Development and delivery of justice, equity, diversity, inclusion, and anti-oppression concepts in entry-level health professional education: A scoping review: BEME Guide No. 88.

PURPOSE: Justice, equity, diversity, inclusion (JEDI), and anti-oppression (AO) concepts are necessary in healthcare settings to promote culturally safe and high-quality care; however, entry-level healthcare program curricula (EHPPC) may lack adequate integration and/or delivery of these concepts. The primary aim of this scoping review is to identify what guidelines, frameworks, and models (GFMs) are used, and how they are used, to develop and deliver JEDI, and AO concepts in mandatory EHPPC. METHODS: A search of Ovid MEDLINE, Ovid EMBASE, and CINAHL was conducted for studies published in English from 2015 onwards that discuss what GFMs are included in mandatory EHPPC and how they guide the development and/or delivery of JEDI and/or AO concepts. Data from the included studies was collated into themes which were presented in tables and figures and described in narrative summaries. RESULTS: Sixty-one studies from various healthcare programs including medicine, nursing, pharmacy, dentistry, and dietetics were included in this review. Data from the studies were organized into eight categories: GFMs, concepts, methods of evaluation, length and frequency of sessions, modes of delivery, learning activities, and training of curricular developers and facilitators. CONCLUSIONS: GFMs are used in a variety of ways to integrate JEDI and/or AO concepts into health professional curriculum. Variability in the training of developers and facilitators of curricular concepts also exists. Future research is needed to determine if consistent or variable GFMs, as well as JEDI and/or AO developer and facilitator training, would be more effective for students' learning of these concepts.

Dissecting through the decade: a 10-year cross-sectional analysis of interprofessional experiences in the anatomy lab.

Interprofessional education (IPE) is prioritized as a critical component in preparing pre-licensure health professional students for effective teamwork and collaboration in the workplace to facilitate patient-centered care. Knowledge in anatomy is fundamental for healthcare professionals, making interprofessional anatomy education an attractive intervention for IPE and anatomy learning. Since 2009, the Education Program in Anatomy at McMaster University has offered an intensive 10-week IPE Anatomy Dissection elective to seven health professional programs annually. From 2011, students were invited to complete the Readiness for Interprofessional Scale (RIPLS) and Interprofessional Education Perception Scale (IEPS) before and after the elective. A total of 264 students from 2011 to 2020 completed RIPLS and IEPS. There were significant differences before and after the elective in students' total RIPLS scores and three of the four subscales: teamwork and collaboration, positive professional identity, and roles and responsibilities. Similarly, there were statistical differences in the total IEPS scores and two of three subscales: competency and autonomy and perceived actual cooperation. Statistically significant differences in RIPLS and IEPS total scores across several disciplines were also observed. This study demonstrates the elective's impact in improving students' IPE perceptions and attitudes, likely from the extended learning and exposure opportunity with other disciplines.

Readiness for interprofessional learning among health science students: a cross-sectional Q-methodology and likert-based study.

BACKGROUND: Interprofessional education (IPE) prepares healthcare students for collaboration in clinical practice, but the effectiveness of this teaching method depends on students' readiness for and perceptions of IPE. Evaluating students' readiness for and perceptions of IPE is challenging, due to the lack of comprehensive measures. This study characterized the level of IPE readiness and perspectives across first-year undergraduate and graduate health science students using the readiness for interprofessional learning Likert Scale (RIPLS) and Q-methodologies. METHODS: This is a cross-sectional, online study. Students were randomized to answer the Likert-scale version of RIPLS (80%) or a matched Q-methodology survey (20%). An ANCOVA compared RIPLS scores between students from different program levels (graduate/undergraduate) and specialization (health professional and general programs). The Q-data was analysed using a by-person factor analysis. RESULTS: Three hundred and four (33% response rate) and 71 (30% response rate) students completed the Likert scale and the Q-methodology surveys, respectively. Students from graduate programs demonstrated high readiness for IPE (higher total RIPLS scores p < 0.001) in comparison to undergraduates. Three factors, associated with program specialization (p = 0.04), emerged from the Q-methodology analysis characterizing students learning priorities. Students in undergraduate general programs were focused on IPE relevance and benefits to "the clinical team", students in graduate programs focused on "the patient", and those in undergraduate health professional programs focused on themselves ("me"). CONCLUSIONS: This novel mixed-methods approach combining traditional Likert-scales with Q-methodology elucidated not only associations between program and specialization with readiness (Likert) but also which components of IPE were valued the most (Q-methodology) and by whom.

Building a theoretical model for virtual interprofessional education.

