Specifying current physical therapy practice for paediatric trials: A survey of United Kingdom physical therapists

Background:Patients with axial spondyloarthritis (axSpA) encounter limitations during daily activities and societal participation which seriously impart health-related quality of life. Optimal management of axSpA consists of combined pharmacological and non-pharmacological treatment modalities, including the encouragement of exercise and the consideration of physical therapy given the latter’s superior efficacy1. Few studies investigated the use of physical therapy and the alignment of treatment content with practice recommendations among patients with axSpA.Objectives:1) To estimate physical therapy use in patients with axSpA in a real life cohort; 2) to quantitatively and qualitatively describe the content of these physical therapy sessions; 3) explore possible determinants of physical therapy use and content.Methods:This cross-sectional study included 197 patients diagnosed with axSpA (Males/Females: 62.4/37.6%; mean±SD, age 42.6±12.0, BASDAI 3.7±2.1, BASFI 3.6±2.4, BASMI 3.1±1.8) and recruited during their routine consultation. The mixed-method approach included questionnaires (physical therapy use and content, medication, depression/anxiety (HADS), fear (TSK), physician global disease activity (PGDA)) and an in-depth qualitative interview (content of physical therapy). Interviews were analyzed using the Qualitative Analysis Guide of Leuven by two physical therapists. Spearman’s Rho correlations guided the exploration of determinants of physical therapy use and content.Results:Less than half (42.6%, n=84) of the axSpA of patients were in treatment with a physiotherapist. Most patients (40.0%) reported a physical therapy frequency of 1x/week. Session duration was typically 30 minutes (51.7% of the sample) and longer in fewer cases (30.0%). Exercise was in only 31.7% the cornerstone of their sessions. The majority of subjects (53.3%) were classified as receiving ‘passive therapy only’, with 10% of cases in the ‘exercise only’ and 36.7% in the ‘combination therapy’ groups. Interviews also revealed a lack of clear patient-centered treatment goals. We found moderate associations between physical therapy use/content parameters and medication, spinal mobility, fear, anxiety, depression, physician’s global disease activity versus (p<.05), but no relationship with patient-reported pain or disease activity.Conclusion:Despite the importance of exercise and the added value of physical therapy in axSpA, few patients engaged in physical therapy sessions that include exercise training of adequate dosage. Remarkably, physical therapy utilization seems to be predominantly guided by psychological factors. Professional education for physical therapists should therefore include skills training in the management of complex clinical presentations2. Last, future research should prepare the evidence-based implementation of state-of-the-art physical therapy guidelines in axSpA.References:[1]van der Heijde D, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis. 2017 Jun;76(6):978-991.[2]Swinnen TW, et al. Widespread pain in axial spondyloarthritis: clinical importance and gender differences. Arthritis Res Ther. 2018 Jul 27;20(1):156.Disclosure of Interests:Evelyne Vanautgaerden: None declared, Marlies Kaerts: None declared, Wim Dankaerts: None declared, Kurt de Vlam Grant/research support from: Celgene, Eli Lilly, Pfizer Inc, Consultant of: AbbVie, Eli Lilly, Galapagos, Johnson & Johnson, Novartis, Pfizer Inc, UCB, Thijs Swinnen: None declared

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Exploring Race Differences in Satisfaction with Rehabilitation Following Total Knee Arthroplasty: a Qualitative Study

The Journals of Gerontology Series A ◽

10.1093/gerona/glab132 ◽

2021 ◽

Author(s):

Allyn M Bove ◽

Erin R Dong ◽

Leslie R M Hausmann ◽

Sara R Piva ◽

Jennifer S Brach ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Physical Therapy ◽

