Assessing the feasibility of a clinical trial to evaluate an advanced practice physiotherapy model of care in chronic pain management: a feasibility study.

BACKGROUND: Chronic pain management is challenging for health systems worldwide. Clinical practice guidelines recommend interprofessional chronic pain management, but chronic pain clinics often have lengthy wait-lists. Advanced practice physiotherapists (APP) in orthopedic clinics and emergency departments have provided effective care and reduced wait times. The purpose of this study is to determine the feasibility of a clinical trial to evaluate the effects of integrating an APP into a chronic pain clinic setting. The primary objectives are as follows: (1) determine the feasibility of implementing trial methods by evaluating participant recruitment rates, retention, and assessment completion; (2) determine the feasibility of implementing the APP model of care by monitoring care provided and treatment fidelity; and (3) assess contextual factors that may influence implementation of the APP model of care by exploring the perspectives of patient participants and healthcare providers related to the model of care. METHODS: This will be a single-arm feasibility study with embedded qualitative interviews to assess contextual factors influencing implementation by exploring participant and provider perspectives. Approximately 40 adults with chronic musculoskeletal pain referred for care at an interprofessional chronic pain clinic will be invited to participate in the feasibility study. Approximately 10-12 patient participants and 5-10 health professionals from the interprofessional team will be interviewed using an interpretive description approach. The APP model of care will involve participants seeing a physiotherapist as the first point of contact within the interprofessional team. The APP will complete an initial assessment and make care recommendations. Outcome measures planned for the full trial will be reported descriptively, including pain severity, pain interference, health-related quality of life, psychosocial risk factors for chronic pain, treatment satisfaction, perceived change, healthcare utilization, and healthcare costs over one year. DISCUSSION: This study will inform plans to implement a full-scale study to evaluate the impact of an APP model of care in an interprofessional chronic pain management program. The results of the full study are intended to inform stakeholders considering this model to improve patient-centered and health system outcomes in interprofessional pain management program settings. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05336903 (Registered April 5, 2022).

Experiences of Physiotherapy Students, Health Care Providers, and Patients with a Role-Emerging Student Clinical Placement in an Emergency Department: A Qualitative Study.

Purpose: To understand the experiences and perspectives of physiotherapy (PT) students, their clinical instructor, nurses, physicians, and patients with a role-emerging student clinical placement in an emergency department (ED) and to identify barriers and facilitators in implementing this placement model. Method: We conducted qualitative semi-structured interviews with 6 PT students, 1 PT clinical instructor, 15 nurses, 12 physicians, and 17 patients. Five researchers independently coded the transcribed interviews and performed thematic analysis in an interpretive description tradition with frequent peer debriefing and reflexive discussions. Results: Students and their clinical instructor reported that the placement setting provided a unique learning opportunity. Patients and ED staff noted that involving the PT students in patient care delivery improved the musculoskeletal assessments and self-management advice provided to patients. Identified barriers included students' inability to chart in the electronic medical record, lack of bed space, and lack of clarity about students' scope and abilities. Reported facilitators included positive perceptions of the students' supervision and a perceived positive impact on patient care and the health care team. Conclusions: Participants reported positive experiences with the student ED placement and recommended similar placements in the future. Understanding barriers and facilitators in implementing PT student clinical placements in an ED can inform future placements.

Objectif : comprendre les expériences et les perspectives des étudiants en physiothérapie, de leur moniteur clinique, des infirmières, des médecins et des patients à l'égard d'un stage clinique émergent en physiothérapie à l'urgence et déterminer les obstacles et les incitatifs à l'adoption de ce modèle de stage. Méthodologie : entrevues qualitatives semi-structurées auprès de six étudiants en physiothérapie, un moniteur clinique en physiothérapie, 15 infirmières, 12 médecins et 17 patients. Cinq chercheurs ont codé la transcription des entrevues de manière indépendante et ont procédé à une analyse thématique dans la tradition de la description interprétative accompagnée de fréquents bilans avec les collègues et de fréquentes discussions réflexives. Résultats : selon les étudiants et leur moniteur clinique, le milieu de stage fournissait une occasion d'apprentissage unique. Les patients et le personnel de l'urgence ont remarqué que les étudiants amélioraient les évaluations musculosquelettiques et les conseils d'autoévaluation fournis aux patients. Les obstacles perçus étaient l'incapacité des étudiants à consigner l'information dans les dossiers médicaux électroniques, le manque de lits et le manque de clarté quant à la portée de pratiques et aux capacités des étudiants. Les incitatifs constatés incluaient les perceptions positives à l'égard de la supervision des étudiants et la perception de conséquences positives sur les soins pour les patients et l'équipe soignante. Conclusions : les participants ont fait état d'expériences positives dans le cadre des stages des étudiants à l'urgence et ont recommandé des stages semblables à l'avenir. Le fait de comprendre les obstacles et les incitatifs à la mise en œuvre de stages cliniques pour les physiothérapeutes à l'urgence pourra éclairer les futurs stages.