BACKGROUND: Virtual interprofessional education (IPE) has emerged as a promising alternative to traditional in-person IPE. However, theoretical frameworks to support virtual interprofessional learning are not well established. Two theoretical frameworks emerged as relevant to virtual IPE: (1) the Canadian Interprofessional Health Collaborative (CIHC) interprofessional learning framework and (2) Dornan's Experience-Based Learning Model (ExBL) of workplace learning. In this study, we sought to explore virtual IPE using both frameworks to develop new theoretical understandings and identify assumptions, gaps and barriers. METHODS: This was a qualitative study. Semi-structured interviews were conducted with medical and nursing student participants (n = 14) and facilitators (n = 3) from virtual IPE workshops. Transcripts were analysed using directed content analysis methodology, informed by the CIHC and ExBL frameworks. Themes were explored using mind-mapping transitional coding. Data collection and analysis were continued iteratively until themes with adequate conceptual depth, relevance and plausibility were identified. RESULTS: Three themes were identified: (1) a shift in the balance of personal and professional, (2) blunted sociologic fidelity and (3) uncertainty and threats to interpersonal connections. Professional distinctions and hierarchies are blurred virtually. This contributed to an increased sense of psychological safety among most learners and lowered the threshold for participation. Separation from workplace sociologic complexity facilitated communication and role clarification objectives. However, loss of immersion may limit deeper engagement. Interprofessional objectives that rely on deeper sociological fidelity, such as conflict resolution, may be threatened. Informal interactions between learners are hindered, which may threaten organic development of interprofessional relationships. CONCLUSIONS: Role clarification and communication objectives are preserved in virtual IPE. Educators should pay close attention to psychological safety and sociologic fidelity-both to leverage advantages and guard against threats to connection and transferability. Virtual IPE may be well suited as a primer to in-person activities or as scaffolding towards interprofessional workplace practice.

Difference in Physiotherapy Students' Training and Objective Structured Clinical Exam Performance Before and During COVID-19.

Purpose: The Objective Structured Clinical Examination (OSCE) and station examinations, in general, have been widely utilized in health professional programmes to evaluate students' clinical performance prior to advancing to a clinical placement. The COVID-19 pandemic impacted student preparation and implementation of our programme's OSCEs. The impact on changes in student OSCE performance due COVID-19 has not been well studied. This non-concurrent cohort study evaluated the difference before and during COVID-19 pandemic on Year 1 physiotherapy students' performances on an in-person OSCE by estimating the mean difference in cohort OSCE scores and safety occurrences. Methods: Two cohorts of MSc (PT) students were compared: Cohort A (not impacted by COVID-19) and Cohort B (impacted by COVID-19). Cohort scores were summarized as means and 95% CIs. Results: Overall OSCE scores for Cohort A and B were 77.9 and 81.9, respectively (d¯ = 4.0, 95% CI: 2.1, 5.8). Cohort B students were approximately 4 times more likely to demonstrate safety occurrences. Conclusion: The impact of COVID-19 did not adversely affect total OSCE scores; however, it did increase safety infractions.

Objectif: en général, les programmes pour les professionnels de la santé font largement appel à l'examen clinique objectif structuré (ECOS) et aux stations d'examen pour évaluer la performance clinique des étudiants avant leur passage au stage clinique. La pandémie de COVID-19 a nui à la préparation des étudiants et à la mise en œuvre des ECOS du programme de physiothérapie. Les effets sur les changements à la performance des étudiants à l'ECOS découlant de la COVID-19 n'ont pas été bien étudiés. La présente étude de cohorte non concomitante a permis d'évaluer la différence entre la performance des étudiants en première année de physiothérapie à un ECOS en personne avant et pendant la pandémie de COVID-19, d'après la différence moyenne des scores d'ECOS et des occurrences d'infractions aux règles de sécurité au sein des deux cohortes. Méthodologie: deux cohortes d'étudiants à la maîtrise en physiothérapie ont été comparées : la cohorte A (non touchée par la COVID-19) et B (touchée par la COVID-19). Les scores des cohortes ont été résumés sous forme de moyennes et d'IC à 95%. Résultats: les scores globaux de l'ECOS pour la cohorte A et la cohorte B s'élevaient à 77,9 et à 81,9, respectivement (d¯ = 4,0, IC à 95 % : 2,1, 5,8). Les étudiants de la cohorte B étaient environ quatre fois plus susceptibles de démontrer des occurrences d'infraction aux règles de sécurité. Conclusion: la COVID-19 n'a pas nui aux scores totaux de l'ECOS, mais les infractions aux règles de sécurité se sont accrues.

The Development of the Canadian Physiotherapy Assessment of Clinical Performance (ACP) 2.0 - Alignment with the 2017 Competency Profile.

