s Études scientifiques et détails des séances de formation présentées au Congrès national de l'Association canadienne de physiothérapie (2013).

Performance assessment of personnel is an important component of an organization's quality management program, benefiting the organization, individuals and clients. Performance appraisal is the most common method. This article describes the three-part performance appraisal tool used at the authors' organization, a private inter-professional healthcare agency providing rehabilitation services to clients in the community, and presents the results of a retrospective analysis of the outcomes. Performance appraisals of 13 personnel were randomly selected, representing 39 chart audits and 25 joint client visits. The achievement of mandatory chart audit standards demonstrated 95 ± 7.2% compliance; expected standards showed 96 ± 3.3% compliance. Qualitative findings from the joint visits and interviews showed that therapists enjoyed the process and experience, valued the feedback and appreciated the support they received. Benefits and challenges of the process were identified, resulting in new initiatives being implemented. The authors confirmed that the tool achieves its intended purpose and is relevant in the home care setting.

Introduction: Our goal was to compare behavioral- and information-based interventions aimed at increasing prescription of inspiratory muscle training (IMT) for people with chronic obstructive pulmonary disease (COPD) by interdisciplinary teams during pulmonary rehabilitation (PR). Methods: Six hospital PR programs were randomly assigned to a behavioral- or information-based intervention. Both interventions provided evidence supporting IMT and its prescription details. However, the behavioral-based intervention focused on barriers and challenges to IMT prescription informed by a nationwide survey and the theory of planned behavior (TPB). It included hands-on practice and content, in part, was driven by learners' questions. In contrast, the information-based intervention delivered information in a typical didactic education session followed by a demonstration and question period. It was supplemented with evidence-based research articles. The primary outcome was the change in prescription rate of IMT for COPD patients by determining the difference during the 6 months preceding compared to the 6 months during the interventions. Results: Sixty-one health professionals and 488 COPD outpatients within 6 PR programs participated. No COPD patients were prescribed IMT at any of the sites during the 6-month preintervention phase. The behavioral-based intervention resulted in an IMT prescription rate of 10.2% to people with COPD, whereas the information-based intervention resulted in no IMT prescriptions. Discussion: A behavioral-based intervention that is based on TPB and addresses challenges identified by health professionals is more effective than a traditional lecture approach to increase health professionals' prescription of IMT for patients with COPD.

Scientific papers, special interest papers and education sessions to be presented at the Canadian Physiotherapy Association national congress (2010).

The updated review of Inspiratory Muscle Training in COPD2Geddes E.L. O'Brien K. Reid D. Brooks D. Crowe J. Inspiratory muscle training in adults with chronic obstructive pulmonary disease: an update of a systematic review.Respir Med. 2008; 102: 1715-1729Abstract Full Text Full Text PDF PubMed Scopus (113) Google Scholar represents a worthy attempt to update and develop the evidence base for IMT use in the clinical management of COPD. However we are concerned that one of the reviews outcome measures, inspiratory muscle endurance, is an inadequate index of respiratory endurance. We believe this distinction is important as improving endurance capacity should be one of the primary goals of respiratory training. The review identified three different non-invasive techniques for testing endurance, which have also been described in national society guidelines.1American Thoracic Society/European Respiratory Society ATS/ERS statement on respiratory muscle testing.Am J Resp Crit Care Med. 2002; 166: 518-624Crossref PubMed Scopus (1550) Google Scholar These three endurance tests, respiratory muscle endurance time (RMET), inspiratory threshold loading (ITL) and maximal ventilation volume (MVV) are maximal in nature. They require a high degree of co-operation to ensure that the participant's maximum respiratory ability is attained, and as such make it difficult to establish whether it is respiratory impairment or inadequate effort that is responsible for poor test outcome.4Moxham J. Respiratory muscles.in: Hughes J. Pride N. Lung function tests: physiological principles and clinical applications. WB Saunders, China2000: 55-74Google Scholar When completed correctly these maximal tests can only establish the point of respiratory fatigue or exhaustion, which is when a participant can no longer continue. This is not a measure of respiratory endurance. Rather endurance (from the latin duro or durare – to make hard, last out, to survive) is best defined as the ability to resist fatigue or exhaustion (from fatigo or fatigaio – to weary, tire or to be overcome).3Morwood J. Oxford Latin dictionary. Oxford University Press, UK1994Google Scholar Endurance should therefore be viewed as the capability to continue, whereas fatigue represents the point when the ability to endure has failed. The two terms are not synonymous. While a measure of fatigue provides valuable information about an individual's maximum capacity, it does not measure the clinically important ability of the respiratory system to endure sub-maximal loads such as those experienced during the physical activities of daily life. Although they appear related endurance cannot be accurately predicted from estimates of maximal; ventilatory pressure, capacity or strength.1American Thoracic Society/European Respiratory Society ATS/ERS statement on respiratory muscle testing.Am J Resp Crit Care Med. 2002; 166: 518-624Crossref PubMed Scopus (1550) Google Scholar Furthermore when using these non-invasive techniques it is frequently stated that it is endurance of the respiratory/inspiratory/ventilatory muscles that is being measured, which is a misnomer as the direct function of the respiratory muscles can only be truly measured invasively. To better assess respiratory system endurance, constant loading of the respiratory system would be more appropriate since pathologies such as airway narrowing, chest wall restriction, or muscle weakness are constant (in the short term) rather than progressing ‘loads’.5Rohrbach M. Peret C. Kayser B. Boutellier U. Spengler C. Task failure from inspiratory resistive loaded breathing: a role for inspiratory muscle fatigue?.Eur J Appl Physiol. 2003; 90: 405-410Crossref PubMed Scopus (24) Google Scholar It is the consideration of the difference between maximal diagnostic testing and sub-maximal functionality testing of the respiratory system that is pertinent, as both are important and valid. Many studies describe their training intervention as inspiratory/respiratory muscle endurance training but then do not employ a representative measure of endurance to assess this outcome. With the increasing implementation of respiratory muscle training protocols as highlighted in this review, new and standardised tests are urgently needed to quantify the efficacy of interventions that aim to improve respiratory endurance. Inspiratory muscle training in adults with chronic obstructive pulmonary disease: An update of a systematic reviewRespiratory MedicineVol. 102Issue 12PreviewThe purpose was to update an original systematic review to determine the effect of inspiratory muscle training (IMT) on inspiratory muscle strength and endurance, exercise capacity, dyspnea and quality of life for adults with chronic obstructive pulmonary disease (COPD). The original MEDLINE and CINAHL search to August 2003 was updated to January 2007 and EMBASE was searched from inception to January 2007. Randomized controlled trials, published in English, with adults with stable COPD, comparing IMT to sham IMT or no intervention, low versus high intensity IMT, and different modes of IMT were included. Full-Text PDF Open Archive