Observations and Performances "with distinction" by Physical Therapy Students in Clinical Education: Analysis of Checkboxes on the Physical Therapist Clinical Performance Instrument (PT-CPI) over a 4-Year Period.

PURPOSE: To describe how often the 24 performance criteria of the Physical Therapist Clinical Performance Instrument (PT-CPI) were not observed and how often they were rated exceptionally well for physical therapy (PT) students in relation to clinical placement descriptors. METHODS: Indicators of "not observed," performance "with distinction," and "significant concerns" were tabulated from 1,460 clinical placements between 2008 and 2012. The rates for these indicators were evaluated with respect to catchment area, practice setting (hospital/institutional or community-based), practice area (musculoskeletal, cardiorespiratory, neurology, paediatrics, geriatrics, or variety), and level (junior to senior). RESULTS: Of the 24 PT-CPI criteria, 15 had observation rates >95%. Of the other nine criteria, some showed significant differences in observation rates across level, practice setting, and practice area. Ratings of "with distinction" were awarded most often for criteria related to professionalism and communication and were awarded more often in community-based settings than in hospital/institutional settings. For some criteria, "with distinction" was awarded more often in paediatrics placements than in other areas. The "significant concerns" checkboxes were rarely used. CONCLUSIONS: The overall observation rates were very similar to those reported elsewhere. The findings related to performance "with distinction" and observation rates relative to setting and practice area are new contributions to physical therapy knowledge.

Objectif : Décrire la fréquence à laquelle les 24 critères de rendement de l'Instrument d'évaluation du rendement clinique des physiothérapeutes (ERC-PT) n'ont pas été observés et la fréquence à laquelle ils ont obtenu une note exceptionnellement élevée pour les étudiants en physiothérapie en fonction des descripteurs des stages cliniques. Méthodes : Les indicateurs de « non-observation ¼ et de rendement « avec distinction ¼ et « avec préoccupations importantes ¼ ont été mis en tableau pour 1 460 stages cliniques de 2008 à 2012. Les taux pour ces indicateurs ont été évalués en fonction de l'aire de recrutement, du contexte de pratique (à l'hôpital/en établissement ou dans la collectivité), du domaine de pratique (appareil locomoteur, appareil cardiorespiratoire, neurologie, pédiatrie, gériatrie, ou divers) et du niveau (débutant à expérimenté). Résultats : Parmi les 24 critères de l'ERC-PT, 15 ont obtenu des taux d'observation supérieurs à 95%. Pour ce qui est des 9 autres critères, certains affichaient des écarts considérables dans les taux d'observation pour le niveau, le contexte de pratique, et le domaine de pratique. La mention « avec distinction ¼ a été accordée le plus souvent pour des critères liés au professionnalisme et à la communication, et plus souvent dans un contexte de pratique dans la collectivité qu'à l'hôpital/en établissement. Pour certains critères, la mention « avec distinction ¼ a été accordée plus souvent dans les stages en pédiatrie que dans d'autres domaines. La case « avec préoccupations importantes ¼ a été très rarement utilisée. Conclusions : Les taux globaux d'observation étaient très semblables à ceux déclarés ailleurs. Les constatations liées au rendement avec distinction et les taux d'observation liés au contexte et au domaine de pratique sont de nouvelles contributions au savoir.

Physiotherapists and Physiotherapy Student Placements across Regions in Ontario: A Descriptive Comparison.

PURPOSE: To describe the distribution and type of physiotherapy student placements in one year relative to the number of practising physiotherapists of Ontario. METHODS: Site information about physiotherapy students' clinical placements in Ontario in 2010 was obtained from Academic Coordinators of Clinical Education. Worksite information about physiotherapists who reported providing direct patient care at a primary employment site in Ontario and at least 600 practice hours in their annual renewal was obtained from the College of Physiotherapists of Ontario. Each placement and each physiotherapist was attributed to one of Ontario's 14 local health integration networks (LHINs). For each LHIN, a ratio of student placements to practising physiotherapists was calculated, using summed counts. Counts of placement types by setting, patient mix, and practice area were also calculated for each LHIN. RESULTS: The 5 LHINs in which the university programmes are located had high placement:physiotherapist ratios, from 0.92 to 0.38. The other 9 LHINs had lower ratios, the 3 lowest at approximately 0.15. There was a wide mix of clinical placement types across LHINs. CONCLUSION: Physiotherapists' participation in physiotherapy students' clinical education varied widely among Ontario regions. Future research could explore whether regional differences are persistent, why they occur, and whether they should be reduced.