Purpose: Clinical education and assessment of students' performance during clinical placements are key components of Canadian entry-to-practice physiotherapy curriculum and important in developing entry-level physiotherapy practitioners. The Canadian Physiotherapy Assessment of Clinical Performance (ACP) is the measure currently used to assess physiotherapy student performance on clinical placements in most of the entry-to-practice physiotherapy programmes across Canada. The release of the 2017 Competency Profile by the National Physiotherapy Advisory Group resulted in a revision of the existing ACP. The purpose of this study is to report the process used to develop a revised version of the ACP based on the 2017 Competency Profile, henceforth called the ACP 2.0. Method: Using a multistage process, we sought input from Canadian clinical education academics, an expert consultant panel, as well as physiotherapists across Canada using a questionnaire, meetings, and an online survey, respectively. Results: Twelve of 15 clinical education academics responded to a questionnaire. The expert consultant panel (n = 12) met three times. There were 144 physiotherapists who initiated the national, online, survey and met the inclusion criteria; 84 completed the survey. In the ACP 2.0, rating scales and comments boxes were grouped, and additional text was added to 12 items for further clarification. The ACP 2.0 came to have 18 items and 9 comment boxes in addition to summative comments, in contrast to the original ACP's 21 items and 9 comment boxes. Conclusions: In November 2020, Canadian clinical education academics reviewed the proposed draft ACP 2.0 and unanimously accepted it for implementation in Canadian physiotherapy university programmes.

Objectif: l'enseignement clinique et l'évaluation du rendement des étudiants pendant les stages cliniques sont des éléments clés du programme canadien d'entrée en pratique de la physiothérapie et sont importants pour former des praticiens de la physiothérapie prêts à entrer en pratique. L'évaluation du rendement clinique de la physiothérapie au Canada (ÉPC) est la mesure actuellement en usage pour évaluer le rendement des étudiants en physiothérapie lors de leur stage clinique dans la plupart des programmes d'entrée en pratique de la physiothérapie au Canada. La publication du Profil des compétences par le Groupe consultatif national en physiothérapie en 2017 a donné lieu à une révision de l'ÉPC. La présente étude vise à rendre compte du processus utilisé pour mettre au point une version révisée de l'ÉPC d'après le Profil des compétences de 2017, désormais appelée l'ÉPC 2.0. Méthodologie: au moyen d'un processus échelonné, les chercheurs ont demandé l'apport d'universitaires canadiens en enseignement clinique, d'un groupe d'experts consultants et de physiothérapeutes des diverses régions du Canada dans le cadre d'un questionnaire, de réunions et d'un sondage en ligne, respectivement. Résultats: au total, 12 des 15 universitaires en enseignement clinique ont répondu à un questionnaire. Le groupe d'experts consultants (n = 12) s'est réuni trois fois. Enfin, 144 physiothérapeutes qui respectaient les critères d'inclusion ont entrepris le sondage national en ligne, et 84 l'ont terminé. Dans l'ÉPC 2.0, les échelles d'évaluation et les encadrés de commentaires ont été regroupés et du texte a été ajouté à 12 des points afin de les clarifier. L'ÉPC 2.0 comporte finalement 18 points et neuf encadrés de commentaires en plus des commentaires sommatifs, par rapport aux 21 points et aux neuf encadrés de commentaires de l'ÉPC original. Conclusions: en novembre 2020, les universitaires en enseignement clinique canadiens ont révisé le projet d'ÉPC 2.0 et en ont adopté la mise en œuvre à l'unanimité au sein des programmes universitaires de physiothérapie du Canada.

Student perceptions of hybrid delivery of interprofessional anatomy-The best of both worlds?

Interprofessional anatomy dissection (IAD) courses increase students' readiness for interprofessional education (IPE) both in-person and online. During the COVID-19 pandemic, virtual environments for anatomy learning were perceived as less effective. Hybrid instruction approaches emerged but have been scarcely evaluated. This study assessed students' experiences with a hybrid IAD course's virtual and in-person components. A hybrid IAD course consisting of virtual and in-person anatomy laboratory-based instruction was offered to 32 students from different health sciences programs. Before and after the full course, students completed the Readiness for Interprofessional Learning Scale (RIPLS) and the Interdisciplinary Education Perception Scale (IEPS). After the virtual and the in-person course components, students completed a Q-methodology survey to assess their perceptions of the course. Twenty-eight students (20 females; 24.8 ± 6.3 years old) from different programs (4 Physician Assistant; 2 Midwifery; 3 Speech-Language Pathology; 4 Physiotherapy; 3 Occupational therapy; 4 Nursing; 8 Medicine) participated. The total RIPLS score improved after the 8-week course (Median 84 interquartile range [78-87] vs. 87 [85-90]; p = 0.0145). The Q-methodology identified three factors: IPE & Virtual Enthusiasts, Introspective Learners, and IPE & Virtual Skeptics. Factors represented different levels of students' engagement with the IPE and virtual environment. The transition to in-person resulted in all factors praising the experience. Health science students showed improvements in their readiness for IPE after an 8-week hybrid IAD course. The main differences in the evaluations of the virtual and in-person components were related to engagement and the ability to learn anatomy; no differences were noted between settings regarding engagement in IPE.

