Abstract Purpose: Dry needling (DN) regulations among the Canadian physiotherapy colleges were compiled to make recommendations toward a national guideline. Method: DN regulatory data extracted from regulatory body websites using an environmental scan framework was checked by an independent reviewer. Colleges were contacted to fill gaps identified from the web. Extracted content was compared to recommendations from two Canadian DN reviews to identify gaps in regulation. Results: DN regulation is done through legislation (two colleges), practice guidelines (one), or both (seven), depending on the college and its provincial or territorial jurisdiction. Three colleges have prerequisites for DN courses, four have approved DN courses, nine require specific course content, three require minimum course hours, nine require registration or rostering, and three have continued competency expectations. No colleges have evidence-based guidelines to inform requirements or meet all DN recommendations. Conclusions: Heterogeneity in regulation likely represents gaps that may potentially expose the public to risk. Physiotherapy colleges could review their regulatory process, address these gaps if they are deemed related to increase risk, and ultimately come to a consensus on what are the safest regulations of practice for Canadian physiotherapists.
Abstract Purpose: Neuromuscular electrical stimulation (NMES) may be used to prevent ICU-acquired weakness. Heart rate variability (HRV), mechanomyography (MMG), and pain objectively assess patient experience and muscle response during NMES, which may facilitate its delivery in non-responsive patients. This study investigated the associations between the secondary outcomes of MMG and HRV with the primary outcomes, quality of contraction (QoC), and pain during NMES. Method: Using a cross-sectional design, an NMES protocol supervised remotely was delivered to the tibialis anterior muscle in 12 healthy participants. Data on MMG assessed using accelerometry, HRV using photoplethysmography, QoC using a modified version of the MRC scale, and self-reported pain using a numeric pain rating scale (NPRS) were collected. A Spearman rank-order correlation was used to determine associations between MMG and NPRS/QoC and between HRV and NPRS/QoC. Results: Positive correlations were found between MMG and NPRS scores, and between MMG and QoC. No significant correlations were observed between HRV and NPRS scores, and between HRV and QoC. Conclusion: MMG, but not HRV, is useful for assessing muscle QoC and pain during NMES. Findings from this study may help guide selection of variables to use in delivery of NMES in non-responsive patients. Further studies with larger sample sizes of non-responsive patients should be explored.
Purpose: The purpose of this scoping review was to search the literature to identify how safety is being defined and to identify the safety frameworks, models, and guidelines that are being integrated into entry-level health professions education (HPE). Method: This scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. A search of Ovid MEDLINE, EMBASE, CINAHL, Web of Science, and ERIC was conducted for studies published in English from 2011. Results: Forty-nine studies were included, and data were organized into four categories: health profession and country; definitions of safety; frequency and types of framework/model/guidelines used; and safety concepts. Studies published in the United States within nursing were reported most frequently. Four papers reported on physiotherapy education. Fifteen studies explicitly defined safety, and the WHO Patient Safety Curriculum Guide for Medical Schools was most commonly cited. Conclusions: Multiple safety frameworks, models, and guidelines are being integrated into HPE. Although some guides have been developed with a multi-profession lens, it is challenging to determine applicability to the physiotherapy profession. There continues to be a focus of minimizing patient harm when safety is integrated into HPE; however, concepts that consider human factors are emerging. Objectif : cette & eacute;tude exploratoire visait & agrave; fouiller les publications pour en extraire les d & eacute;finitions de la s & eacute;curit & eacute; et d & eacute;terminer les cadres, mod & egrave;les et directives de s & eacute;curit & eacute; int & eacute;gr & eacute;es & agrave; l'enseignement des professions de la sant & eacute; (EPS) en entr & eacute;e de pratique. M & eacute;thodologie : les auteurs ont r & eacute;alis & eacute; cette & eacute;tude exploratoire conform & eacute;ment & agrave; la m & eacute;thodologie des & eacute;tudes exploratoires du Joanna Briggs Institute. Ils ont r & eacute;alis & eacute; une recherche dans Ovid MEDLINE, EMBASE, CINAHL, Web of Science et ERIC pour en tirer les & eacute;tudes en anglais publi & eacute;es & agrave; compter de 2011. R & eacute;sultats : au total, 49 & eacute;tudes ont & eacute;t & eacute; incluses, et les donn & eacute;es ont & eacute;t & eacute; class & eacute;es en quatre cat & eacute;gories : profession de la sant & eacute; et pays; d & eacute;finitions de la s & eacute;curit & eacute;; fr & eacute;quence et types de cadre/mod & egrave;le/directives utilis & eacute;s; et concepts de s & eacute;curit & eacute;. Les & eacute;tudes en soins infirmiers, publi & eacute;es aux & Eacute;tats-Unis, & eacute;taient les plus fr & eacute;quentes. Quatre articles portaient sur l'enseignement de la physioth & eacute;rapie. Quinze & eacute;tudes d & eacute;finissaient explicitement la s & eacute;curit & eacute;, et le Guide p & eacute;dagogique pour la s & eacute;curit & eacute; des patients de l'Organisation mondiale de la Sant & eacute; & eacute;tait le plus cit & eacute;. Conclusion : de multiples cadres, mod & egrave;les et directives de s & eacute;curit & eacute; sont int & eacute;gr & eacute;s & agrave; l'EPS. M & ecirc;me si certains guides ont une perspective multiprofessionnelle, il est difficile d'en d & eacute;terminer l'applicabilit & eacute; pour la profession de la physioth & eacute;rapie. La r & eacute;duction des pr & eacute;judices aux patients continue d'& ecirc;tre la priorit & eacute; lorsque la s & eacute;curit & eacute; est int & eacute;gr & eacute;e & agrave; l'EPS, mais des concepts qui tiennent compte des facteurs humains sont en & eacute;mergence.
Abstract Purpose: Our scoping review aimed to explore available evidence on health care providers’ recommendations for return to sport (RTS) after total knee arthroplasty (TKA), particularly in the context of increasing demand among younger patients to restore function, enhance quality of life, and resume sports participation. Method: We searched MEDLINE, CINAHL, Embase, Scopus, and SPORTDiscus for diverse study designs, published between January 1, 1990, and March 30, 2023, that focused on health care provider recommendations for RTS following TKA. Studies were screened through a title/abstract review, followed by a full-text review. The Quality Assessment Tool for Studies with Diverse Designs (QATSDD) was used to evaluate the methodological quality. We synthesized recommendations with a narrative review. Results: Altogether, 23 articles were included for evaluation. Most studies (12) were evaluated as low quality (score < 25%), while remaining studies (11) were rated as moderate quality (score 25%–75%). Recommendations indicated a return to low-to-moderate impact and avoidance of high-impact sports. Concerns for implant survivorship and patient-related factors strongly influenced recommendations. Conclusion: While low-to-moderate impact is recommended, a clear understanding of what defines level of impact and the sports included in each category are not well established and should be explored to offer consistent guidelines.
Abstract Purpose: Patient motivation is essential for successful rehabilitation, so apathy may hinder physiotherapists’ interventions aimed at increasing physical activity. We examined the relationship between apathy and physical activity to identify the factors that influence it. Methods: Pearson product-moment correlations were pooled from eligible studies to examine the relationship between apathy and physical activity. Subgroup meta-analyses and meta-regressions were also conducted. Results: From the systematic review (28 articles) and main meta-analysis (22 studies; N = 12,541), the results showed a negative correlation between apathy and physical activity ( r = −0.13; 95% CI: −0.18, −0.09; p < 0.0001 based on Pearson’s r -values; r = −0.40; 95% CI: −0.68, −0.02; p = 0.043 based on Spearman’s ρ-values). The correlation was statistically significant in patients with Parkinson’s disease and in older adults who were healthy, depressed, fallers, or had mild cognitive impairment. A meta-regression showed an effect of age, with a stronger correlation between apathy and physical activity in older adults compared to younger adults ( p = 0.003). Conclusion: Higher levels of apathy are associated with lower levels of physical activity, and this negative association is stronger with age. Therefore, apathy may limit exercise therapy efficacy and carry prognostic implications for patients whose condition requires physical activity.
