Fisioterapia en cicatrices. Revisión del estado actual / Physiotherapy in scars. Review of current state

Introducción y objetivo: La fisioterapia puede ser importante en el tratamiento de las cicatrices porque estas pueden conllevar problemas físicos, como limitaciones articulares, dolor, prurito o ansiedad, o afectar a la apariencia física de la persona. Sin embargo, la evidencia sobre su eficacia parece todavía débil. El objetivo de este trabajo es analizar el papel actual que las distintas modalidades de fisioterapia presentan en el tratamiento de las cicatrices. Material y método: Realizamos una búsqueda bibliográfica en las bases de datos Scopus, Web of Science, PEDro, Pubmed, Pubmed Central y SciELO utilizando los términos "modalidades de fisioterapia" y "cicatriz". Resultados: Obtuvimos 16 artículos válidos para dar respuesta al objetivo planteado. De ellos, 11 se centran en el tratamiento de cicatrices en quemados y sitios donantes de piel en quemados, y los 5 restantes a otro grupo de otras cicatrices. Conclusiones: Las diferentes modalidades de fisioterapia en el tratamiento de los distintos tipos de cicatriz parecen eficaces mejorando características adversas de las mismas (dolor, elasticidad, prurito, funcionalidad, calidad de vida y estética). Al mismo tiempo, todavía se hace necesario estandarizar protocolos de aplicación y realizar más investigaciones en este campo para alcanzar una evidencia más sólida acerca del tema. (AU)

Background and objective: Physiotherapy can be important in the treatment of scars because they can lead to physical problems, such as joint limitations, pain, itching or anxiety, or affect to the person's physical appearance. However, there is limited evidence for its effectiveness. The aim of this paper is to analyze the current role of different physiotherapy modalities in the treatment of scars. Methods: A literature search on the Scopus, Web of Science, PEDro, Pubmed and Pubmed Central and SciELO databases using the terms "physiotherapy modalities" and "scar" was carried out. Results: Sixteen valid articles were obtained to respond to the objective proposed. Of these, 11 focus on the treatment of burn scars and skin donor sites on burn patients, and the remaining five to another group of other scars. Conclusions: The different physiotherapy modalities in the treatment of different types of scars seem to be effective, improving adverse characteristics of the scars (pain, elasticity, itching, functionality, quality of life and aesthetics). At the same time, it is still necessary to standardize application protocols and to carry out further research in this field in order to achieve more solid evidence on the subject. (AU)

Experiences of telehealth e-mentoring within postgraduate musculoskeletal physical therapy education in the UK and Canada: a protocol for parallel mixed-methods studies and cross-cultural comparison.

INTRODUCTION: Mentored clinical practice is central to demonstrating achievement of International Educational Standards in advanced musculoskeletal physical therapy. While traditionally delivered face-to-face, telehealth e-mentoring is a novel alternative to offering this unique pedagogy to facilitate mentee critical reflection, deeper learning and enhanced knowledge translation to optimise patient care. With COVID-19 resulting in widespread adoption of telehealth and access to mentors often limited by geography or cost, the potential value of telehealth e-mentoring needs investigating. To investigate the experiences and outcomes of multiple stakeholders (student mentees, mentors and patients) engaged in musculoskeletal physical therapy telehealth e-mentoring across two universities (UK and Canada). METHODS AND ANALYSIS: Using case study design, we will use sequential mixed methods involving qualitative and quantitative components based on existing evidence. To examine the influence of telehealth e-mentoring on health outcomes in patients with musculoskeletal complaints, we will use patient-reported outcomes for satisfaction, patient empowerment and change in musculoskeletal health. We will conduct semistructured interviews to explore the development of critical thinking, clinical reasoning, communication skills and confidence of students engaged in telehealth e-mentoring. To explore the mentor acceptability and appropriateness of telehealth e-mentoring, we will conduct a focus group in each site. Finally, we will include a focus group of participants from each site to allow a cross-cultural comparison of findings to inform international stakeholders. Quantitative data will be analysed using descriptive statistics (median and IQR) to describe changes in outcome data and qualitative data will be analysed following the Framework Method. ETHICS AND DISSEMINATION: This study has ethical approval from both institutions: the University of Birmingham (ERN_20-0695) and Western University (2020-116233-47832). Findings will be published in a peer-reviewed journal and disseminated to key stakeholders in musculoskeletal physical therapy education and practice.

Outpatient Orthopedic Rehabilitation in New York State During the COVID-19 Pandemic: Therapist Perspectives.

The COVID-19 pandemic has had a strong impact on the care of orthopedic patients. This impact has been particularly difficult in New York State, which experienced the largest number of COVID-19 cases and led to a state- mandated pause on all elective surgeries. As a result, physical and occupational therapists became the principal providers of care and had to adjust their workflow to ensure quality care. Understanding the perspectives and needs of therapists relative to the circumstances created by COVID-19 is critical to safe and effective care. The goal of this study was to define the perspectives of therapists in New York State regarding the impact of COVID-19 on their work. An email-based 20-question survey was distributed to 250 therapists from all 10 regions of New York State who treated outpatient orthopedic patients during the peak of the pandemic in early April 2020. The survey collected demographic and practice information as well as responses regarding several clinical practice issues. The results provide insight into the concerns of therapists regarding the delivery of care, and responses clarify indications for therapy and for the use of telemedicine to achieve goals during the pandemic. The COVID-19 pandemic is profoundly impacting the work of therapists worldwide. Therapists responded to this survey expressing concerns about the safe delivery of care, access to personal protective equipment, use of telemedicine, and their role within health care during the pandemic. The results of this study can be used to establish guidelines for safe, effective, and efficient therapy during the pandemic. [Orthopedics. 2020;43(5):292-294.].