Predictors of Success in a Graduate, Entry-Level Professional Program: From Admissions to Graduation.

INTRODUCTION: Admission to health professional programs (HPPs) in Canada is competitive. The purpose of this study is to evaluate how factors identifiable by the admissions package may predict incidences of academic concerns in one physiotherapy program in Canada. REVIEW OF LITERATURE: Previous literature has identified many concepts that contribute to "academic success." Some HPPs have investigated if admissions criteria can predict students' academic performance. However, this has not been reported in physiotherapy programs in Canada. SUBJECTS: Study data included candidates' admissions' metrics and physiotherapy students' program data for 4 graduating cohorts, who were admitted from 2016 to 2019 inclusive (N = 256). METHODS: A retrospective, nonconcurrent cohort study was used to estimate the relationship between applicant's admissions data and students' program data pertaining to academic success. Data were summarized as frequencies for categorical variables and means for continuous variables. We calculated odds ratios (ORs) and probabilities of an academic or professional concern for standard scores. Significance was set at P < .05. RESULTS: Cohorts participating in the multiple mini-interview (MMI) had an academic concern incidence of 14/131. The virtual MMI (VMMI) cohort had an incidence of 7/125. Students with higher MMI scores were less likely to have an academic concern (OR = 0.52 [95% CI: 0.30-0.89, P = .017]). Grade point average was not significantly associated with an academic concern when combined with either MMI or VMMI (Ps > 0.05). Admissions round offer was also significantly associated with an academic concern (OR = 2.48 [95% CI: 1.00-6.12, P = .049]), with those beyond the initial round of offers having increased risk of concerns. DISCUSSION AND CONCLUSION: Results of the study reflect the generally low event rates for incidences of academic concerns and the relative homogeneity and range restriction of independent variables across the 4 cohorts of students. HPP's reflection on current admissions processes and ability to identify opportunities for change in admission processes helps ensure that programs are selecting candidates who are likely to succeed.

Development and delivery of justice, equity, diversity, inclusion, and anti-oppression concepts in entry-level health professional education: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to identify the frameworks, guidelines, and models used to develop and deliver justice, equity, diversity, inclusion (JEDI), and anti-oppression (AO) principles in mandatory, entry-level health care professional program curricula (EHCPPC). A secondary objective will be to examine how these frameworks, guidelines, and models are used. INTRODUCTION: Health inequities are perpetuated globally, as observed by the suboptimal quality of care and health outcomes among equity-deserving groups. An understanding of JEDI and AO concepts is necessary in health care settings to promote culturally safe and high-quality care; however, entry-level health care programs may lack adequate integration of content and/or delivery of these principles. This scoping review will summarize the international literature on frameworks, guidelines, and models used to develop and deliver JEDI and AO concepts in EHCPPC. INCLUSION CRITERIA: This review will consider articles that discuss frameworks, models, or guidelines included in EHCPPC that guide the development and/or delivery of JEDI and AO principles in any country. Studies will be considered if they were published from 2015 to the present and are in English. All study designs will be considered for inclusion. METHODS: This review will be conducted in accordance with the JBI methodology for scoping reviews. A search of MEDLINE (Ovid), Embase (Ovid), and CINAHL (EBSCOhost) will be conducted. Two or more independent reviewers will assess titles and abstracts, screen full-text studies, and extract data from included studies. Data from the included studies will be collated into tables or figures and described in a narrative summary. REVIEW REGISTRATION: Open Science Framework osf.io/ewqf8.

Piloting an interprofessional virtual cadaveric dissection course: Responding to COVID-19.

Interprofessional learning improves students' clinical and interprofessional competencies. COVID-19 prevented delivering in-person education and motivated the development of a virtual interprofessional cadaveric dissection (ICD) course. This study reports on the effects of a virtual ICD course compared to a previously delivered in-person course, on students' readiness for, and perceptions about, interprofessional learning. Students attending the ICD course in-person (2019-2020) or virtually (2020-2021) completed the Readiness for Interprofessional Learning Scale (RIPLS) and the Interdisciplinary Education Perception Scale (IEPS). Students in the virtual course also provided written feedback. Thirty-two (24 women; Median: 24 [Q1-Q3: 22-25] years) and 23 students (18 women; 22 [21-23] years) attended the in-person and virtual courses, respectively. In the virtual cohort, the RIPLS total score (82 [76-87] vs. 85 [78-90]; p = 0.034) and the roles and responsibilities sub-score (11 [9-12] vs. 12 [11-13]; p = 0.001) improved significantly. In the in-person cohort, the roles and responsibilities sub-score improved significantly (12 [10-14] vs. 13 [11-14]; p = 0.017). No significant differences were observed between cohorts (p < 0.05). Themes identified in the qualitative analysis were advantages and positive experiences, competencies acquired, disadvantages and challenges, and preferences and suggestions. In-person and virtual ICD courses seem to have similar effects on students' interprofessional learning. However, students reported preferring the in-person setting for learning anatomy-dissection skills.