Purpose: This cross-sectional descriptive study sought to determine the influence of ankle power on balance performance. Method: Twenty healthy older adults (>= 70 years; 11 men, 9 women; mean [SD] age of 76.6 [5.5] years) with no prior debilitating injuries, neurological disorders, or respiratory diseases participated. Ambulatory balance was assessed using the Community Balance and Mobility Scale (CB&M, out of 96) - a performance-based functional outcome measure. Average power about the ankle joint was measured during unilateral isotonic ankle plantarflexion and dorsiflexion contractions. The Gait Real-Time Analysis Interactive Lab (GRAIL) system was used for perturbation tests, which included posteriorly directed movements of treadmill belts (300 ms duration, causing an anterior displacement of the participant's centre of mass) performed unilaterally (left belt) or bilaterally (both belts). The relationship between the average power measured at the ankle joint and balance performance was assessed. Results: Older adults demonstrated a significant positive correlation between ankle plantarflexor power and CB&M score (rho = 0.464; p = 0.04) and between ankle plantarflexor power and unilateral perturbation intensity (rho = 0.486; p = 0.03). Conclusion: Maintaining ankle plantarflexion power during the aging process may be critical in maintenance of functional performance in older adults.
Purpose:Hybrid training programmes (MPT-PhD) were developed at four Canadian universities to support aspiring clinician-scientists in the physiotherapyfield. The purpose of this study was to qualitatively explore the experiences of MPT-PhD trainees to understand (1) the supports needed to be successfulwithin this programme, (2) the associated barriers that can arise within this programme, and (3) careers and opportunities available after graduation.Method:An interpretive descriptive approach was used to interview individuals in various stages of the MPT-PhD programme in Canada. Interviews wereconducted by two researchers.Results:A total of nine participants from three of the four programmes completed interviews. Overall, participants had apositive experience in the programme but noted barriers: lack of clinician-scientist placements, lack of programme structure, and poor work-life balance.Integrating their experiences led to recommendations to set clear milestones: having at least one placement in a clinical setting related to their research,creating social connections with other students, and facilitation of clinician-scientist positions both within and beyond academia.Conclusion:Althoughpreliminary, the results provide an understanding of the MPT-PhD student experience. Findings serve as a first step toward improving and supportingMPT-PhD students' needs as they develop into clinician-scientists
Purpose: Neurogenic bladder and bowel dysfunction (NBBD) is a common sequela of spinal cord injury (SCI). Pelvic floor physiotherapy (PFPT) is a treatment with demonstrated effectiveness that is not yet routinely offered to SCI patients. We developed a knowledge translation (KT) tool for physiotherapists at the Jewish Rehabilitation Hospital (JRH) that communicates recommendations for the physiotherapy management of NBBD in non-traumatic SCI (NTSCI) patients. Method: This mixed-methods study identified knowledge gaps, practice gaps, and barriers to knowledge use in the JRH SCI health care team via a focus group and an interview to inform the design of a KT tool. Concurrently, we conducted a scoping review on physiotherapy management of NBBD and developed treatment recommendations. Results: We identified five evidence-based treatment approaches and developed quick-use recommendation tables. Three major themes emerged that informed KT tool development: (1) the physiotherapist's journey to proficiency in treating NBBD, (2) navigating the development of a physiotherapy NBBD programme, and (3) recognizing the importance of interdisciplinary collaboration. Conclusions: There is evidence to support the use of physiotherapy for treating some forms of NBBD. We devised a KT tool to guide clinicians in using physiotherapy for NBBD. Objectif : la vessie neurog & egrave;ne associ & eacute;e au dysfonctionnement intestinal (VNDI) est une s & eacute;quelle courante des l & eacute;sions m & eacute;dullaires. La physioth & eacute;rapie pelvienne est un traitement & agrave; l'efficacit & eacute; d & eacute;montr & eacute;e qui n'est pas encore offert syst & eacute;matiquement aux patients atteints de l & eacute;sions m & eacute;dullaires. Les chercheuses ont cr & eacute;& eacute; un outil d'application