Practice: a survey of Brazilian physical therapists from the dermatology subdiscipline.

BACKGROUND: Dermatology is a relatively new subdiscipline of physical therapy with growth potential. Therefore, it is important to identify whether professionals from this area have the knowledge and skills required to offer the best available service based on evidence-based practice. OBJECTIVES: To describe the self-reported behavior, knowledge, skills, opinion, and barriers related to the evidence-based practice of Brazilian physical therapists from the dermatology subdiscipline. METHODS: An adapted electronic questionnaire was sent by the Brazilian Association of Dermatology Physical Therapy via email to all registered members. The data were analyzed descriptively. RESULTS: The response rate was 40.4% (101/250). Brazilian physical therapists from the dermatology subdiscipline reported that they update themselves equally through scientific papers and courses, and access preferentially databases that offer scientific papers in the Portuguese language. Respondents believe they have sufficient knowledge to use evidence-based practice, inform patients about treatment options and consider their choices in the decision-making process. However, there were inconsistencies in responses regarding the experience with evidence-based practice during undergraduate or postgraduate degree, as well as having discussions about evidence-based practice in the workplace. The barriers most frequently reported were difficulty to obtain full-text papers, lack of quality of the scientific papers, applicability of the findings into clinical practice, lack of evidence-based practice training and difficulty to understand the statistics. CONCLUSION: Brazilian physical therapists from the dermatology subdiscipline have positive perceived behavior, believe that they have sufficient knowledge and skills, and have favorable opinion related to evidence-based practice. However, there are inconsistencies related to some aspects of knowledge and skills set.

Funcionalidade e qualidade de vida em indivíduos com linfedema unilateral em membro inferior: um estudo transversal / Functionality and quality of life of patients with unilateral lymphedema of a lower limb: a cross-sectional study

O linfedema de membros inferiores é uma doença crônica decorrente de dano no sistema linfático que influencia a mobilidade, a funcionalidade e a qualidade de vida dos indivíduos. Questionários e o teste físico são métodos bastante práticos, de fácil aplicação e baixo custo, que fornecem dados importantes para a avaliação desses pacientes. Objetivos Avaliar a influência do linfedema unilateral de membro inferior na funcionalidade e na qualidade de vida, correlacionando três ferramentas de avaliação. Métodos Estudo descritivo com 25 indivíduos com linfedema unilateral em membro inferior, de ambos os sexos. Foi avaliada a perimetria e foram aplicados The Medical Outcome Study Short Form-36 Health Survey (SF-36) para avaliação da qualidade de vida, Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL) para estudo das habilidades físicas, mentais e sociais relacionadas ao linfedema e o Timed Up and Go (TUG) para avaliação da funcionalidade. Resultados Houve a presença de linfedema em todo o membro inferior dos participantes. Os domínios mais prejudicados pelo linfedema foram os aspectos físicos (25,0 ± 31,4) e emocionais (36,0 ± 42,9) no SF-36 e o domínio mobilidade (6,0 ± 2,6) no Lymph-ICF-LL. O TUG foi realizado em 9,88 ± 1,98 s. Houve correlação entre o TUG e os questionários e entre os dois questionários utilizados. Conclusões Indivíduos com linfedema unilateral em membro inferior apresentam um impacto negativo na qualidade de vida e na funcionalidade avaliadas através de questionários, que correlacionam entre si. Não foi encontrada alteração no TUG, mas houve correlação entre ele e os questionários utilizados

Lymphedema of the lower limbs is a chronic disease caused by damage to the lymphatic system that influences people's mobility, functionality, and quality of life. Questionnaires and physical test are very practical, easy to apply, and low cost methods that provide important data for evaluation of these patients. Objectives To evaluate the influence of unilateral lower limb lymphedema on functionality and quality of life, correlating 3 assessment tools. Methods This was a descriptive study investigating 25 patients of both sexes with unilateral lymphedema in a lower limb. Limb volume was assessed using circumferential tape measurements, the Medical Outcomes Study Short Form-36 Health Survey (SF-36) was used to assess quality of life, the Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL) was used to assess physical, mental, and social skills related to lymphedema, and the Timed Up and Go (TUG) test was used for functional assessment. Results Lymphedema was present throughout the affected lower limb of participants. The domains most affected by lymphedema were physical aspects (25.0 ± 31.4) and emotional aspects (36.0 ± 42.9) from the SF-36 and the mobility domain (6.0 ± 2.6) from the Lymph -ICF-LL. Patients performed the TUG in 9.88 ± 1.98 seconds. The TUG was correlated with the questionnaires and the questionnaires were correlated with each other. Conclusions People with unilateral lower limb lymphedema exhibited negative impacts on quality of life and functionality, as evaluated by questionnaires, which were correlated with each other. TUG performance was within normal limits, but results correlated with the questionnaires used

Physical therapists' perspectives on using contextual factors in clinical practice: Findings from an Italian national survey.

BACKGROUND: Contextual factors (CFs) represent a potential therapeutic tool to boost physiotherapy outcomes, triggering placebo effects. Nevertheless, no evidence about the use of CFs among physical therapists is currently available. OBJECTIVE: To investigate the use of CFs and the opinion of Italian physical therapists specialized in Orthopaedic Manual Therapy (OMTs) on their therapeutic benefits. DESIGN: An exploratory cross-sectional online survey. METHODS: A 17-item questionnaire and 2 clinical vignettes assessed the perspective of OMTs on the adoption of CFs in daily clinical practice. The target population was composed of 906 OMTs. An online survey was performed in 2016 using SurveyMonkey Software. Data were analyzed by descriptive and inferential statistics. RESULTS: A total of 558 volunteers (61.6% of the target OMT population) participated in the study. Half of the participants (52.0%) claimed to use CFs frequently in their practice. More of 50% of OMTs valued the therapeutic significance of CFs for different health problems as determined by a combined psychological and physiological effect. OMTs considered the use of CFs ethically acceptable when they exert beneficial therapeutic effects and their effectiveness has emerged in previous clinical experiences (30.6%). They disagreed on the adoption of CFs when they are deceptive (14.1%). Moreover, OMTs did not communicate the adoption of CFs to patients (38.2%), and CFs were usually used in addition to other interventions to optimize clinical responses (19.9%). Psychological mechanisms, patient's expectation and conditioning were believed to be the main components behind CFs (7.9%). LIMITATIONS: Considering that the data collected were self-reported and retrospective, recall and response biases may limit the internal and external validity of the findings. CONCLUSIONS: OMTs used CFs in their clinical practice and believed in their therapeutic effect. The knowledge of CFs, placebo and nocebo mechanisms and their clinical effects should be included in physical therapists' university studies.