Evaluation of virtual problem-based tutorials in healthcare professional education.

PURPOSE: To explore student and tutor perspectives on the learning efficacy of virtual, compared to in-person, problem-based tutorial (PBT) in occupational therapy, physiotherapy, and speech-language pathology health professional programs. MATERIALS AND METHODS: This was a quality improvement study using a cross sectional survey at a single institution. Separate student and tutor surveys were disseminated online. Students received the survey at two timepoints, tutors received the survey at one timepoint. Descriptive statistics summarized quantitative survey questions. Chi-squared or Fischer's Exact analyses explored differences between in-person and virtual PBT. Exploratory analyses determined if associations amongst programs and/or between cohorts existed on variables of interest. Open-ended survey questions were analyzed using content analysis. RESULTS: A total of 241 students and 85 tutors completed the survey. Results demonstrate most students and tutors were satisfied with the use of virtual tutorials (77%; 89% respectively) and felt that they were effective in exploring content within the PBT course. However, students in the most recent cohort rated virtual tutorials more highly (p = 0.01). CONCLUSIONS: Virtual modes of PBT were successful in achieving course objectives and led to high satisfaction in users. Health professional programs can use this information when designing virtual problem-based tutorial courses in the post-pandemic era.

Problem-based learning (PBL) involves the active engagement of students in self-directed learning where learning gaps are identified, and information is retrieved and critically appraised to apply clinical reasoning to healthcare decisions.Traditionally, the PBL process has been implemented in-person through the use of small group tutorial with six to eight students and a tutor, however, the COVID-19 pandemic led to a quick transition to virtual tutorials.This study found that virtual modes of conducting PBL tutorial were successful in achieving course objectives and both students and tutors were satisfied with using virtual means to achieve course objectives in three professional rehabilitation programs (Occupational Therapy, Physiotherapy, Speech Language Pathology).Health professional programs in rehabilitation can use this information when designing courses using PBL processes in the future, and clinicians can use this information when considering the use of virtual means for care and for collaboration between professionals in various healthcare settings.

Framing asynchronous interprofessional education: a qualitative study on medical, physiotherapy and nursing students.

Objectives: To explore how virtual, asynchronous modules can be used in interprofessional health education curricula and to identify any advantages and shortcomings of asynchronous interprofessional education. Methods: A sample of 27 health professional students who attended in-person interprofessional education workshops at the McMaster Centre for Simulation-Based Learning from 2019-2020 were recruited through email discourse. Participants were asked to complete an asynchronous interprofessional education module and take part in a semi-structured interview that was recorded and transcribed verbatim. Techniques of direct content analysis were used to analyze the qualitative data from recorded transcripts. Results: The following emergent themes from participants' responses were identified: 1) the modules, as well as the features interspersed throughout, taught strategies for conflict resolution and interprofessional communication, 2) the modules have utility in preparing students for future interprofessional learning, 3) the convenience of virtual asynchronous modules introduces a sense of learner safety, and 4) a sense of isolation and fatigue was identified as a consequence of the lack of face-to-face interaction in these modules. Conclusion: Asynchronous interprofessional education modules may be best suited to prepare students for future interprofessional learning in a synchronous setting. Asynchronous modules effectively provide an introduction to interprofessional objectives such as conflict resolution and role clarification, yet the competency of team functioning is more difficult to achieve in an asynchronous environment. Future studies may focus on establishing a sequence of completing asynchronous modules for ideal development of interprofessional competencies in health professions learners.

Development, Implementation and Evaluation of an Acute Care Physical Therapy 'Float' Placement during the COVID-19 Pandemic: A Case Report.

Clinical education is a mandatory component of physical therapy curricula globally. COVID-19 disrupted clinical education, jeopardizing students' abilities to meet graduation requirements. The objective of this case report is to outline the development, implementation and evaluation of a multiple clinical instructor (CI), multiple unit, acute care float clinical placement for a final year, entry-level physical therapy student and offer implementation recommendations. This placement included an eight-week, multiple CI (one primary, four supporting), multiple (five) unit clinical placement which was developed between St. Joseph's Healthcare and the McMaster University Masters of Science (Physiotherapy) Program between 10 August and 2 October 2020. Student evaluations and reflections by the student and CIs were collected and analyzed using interpretive description. Analysis from the reflections revealed six themes: (1) CI and student attributes; (2) increased feasibility; (3) varied exposure; (4) central communication and resources; (5) organization; and (6) managing expectations. An acute care clinical experience is required for students in Canadian entry-to-practice physical therapy programs. Due to COVID-19, placement opportunities were limited. The float placement allowed clinicians to offer supervision despite staff re-deployment and increased organizational and work-life pressures during the pandemic. This model provides an approach to extenuating circumstances and may also increase acute care placements during non-pandemic times for physical therapy and other similarly structured healthcare professions.