Focus Group ◽

Knee Arthroplasty ◽

Physical Therapists ◽

Race Differences ◽

Theory Approach ◽

Focus Group Study ◽

Black And White ◽

Total Knee

Abstract Background The purpose of this qualitative focus group study was to explore race differences in the rehabilitation experience and satisfaction with rehabilitation following total knee arthroplasty (TKA). Methods We conducted a series of qualitative focus group discussions with groups of Non-Hispanic White and Non-Hispanic Black older adults who recently underwent TKA. We used grounded theory approach, which asks the researcher to develop theory from the data that are collected. Participants discussed barriers and facilitators to accessing rehabilitation after surgery, opinions regarding their physical therapists, the amount of post-operative physical therapy received, and overall satisfaction with the post-operative rehabilitation process. Results Thirty-six individuals participated in focus groups. Three major themes emerged: (1) Participants reported overall positive views of their post-TKA rehabilitation experience. They particularly enjoyed one-on-one care, the ability to participate in “prehabilitation”, and often mentioned specific interventions they felt were most helpful in their recovery. (2) Despite this, substantial barriers to accessing physical therapy exist. These include suboptimal pain management, copayments and other out-of-pocket costs, and transportation to visits. (3) There were minor differences in the rehabilitation experiences between Black and White participants. Black participants reported longer paths toward surgery and occasional difficulty interacting with rehabilitation providers. Conclusions Individuals undergoing TKA can largely expect positive rehabilitation experiences post-operatively. However, some barriers to post-operative physical therapy exist and may differ between Black and White patients. Physical therapists should increase their awareness of these barriers and work to minimize them whenever possible.

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Feasibility of Goal Attainment Scaling in Chronic Low Back Pain: Protocol for Training & Implementation in an Outpatient Physical Therapy Setting (Preprint)

10.2196/preprints.32457 ◽

2021 ◽

Author(s):

Douglas Haladay ◽

Rebecca Edgeworth Ditwiler ◽

Aimee Klein ◽

Rebecca Miro ◽

Matthew Lazinski ◽

...

Keyword(s):

Physical Therapy ◽

Clinical Setting ◽

Goal Attainment ◽

Physical Therapists ◽

The United States ◽

Goal Attainment Scaling ◽

Low Back ◽

Patient Centered ◽

Patient Reported ◽

Qualitative Phase

BACKGROUND Patient engagement in decisions regarding their healthcare may lead to improved outcomes and improved adherence to treatment plans. While there are several options for involving patients in their healthcare, goal setting is a readily accessible method for physical therapists to increase the involvement of patients in healthcare decisions. Physical therapy goals are often provider-generated and based on subjective information or standardized fixed-item patient-reported outcome measures. However, these outcome measures may provide a limited scope of activity and participation limitations which may not capture the needs of individual patients. Goal Attainment Scaling (GAS) is a patient-centered approach to involving patients in setting meaningful goals. While GAS has been shown to be reliable, valid, and sensitive to change in various population, there is limited evidence in the United States about utilizing GAS in the physical therapist management of patients with low back pain (LBP). OBJECTIVE The purpose of this report is to describe the protocol for a study to a) develop an application of GAS procedures to be used by physical therapists treating patients with chronic LBP in the United States and b) to test the feasibility of applying GAS procedures in chronic LBP in an outpatient physical therapy setting. METHODS This study will use a mixed-methods design with two (2) phases (Phase 1: Qualitative, Phase 2: Quantitative). The qualitative phase of the study will employ focus groups of patients with chronic LBP to identify an inventory of goals that are important and measurable. This inventory will be used to develop a series of leading questions that will allow physical therapists to assist patients in establishing goals in the clinical setting. The quantitative phase of the study will pilot-test the inventory developed in the qualitative arm in patients with chronic LBP to determine feasibility, reliability, validity, and responsiveness. We will also compare how well GAS captures change over time as compared to traditional fixed-item patient-reported measures. RESULTS We anticipate that this study will demonstrate that GAS can be implemented successfully by outpatient physical therapists, and it will demonstrate clinically important changes that are important to patients with chronic LBP. CONCLUSIONS GAS represents an opportunity for patient-centered care in the physical therapy management of chronic LBP. While GAS is not new, it has never been studied in a real-world clinical setting for the physical therapy management of chronic LBP which have unique time and productivity constraints. For GAS to be successfully implemented in this environment, we must demonstrate that clinicians can be trained efficiently and reliably, that GAS can be implemented in the clinical setting in under 15 minutes, and that GAS is able to detect clinically meaningful change in patient outcomes. CLINICALTRIAL N/A

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Implementation of Clinical Guidelines on Physical Therapy for Patients With Low Back Pain: Randomized Trial Comparing Patient Outcomes After a Standard and Active Implementation Strategy

Physical Therapy ◽

10.1093/ptj/85.6.544 ◽

2005 ◽

Vol 85 (6) ◽

pp. 544-555 ◽

Cited By ~ 88

Author(s):

Geertruida E Bekkering ◽

Maurits W van Tulder ◽

Erik JM Hendriks ◽

Marc A Koopmanschap ◽

Dirk L Knol ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Physical Therapy ◽