des connaissances (AC) pour les physioth & eacute;rapeutes du Jewish Rehabilitation Hospital (JRH), lequel contient des recommandations pour la prise en charge physioth & eacute;rapique de la VNDI chez les patients atteints de l & eacute;sions m & eacute;dullaires non traumatiques (LMNT). M & eacute;thodologie : cette & eacute;tude & agrave; m & eacute;thodes mixtes a fait ressortir des lacunes sur le plan des connaissances et de la pratique et des obstacles & agrave; l'utilisation des connaissances de l'& eacute;quipe soignante responsable des l & eacute;sions m & eacute;dullaires du JRH. Pour parvenir & agrave; ces constatations, elles ont form & eacute; un groupe de travail et proc & eacute;d & eacute; & agrave; une entrevue pour & eacute;clairer la conception d'un outil d'AC. Parall & egrave;lement, elles ont r & eacute;alis & eacute; une analyse exploratoire sur la prise en charge de la physioth & eacute;rapie de la VNDI et formul & eacute; des recommandations en mati & egrave;re de traitement. R & eacute;sultats : les chercheuses ont relev & eacute; cinq approches th & eacute;rapeutiques fond & eacute;es sur des donn & eacute;es probantes et cr & eacute;& eacute; des tableaux de recommandations & agrave; consultation rapide. Trois th & egrave;mes majeurs ont & eacute;merg & eacute; qui ont & eacute;clair & eacute; l'& eacute;laboration de l'outil d'AC : 1) le parcours du physioth & eacute;rapeute vers la ma & icirc;trise du traitement de la VNDI, 2) la fa & ccedil;on de man oe uvrer dans l'& eacute;laboration d'un programme de VNDI en physioth & eacute;rapie et 3) l'importance de la collaboration interdisciplinaire. Conclusions : des donn & eacute;es probantes appuient le recours & agrave; la physioth & eacute;rapie pour traiter la VNDI. Les chercheuses ont con & ccedil;u un outil d'AC pour guider les cliniciens afin qu'ils utilisent la physioth & eacute;rapie dans le traitement de la VNDI.
Purpose: To evaluate final-year physiotherapy and medical students' perceptions of physical activity prescription. Method: A cross-sectional non-validated survey was designed/piloted in English and French. Survey sections/questions were informed by validated questionnaires and existing evidence for physical activity prescription. The open online survey was hosted on Qualtrics, a secure online data collection system. A convenience sample of Canadian final-year physiotherapy and medical students were recruited June 2022 to April 2023 through their programme leads. Altogether 107 students participated (58 medical, 49 physiotherapy). Independent variables were field of study (physiotherapy/medicine) and previous degree. Results: Most participants (99.1%) strongly agreed that physical activity is an essential component of preventive medicine, and 95.3% agreed they needed more training regarding the role of physical activity in preventive medicine. Students felt they had the knowledge (77.0%) and skills (82.0%) required to prescribe physical activity. Knowledge to prescribe was highly correlated with confidence to prescribe physical activity. However, confidence varied with degree programmes and prior education. Conclusions: Physical activity is highly valued among final-year medical/physiotherapy students; they feel knowledgeable and confident in their skills prescribing physical activity. Some factors, such as previous degree (kinesiology) and field of study (physiotherapy), positively influence confidence in designing physical activity programmes. Objectif : & eacute;valuer la perception des finissants en physioth & eacute;rapie/m & eacute;decine concernant la prescription d'activit & eacute; physique. M & eacute;thode : un questionnaire transversal non valid & eacute;, & eacute;labor & eacute;/test & eacute; en fran & ccedil;ais/anglais & agrave; partir d'outils valid & eacute;s et de donn & eacute;es existantes, a & eacute;t & eacute; diffus & eacute; en ligne sur Qualtrics (plateforme s & eacute;curis & eacute;e). Un & eacute;chantillon de convenance de finissants canadiens en physioth & eacute;rapie/m & eacute;decine a & eacute;t & eacute; recrut & eacute; de juin 2022 & agrave; avril 2023 via leurs responsables de programme. Au total, 107 & eacute;tudiants ont particip & eacute; (58 en m & eacute;decine, 49 en physioth & eacute;rapie). Les variables ind & eacute;pendantes & eacute;taient le domaine d'& eacute;tudes et les dipl & ocirc;mes ant & eacute;rieurs. R & eacute;sultats : presque tous les r & eacute;pondants (99,1 %) consid & eacute;raient que l'activit & eacute; physique & eacute;tait une composante essentielle en m & eacute;decine pr & eacute;ventive, et 