A longitudinal Q-study to assess changes in students' perceptions at the time of pandemic.

The COVID-19 pandemic forced many universities and colleges to rapidly adopt online course delivery. As with any new foray, realizing the optimal aspects of a course to change became incredibly important for course instructors. In this study, we used a particularly sensitive method, i.e. Q-methodology, to evaluate changes based on students' perceptions from fall 2020 to winter 2021. Q-methodology is commonly used to uncover shared values, opinions, and preferences. Using Q-methodology, students participating in both semesters of an undergraduate anatomy and physiology course were surveyed in fall 2020 and winter 2021. The Q-sample included 44 statements. Data from fall 2020 were treated as the baseline and changes in students' perceptions from 2020 to 2021 were assessed. In total, 31 students completed both fall 2020 and winter 2021 course evaluations. Three salient factors emerged from the fall 2020 evaluation: Overtaxed students, Solo Achievers, and In-Person Learners. At the baseline, students were concerned mostly about the delivery of the course, then the winter 2021 evaluation showed how they were adjusting to online learning. The longitudinal Q-study proved to be robust in identifying changes in perceptions. These granular findings indicate how students might differ in viewing and evaluating online courses. This methodology can be used in redesigning and restructuring different components of an online course in higher education settings.

Monitoring physical functioning as the sixth vital sign: evaluating patient and practice engagement in chronic illness care in a primary care setting--a quasi-experimental design.

BACKGROUND: In Canada, one in three adults or almost 9 million people report having a chronic condition. Over two thirds of total deaths result from cardiovascular disease, diabetes, cancer and respiratory illness and 77% of persons ≥65 years have at least one chronic condition. Persons with chronic disease are at risk for functional decline; as a result, there is an increased awareness of the significance of functional status as an important health outcome. The purpose of this study was to determine whether patients who receive a multi-component rehabilitation intervention, including online monitoring of function with feedback and self-management workshops, showed less functional decline than case matched controls who did not receive this intervention. In addition, we wanted to determine whether capacity building initiatives within the Family Health Team promote a collaborative approach to Chronic Disease Management. METHODS: A population-based multi-component rehabilitation intervention delivered to persons with chronic illnesses (≥ 44 yrs) (n = 60) was compared to a group of age and sex matched controls (n = 60) with chronic illnesses receiving usual care within a primary healthcare setting. The population-based intervention consisted of four main components: (1) function-based individual assessment and action planning, (2) rehabilitation self-management workshops, (3) on-line self-assessment of function and (4) organizational capacity building. T-tests and chi-square tests were used for continuous and categorical variables respectively in baseline comparison between groups. RESULTS: Two MANOVA showed significant between group differences in patient reported physical functioning (Λ = 0.88, F = (2.86) = 5.97. p = 0.004) and for the physical performance measures collectively as the dependent variable (Λ = 0.80, F = (6.93) = 3.68. p = 0.0025). There were no within group differences for the capacity measures. CONCLUSION: It is feasible to monitor physical functioning as a health outcome for persons with chronic illness in primary care. The timeline for this study was not sufficient to show an increase in the capacity within the team; however there were some differences in patient outcomes. The short timeline was likely not sufficient to build the capacity required to support this approach. TRIAL REGISTRATION: NCT00859638.

The relationship between fear of falling and functional ability following a multi-component fall prevention program: an analysis of clinical data.

OBJECTIVES: The first objective was to evaluate clinical data from a multi-component fall prevention program. The second objective was to explore the relationship between physical function and fear of falling (FoF). METHODS: Adults (N = 287, mean age = 76 years) who participated in the Building Balance Program between 2011-2020 were assessed with five physical function measures and two FoF measures. Repeated measures ANOVA controlling for age and sex were performed to assess change from baseline. Linear regressions were conducted to evaluate how physical function explained variations in FoF. RESULTS: There were significant improvements between pre and post-program Berg Balance Scale (BBS) scores (p < .001), Timed-Up and Go (TUG) times (p < .001), 30 second Chair-Stand (30 CST repetitions) (p < .001), Functional Reach (FR) distance (p < .001), gait speed (p < .001), single item-FoF score (p < .001), and short Falls Efficacy Scale-International (FES-I score) (p < .001). After controlling for sex on all regression analyses, age, and pre-program gait speed explained variations in pre-program short FES-I scores (Adjusted R2 = 0.19). Age, pre-program BBS and 30 CST repetitions explained variations in pre-program level of FoF (Adjusted R2 = 0.25). Variations in post-program short FES-I scores (Adjusted R2 = 0.17) were explained by age, post-program TUG times and FR distance after controlling for age and sex. Robust regressions indicated variations in post-program level of FoF explained by age, post-program TUG and FR distance with a two-way interaction between age and FR. CONCLUSION: A multi-component fall prevention program improved physical function and decreased FoF. A small association between physical function and FoF similar between pre- and post-program conditions was identified.