Objectif : Mesurer la répartition et décrire le type de stages des étudiants en physiothérapie en une année, comparativement au nombre de physiothérapeutes en exercice en Ontario. Méthode : Les renseignements sur les lieux des stages des étudiants en physiothérapie en Ontario en 2010 ont été obtenus en faisant appel aux coordonnateurs de l'enseignement clinique des universités. Les renseignements sur les milieux de travail des physiothérapeutes qui ont dit offrir des soins directement aux patients dans un établissement de soins de santé primaires en Ontario et qui comptent au moins 600 heures de pratique lors de leur renouvellement annuel ont été obtenus auprès du College of Physiotherapists of Ontario. Chaque stage et chaque physiothérapeute ont été attribués à l'un des 14 Réseaux locaux d'intégration des soins de santé (RLISS) de l'Ontario. Pour chaque RLISS, un rapport entre le nombre de stages étudiants et le nombre de physiothérapeutes en exercice a été calculé à l'aide du total cumulé de chacun. Le nombre de stages d'un type précis par établissement, par type de patients et par domaine de pratique a aussi été calculé pour chaque RLISS. Résultats : Les cinq RLISS situés dans la même région où sont offerts les programmes universitaires affichaient un fort taux de stages: le rapport par physiothérapeute y variait de 0,92 à 0,38. Les neuf autres RLISS affichaient des rapports moins élevés, et les trois RLISS comportant le rapport le plus faible affichaient un coefficient de 0,15. On a dénombré un ensemble très varié de types de stages à travers les différents RLISS. Conclusion : En Ontario, la participation des physiothérapeutes à la formation clinique des étudiants en physiothérapie varie d'une région à l'autre. Des recherches futures pourraient se pencher sur les différences entre les régions et voir si ces différences sont persistantes, pourquoi elles surviennent et s'il serait important de les atténuer.

A chemical proteomics approach to phosphatidylinositol 3-kinase signaling in macrophages.

Prior work using lipid-based affinity matrices has been done to investigate distinct sets of lipid-binding proteins, and one series of experiments has proven successful in mammalian cells for the proteome-wide identification of lipid-binding proteins. However, most lipid-based proteomics screens require scaled up sample preparation, are often composed of multiple cell types, and are not adapted for simultaneous signal transduction studies. Herein we provide a chemical proteomics strategy that uses cleavable lipid "baits" with broad applicability to diverse biological samples. The novel baits were designed to avoid preparative steps to allow functional proteomics studies when the biological source is a limiting factor. Validation of the chemical baits was first confirmed by the selective isolation of several known endogenous phosphatidylinositol 3-kinase signaling proteins using primary bone marrow-derived macrophages. The use of this technique for cellular proteomics and MS/MS analysis was then demonstrated by the identification of known and potential novel lipid-binding proteins that was confirmed in vitro for several proteins by direct lipid-protein interactions. Further to the identification, the method is also compatible with subsequent signal transduction studies, notably for protein kinase profiling of the isolated lipid-bound protein complexes. Taken together, this integration of minimal scale proteomics, lipid chemistry, and activity-based readouts provides a significant advancement in the ability to identify and study the lipid proteome of single, relevant cell types.

Evaluation of the flexion relaxation phenomenon of the trunk muscles in sitting.

STUDY DESIGN: A normative, single-group study was conducted. OBJECTIVE: To investigate the flexion relaxation phenomenon in the thoraco-lumbopelvic muscles among a pain-free population when moving from an upright to a slump sitting posture. SUMMARY OF BACKGROUND DATA: The presence of the flexion relaxation phenomenon (FRP) of the back muscles is well documented at end-range spinal flexion when standing. This phenomenon is commonly found disrupted in low back subjects. However, whether FRP occurs in sitting remains controversial. METHODS: The sample consisted of 24 healthy pain-free adults. Surface electromyography was used to measure activity in the superficial lumbar multifidus (SLM), the thoracic erector spinae (TES), and the transverse fibers of the internal oblique (IO) muscles while subjects moved from an erect to a slump sitting posture. An electromagnetic motion-tracking device simultaneously measured thoracolumbar kinematics during this task. RESULTS: There was a significant decrease in both the SLM and the IO activity when moving from an erect to a slump sitting posture (P = 0.001 and P = 0.004, respectively), indicating the presence of FRP. TES activity was highly variable. While 13 subjects exhibited an increase in activity (P = 0.001), 11 demonstrated a decrease in activity (P = 0.001), indicating the presence of FRP. FRP occurred in the mid-range of spinal flexion for the SLM, IO and TES when present. CONCLUSION: The findings show that the SLM and the IO are facilitated in neutral lordotic sitting postures and exhibit FRP at mid range flexion while moving from upright sitting to slump sitting. These findings show that FRP in sitting differs from that in standing. Variable motor patterns (activation or FRP) of the TES were observed. These findings suggest that sustaining mid to end-range flexed sitting spinal postures result in relaxation of the spinal stabilizing muscles.