95,3 % estimaient avoir besoin de davantage de formation au sujet de son r & ocirc;le en m & eacute;decine pr & eacute;ventive. Les & eacute;tudiants croyaient majoritairement d & eacute;tenir les connaissances (77 %) et comp & eacute;tences (82 %) n & eacute;cessaires pour en prescrire. Les connaissances & eacute;taient fortement corr & eacute;l & eacute;es & agrave; la confiance, laquelle variait selon le programme et la formation pr & eacute;alable. Conclusion : l'activit & eacute; physique est fortement valoris & eacute;e par les finissants en m & eacute;decine/physioth & eacute;rapie, qui se sentent globalement comp & eacute;tents pour en prescrire. Les & eacute;tudes ant & eacute;rieures, notamment en kin & eacute;siologie, ainsi que le domaine d'& eacute;tudes, semblent renforcer la confiance envers la conception de programmes d'activit & eacute; physique.
Purpose: We described physiotherapy (PT) learner confidence and comfort in engaging in challenging conversations before and after a simulation-based lab and explored how learners found the activity helpful. Method: Quantitative data were collected through three online surveys (before, immediately after, and 3 months after the lab) and analyzed via descriptive statistics. Qualitative data were collected through open-ended survey questions and reflection papers, and analyzed via thematic content analysis. Method: Twenty-two, predominantly female (72.7%) second year entry-level PT learners participated (mean age 25.7 [SD 2.9] years). Learners' confidence or comfort increased 16%-100% after the lab. Learners found the lab to be a valuable learning experience and reported that feedback and observation, realism, and preparation influenced their learning. The lab reinforced and provided new learning about several communication skills like developing a connection and reading non-verbal cues. Some learners had difficulty integrating communication into their perception of PT skills and felt the need to resolve or "fix" the issue. Method: A simulation-based Challenging Conversations Lab was perceived to be a valuable learning experience that may have increased comfort and confidence in engaging in challenging communication scenarios for entry-level PT students. Method: les autrices ont d & eacute;crit la confiance et l'aisance des personnes en apprentissage de la physioth & eacute;rapie & agrave; participer & agrave; des & eacute;changes difficiles avant et apr & egrave;s un laboratoire de simulation et ont & eacute;tabli si ces personnes avaient trouv & eacute; l'activit & eacute; utile. Method: les autrices ont recueilli des donn & eacute;es quantitatives au moyen de trois sondages en ligne (avant, imm & eacute;diatement apr & egrave;s et trois mois apr & egrave;s le laboratoire) et ont utilis & eacute; des statistiques descriptives pour les analyser. Elles ont amass & eacute; les donn & eacute;es qualitatives par des questions de sondage ouvertes et des articles de r & eacute;flexion et les ont analys & eacute;es & agrave; l'aide d'une analyse de contenu th & eacute;matique. Method: au total, 22 personnes en apprentissage de deuxi & egrave;me ann & eacute;e en entr & eacute;e de pratique, surtout des femmes (72,7 %), ont particip & eacute; (& acirc;ge moyen de 25,7 [& Eacute;T 2,9] ans). Leur confiance et leur aisance sont pass & eacute;es de 16 % & agrave; 100 % apr & egrave;s le laboratoire. Ces personnes ont consid & eacute;r & eacute; le laboratoire comme une exp & eacute;rience d'apprentissage pr & eacute;cieuse et ont soulign & eacute; que les commentaires, l'observation, le r & eacute;alisme et la pr & eacute;paration ont influ & eacute; sur leur apprentissage. Le laboratoire a renforc & eacute; et fourni de nouvelles connaissances sur diverses habilet & eacute;s de communication, telles que l'& eacute;tablissement d'un lien et le d & eacute;codage des indices non verbaux. Certaines personnes en apprentissage & eacute;prouvaient de la difficult & eacute; & agrave; int & eacute;grer la communication & agrave; leur perception des habilet & eacute;s des physioth & eacute;rapeutes et ressentaient le besoin de r & eacute;soudre le probl & egrave;me ou d'y & laquo; rem & eacute;dier & raquo;. Method: un laboratoire d'& eacute;changes difficiles fond & eacute; sur la simulation a & eacute;t & eacute; per & ccedil;u comme une pr & eacute;cieuse exp & eacute;rience d'apprentissage qui peut avoir accru l'aisance et la confiance & agrave; participer & agrave; des sc & eacute;narios de communication difficiles pour les & eacute;tudiantes et & eacute;tudiants en physioth & eacute;rapie en entr & eacute;e de pratique.