Physiotherapy Practice in Primary Health Care: A Survey of Physiotherapists in Team-Based Primary Care Organizations in Ontario.

Purpose: This study describes (1) the current state of physiotherapy practice in team-based primary care organizations in Ontario, (2) the perceived barriers to and facilitators of providing physiotherapy services, and (3) recommendations for improving how these services are provided. Method: This was a cross-sectional, web-based survey. We analyzed the responses using descriptive statistics and summative content analysis. Results: A total of 66 responses were received, and 61 were included in the final analysis. The respondents reported that most of their practice was directed toward musculoskeletal care, followed by multi-system, neurological, and cardiorespiratory conditions, and that most of their direct patient care was focused on in-person, one-to-one assessment or follow-up. Frequently identified barriers to providing physiotherapy services included a lack of space, resources, time, and equipment. The most common facilitators were support from management, recognition and support from other health care providers about the value and role of physiotherapists, and appropriate referrals from other health care providers. The most common recommendation was to increase the physiotherapist-to-patient ratio at primary care sites. Conclusions: Physiotherapists provide care to diverse populations in team-based primary care, which is influenced by specific barriers and facilitators. Our results highlight opportunities for physiotherapists in this context, such as increasing the provision of first-contact care and group-based interventions.

Objectif : décrire 1) l'état actuel de la pratique de la physiothérapie dans les organisations de soins de première ligne en équipe de l'Ontario; 2) les obstacles et les incitations perçus à la prestation des services de physiothérapie et 3) les recommandations pour améliorer le mode de prestation de ces services. Méthodologie : sondage transversal en ligne. Les chercheurs ont évalué les réponses au moyen de l'analyse des statistiques descriptives et du contenu sommatif. Résultats : les chercheurs ont reçu 66 réponses et en ont retenu 61 dans l'analyse définitive. Les répondants ont indiqué que la majorité de leur pratique était axée sur les soins musculosquelettiques, suivie par les affections multisystémiques, neurologiques et cardiorespiratoires, et que la plupart des soins directs aux patients prenaient la forme d'évaluations en personne, d'évaluations individuelles ou de suivis. Les obstacles fréquents à la prestation des services de physiothérapie incluaient le manque d'espace, de ressources, de temps et d'équipement. Les principales incitations étaient le soutien de la direction, la reconnaissance et le soutien des autres travailleurs de la santé quant à l'importance et au rôle des physiothérapeutes et des envois appropriés en physiothérapie de la part des autres travailleurs de la santé. Les recommandations les plus courantes consistaient à accroître le ratio entre le physiothérapeute et les patients dans les établissements de soins de première ligne. Conclusions : les physiothérapeutes donnent des soins à des populations diversifiées dans des équipes de soins de première ligne, lesquels sont influencés par des obstacles et des incitatifs particuliers. Les résultats font ressortir les possibilités qui s'offrent aux physiothérapeutes dans ce contexte, telles que l'accroissement de la prestation de soins de premier contact et d'interventions de groupe.

Entry-to-practice competency expectations for health justice in Canadian physiotherapy curricula: A scoping review protocol.

Background: In Canada, physiotherapists are expected to possess and demonstrate several essential competencies upon entry-to-practice. Over the past decade, knowledge and skills relating to health justice have become increasingly important for healthcare professionals. However, health justice is still an emerging topic among Canadian physiotherapy programs and current curricula may be lacking explicit content to develop knowledge, skills and behaviours related to health justice which can be used to prepare students for entry-to-practice. This paper outlines a protocol for a planned scoping review. The purpose of this scoping review will be to examine existing Canadian entry-level competencies for physiotherapy related to health justice. Methods: A comprehensive literature search will be completed on four databases: OVID MEDLINE, OVID Emcare, OVID Embase, and EBSCOhost CINAHL. This scoping review will include both quantitative and qualitative methodological study designs. A grey literature search will involve advanced Google searches. Two authors will independently screen titles and abstracts to select articles for full text review. Data extraction for each selected paper will be completed independently by two authors using the proposed data extraction form. The extracted data will be presented through tables and a narrative summary that aligns with the objectives and scope of this review. Conclusion: The data collected from this proposed review will identify existing competencies and gaps related to health justice in current entry-level physiotherapy curricula. This information will assist academic programs in understanding how to integrate and identify competencies and frameworks related to health justice into Canadian physiotherapy programs to ensure students are better prepared to provide culturally competent and inclusive care and promote health justice in practice.