Patient Outcomes ◽

Physical Functioning ◽

Clinical Guidelines ◽

Physical Therapists ◽

Low Back ◽

Active Strategy ◽

Active Implementation

Abstract Background and Purpose. An active strategy was developed for the implementation of the clinical guidelines on physical therapy for patients with low back pain. The effect of this strategy on patients' physical functioning, coping strategy, and beliefs regarding their low back pain was studied. Subjects. One hundred thirteen primary care physical therapists treated a total of 500 patients. Methods. The physical therapists were randomly assigned to 1 of 2 groups. The control group received the guidelines by mail (standard passive method of dissemination). The intervention group, in contrast, received an additional active training strategy consisting of 2 sessions with education, group discussion, role playing, feedback, and reminders. Patients with low back pain, treated by the participating therapists, completed questionnaires on physical functioning, pain, sick leave, coping, and beliefs. Results. Physical functioning and pain in the 2 groups improved substantially in the first 12 weeks. Multilevel longitudinal analysis showed no differences between the 2 groups on any outcome measure during follow-up. Discussion and Conclusion. The authors found no additional benefit to applying an active strategy to implement the physical therapy guidelines for patients with low back pain. Active implementation strategies are not recommended if patient outcomes are to be improved.

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Adjustment of oxygen use by means of pulse oximetry: an important tool for patient safety

Einstein (São Paulo) ◽

10.1590/s1679-45082010ao1377 ◽

2010 ◽

Vol 8 (4) ◽

pp. 449-455 ◽

Cited By ~ 5

Author(s):

Telma de Almeida Busch Mendes ◽

Paola Bruno de Araújo Andreoli ◽

Leny Vieira Cavalheiro ◽

Claudia Talerman ◽

Claudia Laselva

Keyword(s):

Patient Safety ◽

Quality Of Care ◽

Physical Therapy ◽

Confidence Interval ◽

Pulse Oximetry ◽

Patient Care ◽

Physical Therapists ◽

Severe Damage ◽

Margin Of Error

ABSTRACT Objective: To assess patient's level of oxygenation by means of pulse oximetry, avoiding hypoxia (that causes rapid and severe damage), hyperoxia, and waste. Methods: Calculations were made with a 7% margin of error and a 95% confidence interval. Physical therapists were instructed to check pulse oximetry of all patients with prescriptions for physical therapy, observing the scheduled number of procedures. Results: A total of 129 patients were evaluated. Hyperoxia predominated in the sectors in which the patient was constantly monitored and hypoxia in the sectors in which monitoring was not continuous. Conclusions: Professionals involved in patient care must be made aware of the importance of adjusting oxygen use and the risk that non-adjustment represents in terms of quality of care and patient safety.

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Critical analysis of the drafting of physical therapy randomized controlled trials published in Portuguese

Fisioterapia em Movimento ◽

10.1590/0103-5150.029.002.ao21 ◽

2016 ◽

Vol 29 (2) ◽

pp. 421-427

Author(s):

Ercole da Cruz Rubini ◽

Fabio Dutra Pereira ◽

Renato Sobral Monteiro-Junior ◽

Patricia Zaidan ◽

Cintia Pereira de Souza ◽

...

Keyword(s):

Physical Therapy ◽

Randomized Controlled Trials ◽

Gold Standard ◽

Critical Analysis ◽

Physical Therapists ◽

Controlled Trials ◽

High Quality ◽

Randomized Controlled ◽

Methodological Procedures

Abstract Introduction: randomized controlled trials are high quality studies. Many problems related to the drafting of these studies have been identified and consequently various national and international journals, in an attempt to improve this writing, have adopted the Consolidated Standards of Reporting Trials recommendations. Regarding the studies written specifically by physical therapists, until now, the quality of the drafting in Portuguese has been unknown. Aim: To critically analyze the drafting of RCTs in the area of physical therapy, published in Portuguese, in relation to the CONSORT recommendations. Materials and Methods: On 17th Oct, 2012, 548 RCTs in Portuguese were recovered from the MEDLINE and PEDro databases, which were divided among four evaluators who, after reading the abstracts, selected those related to physical therapy. Of these studies, 78 RCTs were related to physical therapy, which were divided among the four evaluators for the analysis of the drafting according to the CONSORT recommendations. The four evaluators who participated in this study previously obtained a median kappa above 70% when their analyses were compared to the analyses of the evaluator considered the gold standard due to having greater experience. Results: The quantity of items of the CONSORT recommendations according to year of publication was very small, corresponding to a mean of 43% of the items in the articles analyzed. Conclusion: The results make very clear the need to improve the quality of the drafting of the RCTs related to physical therapy in Portuguese and to include more rigorous methodological procedures, such as sample size, randomization and blinding. The dissemination and adoption of the CONSORT recommendations by physical therapy researchers would, without doubt, be a big step towards improving this quality.