Purpose: This study explores how older adults with and without major neurocognitive disorder experienced the use of immersive virtual reality (VR) applications aiming to promote and assess upper limb activity. Method: A qualitative design within an interpretivist paradigm was employed. Thirty participants over 60 years of age were recruited from the Canadian population. After an upper limb immersive VR session, semi-structured interviews were conducted to gather insights from the participants. Thematic analysis using a six-phase framework was performed to identify and analyze key themes in the interview data. Results: Five main themes emerged from the analysis: prior experience and apprehensions toward immersive VR, comfort and usability of the device, design of the virtual background, interaction in immersive VR, and clinical applicability of immersive VR. Overall, older adults seemed motivated by the playful, challenging, and entertaining interactions offered by immersive VR. Conclusion: Immersive VR was described as beneficial for motricity and cognition. Participants found it to be an interesting tool for performing exercises and assessing performance more autonomously. Objectif : cette & eacute;tude explore la mani & egrave;re dont les personnes & acirc;g & eacute;es ayant ou non un trouble neurocognitif majeur vivaient l'utilisation des applications de r & eacute;alit & eacute; virtuelle (RV) pour promouvoir et & eacute;valuer l'activit & eacute; des membres sup & eacute;rieurs. M & eacute;thodologie : les chercheuses et chercheurs ont privil & eacute;gi & eacute; une m & eacute;thodologie qualitative assortie d'un paradigme interpr & eacute;tatif. Au total, 30 participants de plus de 60 ans ont & eacute;t & eacute; recrut & eacute;s au sein de la population canadienne. Apr & egrave;s une s & eacute;ance de RV immersive des membres sup & eacute;rieurs, des entrevues semi-structur & eacute;es ont & eacute;t & eacute; r & eacute;alis & eacute;es pour obtenir leurs points de vue. L'analyse th & eacute;matique au moyen d'un cadre en six phases a permis de d & eacute;gager et d'& eacute;valuer les principaux th & egrave;mes des donn & eacute;es d'entrevue. R & eacute;sultats : cinq grands th & egrave;mes ont & eacute;merg & eacute; de l'analyse : une exp & eacute;rience ant & eacute;rieure et les appr & eacute;hensions envers la RV immersive, le confort et l'utilisabilit & eacute; de l'appareil, la conception de l'arri & egrave;re-plan virtuel, l'interaction avec la RV immersive et l'applicabilit & eacute; clinique de la RV immersive. Dans l'ensemble, les personnes & acirc;g & eacute;es semblaient motiv & eacute;es par les interactions amusantes, difficiles et divertissantes offertes par la RV immersive. Conclusion : la RV immersive a & eacute;t & eacute; d & eacute;crite comme b & eacute;n & eacute;fique pour la motricit & eacute; et la cognition. Les participants ont & eacute;tabli qu'il s'agissait d'un outil int & eacute;ressant pour faire de l'exercice et & eacute;valuer la performance de mani & egrave;re plus autonome.