Physiotherapy Students' Performance in Clinical Education: An Analysis of 1 Year of Canadian Cross-Sectional Data.

Purpose: This research examines 1 year of cross-sectional, Canada-wide ratings from clinical instructors using the Canadian Physiotherapy Assessment of Clinical Performance (ACP) and analyzes the performance profiles of physiotherapy students' performance ratings over the course of their entry-to-practice clinical placements. Method: Canadian physiotherapy programmes that use the ACP were invited to submit anonymized, cross-sectional data for placements completed during 2018. Descriptive analyses and summary statistics were completed. Mixed-effects modelling was used to create typical performance profiles for each evaluation criterion in the ACP. Stepwise ordered logistic regression was also completed. Results: Ten programmes contributed data on 3,290 placements. Profiles were generated for each ACP evaluative item by means of mixed-effects modelling; three profiles are presented. In all cases, the predicted typical performance by the end of 24 months of study was approximately the rating corresponding to entry level. Subtle differences among profiles were identified, including the rate at which a student may be predicted to receive a rating of "entry level." Conclusions: This analysis identified that, in 2018, the majority of Canadian physiotherapy students were successful on clinical placements and typically achieved a rating of "entry level" on ACP items at the end of 24 months.

Objectif : étude transversale d'un an des évaluations canadiennes des moniteurs cliniques au moyen de l'Évaluation physiothérapique canadienne de la performance clinique (ÉPC) pour analyser les profils de performance des étudiants en physiothérapie pendant la durée de leurs stages cliniques débutants. Méthodologie : les programmes de physiothérapie canadiens qui font appel à l'ÉPC ont été invités à soumettre des données transversales anonymisées sur les stages effectués en 2018. Les chercheurs ont procédé à des analyses descriptives et des statistiques sommaires. Ils ont utilisé des modèles non linéaires à effets mixtes pour créer des profils de performance types pour chaque critère d'évaluation de l'ÉPC. Ils ont également procédé à la régression logistique séquentielle. Résultats : dix programmes ont fourni des données sur 3 290 stages. Les chercheurs ont produit des profils pour chaque point d'évaluation de l'ÉPC au moyen du modèle non linéaire à effets mixtes et en ont retenu trois. Dans tous les cas, la performance type anticipée à la fin des 24 mois d'étude correspondait environ au classement de premier échelon. Les chercheurs ont constaté des différences discrètes entre les profils, y compris la vitesse à laquelle il est possible d'anticiper qu'un étudiant recevra un classement de premier échelon. Conclusions : cette analyse a déterminé qu'en 2018, la majorité des étudiants en physiothérapie canadiens réussissaient leur stage clinique, et ils obtenaient habituellement une note de premier échelon aux points de l'ÉPC à la fin des 24 mois.

Risk-taking behaviors and falls in community-dwelling older adults: a scoping review protocol.

OBJECTIVE: The objectives of this proposed scoping review are to systematically identify the risk-taking behaviors in community-dwelling older adults as well as the methods used to identify these behaviors. This review explores predisposing factors to fall-related, risk-taking behaviors in community-dwelling older adults. INTRODUCTION: Most falls occur as a result of complex interactions between fall risk factors. Research has identified the role of mobility and environmental factors in falls; however, little is known about the role of risk-taking behaviors on falls. INCLUSION CRITERIA: Studies that explore fall-related, risk-taking behaviors in community-dwelling older adults (≥65 years) will be included for this review. Studies will be considered if they are conducted in a research laboratory or community-based setting. Hospital settings will be considered if the study discusses risk-taking in community-based settings. METHODS: A comprehensive literature search will be completed in Ovid AMED, Ovid Embase, Ovid MEDLINE, Ovid PsycINFO, EBSCOhost CINAHL and EBSCOhost AgeLine. Only studies published from the year 2000 onward will be considered for inclusion. Studies published in English and French will be considered for inclusion. Two reviewers will independently screen titles and abstracts to identify studies for full review. The full texts will then be independently reviewed by the same reviewers to assess eligibility, with a third reviewer available to resolve disagreements. A data extraction tool will be used to extract the data from the studies that meet full eligibility criteria. Data extracted from the texts will be synthesized and reported in table format accompanied by a narrative summary that will connect the results the objective of the scoping review. SCOPING REVIEW REGISTRATION: Open Science Framework: https://osf.io/r9f7v.