Aged care as a bellwether of future physiotherapy.

Aged care is becoming an increasingly significant feature of health care, but it is not an area physiotherapists have traditionally favored. Aging populations of increasingly chronically ill people represent the most important community of need in health care however, and so physiotherapists risk being marginalized if they do not adapt their practices to meet this growing need. Aged care may therefore represent a testing ground for a new physiotherapy, and the lessons learned in reforming physiotherapy for older adults may extend to all aspects of practice. In this paper, I explore how our current approach to aged care came about, and make the case for change. Having critiqued biomedicine, I also argue that the newer holistic models of health care are equally inadequate, because they attempt to dissolve important philosophical differences between physical, experiential, and social paradigms into an amorphous whole. I argue that these 'embodied' models of health make a holistic approach to aged care impossible and, instead, suggest new materialism and object-oriented ontologies as alternative physiotherapy paradigms.

50 aniversario Asociación Española de Fisioterapeutas: pasado, presente y futuro / 50th anniversary of the Spanish Association of Physiotherapists: past, present and future

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Health Competency Standards in Physical Therapist Practice.

Although the physical therapist profession is the leading established, largely nonpharmacological health profession in the world and is committed to health promotion and noncommunicable disease (NCD) prevention, these have yet to be designated as core physical therapist competencies. Based on findings of 3 Physical Therapy Summits on Global Health, addressing NCDs (heart disease, cancer, hypertension, stroke, diabetes, obesity, and chronic lung disease) has been declared an urgent professional priority. The Third Summit established the status of health competencies in physical therapist practice across the 5 World Confederation for Physical Therapy (WCPT) regions with a view to establish health competency standards, this article's focus. Three general principles related to health-focused practice emerged, along with 3 recommendations for its inclusion. Participants acknowledged that specific competencies are needed to ensure that health promotion and NCD prevention are practiced consistently by physical therapists within and across WCPT regions (ie, effective counseling for smoking cessation, basic nutrition, weight control, and reduced sitting and increased activity/exercise in patients and clients, irrespective of their presenting complaints/diagnoses). Minimum accreditable health competency standards within the profession, including use of the WCPT-supported Health Improvement Card, were recommended for inclusion into practice, entry-to-practice education, and research. Such standards are highly consistent with the mission of the WCPT and the World Health Organization. The physical therapist profession needs to assume a leadership role vis-à-vis eliminating the gap between what we know unequivocally about the causes of and contributors to NCDs and the long-term benefits of effective, sustained, nonpharmacological lifestyle behavior change, which no drug nor many surgical procedures have been reported to match.

Optimization of Movement: A Dynamical Systems Approach to Movement Systems as Emergent Phenomena.

The term "movement system" has been defined as "represent(ing) the collection of systems (cardiovascular, pulmonary, endocrine, integumentary, nervous, and musculoskeletal) that interact to move the body or its component parts."5 Although we do not dispute the advantage of defining the "movement system" as a physiological system, we contend that how the profession is identified with a monolithic "movement system" is imprudent. We contend that our scientific expertise regarding "movement optimization" should move forward by reconsidering how movement is produced (and potentially optimized) as a behavioral phenomenon in itself and abandon further attempts to promote "the movement system" with a purportedly unique and static label. We believe that reframing diagnosis is possible if there is a move away from an exclusive emphasis on classification of anatomical and physiological deviations from "normal" based on organismic constraints when such data yield, at best, an incomplete insight into functional performance that includes environmental and task constraints. The recent application of complex systems approaches to disciplines as diverse as medicine, biology, economics, and meteorology warrants thoughtful consideration of the potential benefits of incorporating similar advances in conceptualization of the central questions in physical therapy.

Impact of funding allocation on physical therapist research productivity and DPT student graduates: an analysis using panel data.

Financial support for institutional research is relatively stagnant, and thus institutions are likely to seek tuition revenue to offset the costs of research and teaching. It is likely that this has led to increases in tuition driven activities, and thus has limited research activities of academic physical therapy (PT) programs in particular. However, the relationships between sources of program revenue, the number of graduates from PT programs, and the scholarly production of PT faculty have not been studied. The purpose of this paper is to study the effects of types of funding-including research grants and tuition-on the number of physical therapy graduates from each program and the research productivity of physical therapy faculty. Data from 2008 to 2016 were utilized to perform a fixed-effects panel analysis. Panel models created predictions for the number of graduates and the number of peer-reviewed publications for programs from grant funding, annual tuition, and number of funded faculty members. In any given program, a 1% increase in annual tuition is associated with 24% more graduates per year, but a single percentage point increase in the mix of NIH grant funding over other funding types is associated with 8% fewer graduates, all else equal. For every 1% increase in annual tuition, a program can expect to have 41% fewer publications per year. Those institutions with higher numbers of graduates tended to have higher numbers of publications. Higher annual program tuition appears to be associated with both higher numbers of physical therapy graduates and lower levels of publications. Different funding sources have variable effects on degree production and scholarly productivity. Data are self-reported by programs on the Annual Accreditation Report, and cause and effect cannot be established through observational design.