Purpose: This study aimed to identify simulation practices currently working well to teach cardiovascular pulmonary (CVP) physiotherapy skills, and to describe what educators perceive as the ideal future use for simulation. Method: Participants were physiotherapists involved in teaching CVP physiotherapy at 1 of the 15 Canadian entry-to-practice physiotherapy programmes. We collected data with an online survey and through virtual focus groups. We conducted the focus groups using an appreciative inquiry approach and analyzed results using directed content analysis. Results: Eleven people (representing 73.3% of Canadian physiotherapy programmes) completed the survey, and 12 (representing 80.0% of Canadian physiotherapy programmes) participated in focus groups. They described various simulation practices across programmes, detailing equipment used, educational context, and skills targeted. We identified six themes: (1) there is value in different simulation modalities and levels of fidelity; (2) using simulation presents multiple ubiquitous challenges; (3) educators are open to innovative and collaborative co-design; (4) the ideal use of simulation involves dynamic scenarios that build in complexity; (5) structured debriefing from experienced educators is an essential component; and (6) sustainable delivery requires advocacy, initial investment, and broadening the application of simulation. Conclusions: Innovative and collaborative co-design may further evolve and strengthen simulation practice in CVP physiotherapy education.
Purpose: The Rehabilitation Advice Line (RAL) was implemented in May 2020 in Alberta, Canada, offering real-time occupational and physical therapy advice. This study investigates (1) Did patients' health services utilization (HSU) costs change after calling RAL?; (2) What were the determinants of cost reduction? Method: We used a population-based retrospective cohort design including all RAL-answered calls between May 2020 and March 2023. We compared HSU costs (in-patient, outpatient, physician services, and prescription drugs) across three 1-year periods from the date of first RAL call: 2-years prior, 1-year prior, and 1-year post. Multivariable analyses were used to examine determinants of the probability and the amount of HSU cost reduction. Results: The analyses included 19,455 callers. A cost reduction of $12,121 (95% CI: $10,073, $14,168) per caller was observed from 1-year prior to 1-year post first call to RAL. Key determinants of cost reduction were being male, calling RAL soon after hospital discharge or physician visit, and higher Charlson Comorbidity Index. Conclusion: RAL is associated with reduced HSU costs incurred by the public health care system following a patient's first call. Further study with a control group accounting for natural change is recommended to quantify the magnitude of the impact of RAL. Objectif : la Rehabilitation Advice Line (RAL - ligne de conseils en r & eacute;adaptation) a & eacute;t & eacute; cr & eacute;& eacute;e en mai 2020 en Alberta pour offrir des conseils professionnels ou physioth & eacute;rapiques en temps r & eacute;el. Cette & eacute;tude a & eacute;tudi & eacute; 1) si les co & ucirc;ts de l'utilisation des services de sant & eacute; (USS) par les patients changent apr & egrave;s un appel & agrave; la RAL; 2) les d & eacute;terminants de r & eacute;duction des co & ucirc;ts. M & eacute;thodologie : les chercheurs ont utilis & eacute; une m & eacute;thodologie de cohorte r & eacute;trospective en population qui incluait tous les appels auxquels a r & eacute;pondu la RAL entre mai 2020 et mars 2023. Ils ont compar & eacute; les co & ucirc;ts de l'USS (hospitalisation, soins ambulatoires, services de m & eacute;decins et m & eacute;dicaments sur ordonnance) sur trois p & eacute;riodes d'un an & agrave; compter de la date du premier appel & agrave; la RAL : deux ans auparavant, un an auparavant et un an apr & egrave;s. Ils ont utilis & eacute; les analyses multivariables pour examiner les d & eacute;terminants de la probabilit & eacute; et la valeur de la r & eacute;duction des co & ucirc;ts d'USS. R & eacute;sultats : les analyses ont inclus 19 455 appelants. Une r & eacute;duction des co & ucirc;ts de 12 121 $ (IC & agrave; 95 % : 10 073 $, 14 168 $) par appelant a & eacute;t & eacute; observ & eacute;e entre la p & eacute;riode d'un an avant & agrave; un an apr & egrave;s le premier appel & agrave; la RAL. Les principaux d & eacute;terminants de r & eacute;duction des co & ucirc;ts & eacute;taient le sexe masculin, l'appel & agrave; la RAL peu apr & egrave;s le cong & eacute; de l'h & ocirc;pital ou la visite chez le m & eacute;decin et un indice de comorbidit & eacute; de Charlson & eacute;lev & eacute;. Conclusion : la RAL est associ & eacute;e & agrave; une r & eacute;duction des co & ucirc;ts d'USS engag & eacute;s par le syst & egrave;me de sant & eacute; publique apr & egrave;s le premier appel d'un patient. Il est recommand & eacute; de mener une & eacute;tude plus approfondie dot & eacute;e d'un groupe t & eacute;moin qui tiendra compte des changements naturels des patients pour quantifier l'ampleur des effets de la RAL.