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Manual hyperinflation and the role of physical therapy in intensive care and emergency units

Fisioterapia em Movimento ◽

10.1590/1980-5918.030.s01.ao23 ◽

2017 ◽

Vol 30 (suppl 1) ◽

pp. 241-248

Author(s):

Rafael Vinícius Santos Cruz ◽

Fabiana do Socorro da Silva Dias de Andrade ◽

Pollyanna Dórea Gonzaga de Menezes ◽

Bruno Oliveira Gonçalves ◽

Robson da Silva Almeida ◽

...

Keyword(s):

Intensive Care ◽

Physical Therapy ◽

Airway Pressure ◽

Physical Therapists ◽

High Peak ◽

Peak Airway Pressure ◽

Routine Practice ◽

Perceived Benefits ◽

Therapy Technique ◽

Emergency Units

Abstract Introduction: Although manual hyperinflation (MHI) is a physical therapy technique commonly used in intensive care and emergency units, there is little consensus about its use. Objective: To investigate the knowledge of physical therapists working in intensive care and emergency units about manual hyperinflation. Methods: Data were collected through self-administered questionnaires on manual hyperinflation. Data collection took place between September 2014 and January 2015, in Itabuna and Ilhéus, Bahia, Brazil. Results: The study sample was composed of 32 physical therapists who had between 4 months and 10 years working experience. All respondents affirmed that they used the technique in their professional practice. However, only 34.4% reported it to be a routine practice. 90.6% stated that the most common patient position during manual hyperinflation is “supine”. Participants were almost unanimous (93.8%) in citing secretion removal and cough stimulation as perceived benefits of MHI. High peak airway pressure was identified as being a precaution to treatment with MHI by 84.4% of participants, whilst 100% of the sample agreed that an undrained pneumothorax was a contraindication to MHI. Conclusion: The most common answers to the questionnaire were: supine position during MHI; secretion removal and cough stimulation as perceived benefits; high peak airway pressure as a precaution; and an undrained pneumothorax as a contraindication.

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Increasing Rehabilitation Therapists’ Confidence Utilizing Evidence-Based Interventions: Pilot Study

Internet Journal of Allied Health Sciences and Practice ◽

10.46743/1540-580x/2018.1759 ◽

2018 ◽

Author(s):

Stephanie Hovick ◽

Ingrid Provident

Keyword(s):

Physical Therapy ◽

Occupational Therapy ◽

Evidence Based Practice ◽

Physical Therapists ◽

Skilled Nursing Facility ◽

Occupational Therapists ◽

Evidence Based ◽

Nursing Facility ◽

Skilled Nursing ◽

Confidence Levels

Evidence-based practice enables rehabilitation therapists to provide the best quality of care and outcomes for patients. However, rehabilitation therapists are often not confident in using evidence in many settings. Purpose. The objective of this evidence-based practice project was to determine if educational small group sessions enhanced occupational therapists, occupational therapy assistants, physical therapists, physical therapy assistants, and a speech and language pathologist’s confidence in utilizing and applying evidence. Method. Eleven rehabilitation therapists of multiple disciplines (occupational therapists, occupational therapy assistants, physical therapists, physical therapy assistants, and a speech and language pathologist) from a skilled nursing facility participated in six educational sessions designed to increase evidence-based practice. A pre- and post-test utilizing the Evidence-Based Practice Profile Questionnaire (EBPPQ), measured change in therapists’confidence regarding evidence-based practice. Results. Results on the Evidence-Based Practice Profile Questionnaire concluded that 7 of 11 rehabilitation therapists reported an increase in confidence levels. Conclusion. Educational small group sessions can be an effective method to assist rehabilitation therapists in developing this confidence. KEYWORDS: Evidence-based practice, confidence levels, rehabilitation therapists, educational sessions, skilled nursing facility

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