Purpose: Models of care using advanced practice physiotherapists (APPTs) have been proposed as a solution to improve health care access and efficiency for patients with spinal disorders referred to specialized spine surgery care. The objective was to explore the experiences and perceptions of both APPTs and patients with spinal disorders within a specialized spinal surgery model of care. Method: APPTs and patients with spinal disorders who provided or received care as part of a randomized controlled trial evaluating a new spinal surgery model of care were invited to participate in this qualitative study. Semi-structured interviews were performed to identify themes related to their experiences and perceptions of this model of care. Verbatim transcripts were coded and analyzed using an inductive thematic analysis. Results: Seven APPTs and nine patients were included. Three main themes emerged from our analysis: (1) The standard medical model of care for spinal disorders is problematic; (2) the advanced practice physiotherapy model of care is a great solution to help manage patients with spinal disorders; but (3) there are areas for improvement in this model. Conclusions: Overall, patients and APPTs were positive regarding this advanced practice physiotherapy model of care as a solution to improve health care access and quality.
Purpose: Professionalism in health care is acknowledged as a significant factor in driving positive outcomes. Within physical therapy, professionalism is commonly represented by core values, with values of social responsibility and compassion increasingly desired to impact health from individual and societal levels. Assessment remains challenging with limitations in evidence concerning the psychometric properties of instruments. The purpose of this study was to examine the psychometric properties of the scores for the Societal Outreach Scale (SOS) and the Compassion Scale (CS) among entry-level Doctor of Physical Therapy (DPT) students. Method: Seventy-one second-year DPT students in the Southeastern United States were included in the pretest-posttest study. An online survey of SOS, CS, and Physical Therapy Core Values Self-Assessment (PTCVSA) was distributed at pre and post-intervals of a service-learning practicum (SLP). Examined psychometric properties for SOS and CS scores included test-retest reliability using intraclass correlation coefficient (ICC), construct validity using Pearson correlation coefficients (r) to examine correlations between SOS scores and domains of the PTCVSA, and responsiveness through effect sizes (ES). Item analysis examined agreement and order effect between SOS and corresponding items within the PTCVSA. Results: The SOS scores demonstrated good reliability (ICC: 0.83 [95% CI: 0.71, 0.91]). The total SOS scores and those extracted from the same items on the PTCVSA demonstrated no difference (p = 0.661). Minus one item, participants scored higher on the PTCVSA with 6 items, demonstrating a significantly higher score (p < 0.05). The ES for SOS scores was 0.86 (95% CI: 0.55, 1.17), suggesting excellent responsiveness. Correlations of SOS items to PTCVSA social responsibility items ranged from 0.46 (95% CI: 0.21, 0.65) to 0.73 (95% CI: 0.56, 0.84), indicating moderate correlation (10 items), and strong correlation (2 items). The CS demonstrated poor reliability (ICC: 0.57 [0.26-0.75]) and poor responsiveness (ES: 0.35 [95% CI: 0.07, 0.62]). Conclusions: The SOS is a psychometrically strong instrument that allows independent assessment of students' social responsibility values. Results support the use of the SOS as a reliable and responsive assessment measure.