The purpose of this cross-cultural study was to compare the level of moral judgement between two groups of students over the period of their professional physical therapy educational programmes as measured by the Defining Issues Test (DIT). Students from two entry-level physical therapy programmes volunteered to participate. The DIT was completed at entry and exit of their respective programmes. DIT mean scores were compared using ancova controlling for age and grade point average. Thirty-eight female, second baccalaureate degree students of diverse religious backgrounds, living in a Western culture and 13 female, first baccalaureate degree students of Islamic religious backgrounds living in an Arabic culture participated. At both entry and exit of their programmes, students from the Western group scored significantly higher on the DIT than the Arabic group (average: 51.1 and 29.9 respectively, P < 0.001). An initial score difference was anticipated given the different levels of education between the groups. Over the period of their studies, the DIT scores of the Western group increased significantly while the scores of the Arabic group remained constant. The DIT appears to not measure moral judgement uniformly across cultures. The moral dilemmas are based in Western values and offer limited insight into Arabic, Muslim moral judgement. With increasingly diverse student populations, physical therapy programmes may need to re-examine the nature of moral judgement and adapt their curricula.

We appreciate the opportunity to respond to the Letter to the Editor. While endurance tests of the inspiratory muscles have limitations, they are not inadequate. We agree with Drs. Powell and Williams that some of the endurance tests cited in our systematic review require a high degree of cooperation and that it might be difficult to establish whether it is impairment or lack of effort that contributes to a poor outcome. However, patient effort and motivation are key components of motor performance. Considering their role in muscle endurance tests will enhance our understanding of how our evaluative measures relate to improvements in a patient's daily life. Several of the inspiratory muscle endurance tests establish the point that a participant can no longer continue, also termed “task failure.” We prefer not to use the term fatigue because of the broader connotations it implies when used in the context of neuromuscular or cognitive fatigue. In such instances, the participant may be able to perform a task while experiencing various types of fatigue. We do not agree that “…direct function of the respiratory muscles can only be truly measured invasively.” This statement is not supported by the NHLBI Working Group report1NHLBI Workshop summary Respiratory muscle fatigue: report of the respiratory muscle fatigue workshop group.Am Rev Respir Dis. 1990; 142: 474-480Crossref PubMed Scopus (109) Google Scholar nor authors, like those included in our systematic review, who perform clinical research and perceive these tests to be estimates of respiratory muscle endurance. Review of the broader literature on limb muscles demonstrates that many clinical tests of muscle performance are used to estimate muscle endurance and are not restricted to invasive measures.2Bentley D.J. Newell J. Bishop D. Incremental exercise test design and analysis: implications for performance diagnostics in endurance athletes.Sports Med. 2007; 37: 575-586Crossref PubMed Scopus (222) Google Scholar, 3Erlenbusch M. Haub M. Munoz K. MacConnie S. Stillwell B. Effect of high-fat or high-carbohydrate diets on endurance exercise: a meta-analysis.Int J Sport Nutr Exerc Metab. 2005; 15: 1-14PubMed Google Scholar, 4Meyer T. Kindermann M. Kindermann W. Exercise programmes for patients with chronic heart failure.Sports Med. 2004; 34: 939-954Crossref PubMed Scopus (18) Google Scholar The inspiratory muscles in different respiratory conditions may undergo relentless loading, however, these loads are not constant. Levels of ventilation, blood flow distribution, and energy supply will vary throughout the day and lifetime of these individuals dependent on physical demands, progression of disease, and the presence of superimposed acute illness or exacerbation. Without a doubt, the inability to sustain a steady-state submaximal load might be attributed to a different combination of factors than those that limit an incremental, progressive threshold loading test of the respiratory muscles. We are not aware of any data to support the clinical utility of one measure over the other but are aware of the practical considerations of performing tests on patients. It would appear that respiratory muscle tests are selected based on whether they can estimate the desired outcome, are straightforward to perform, are not unduly challenging, and are accessible, reliable, and preferably non-invasive. We agree that endurance testing of the inspiratory muscles should be standardized and that new technologies could provide better information to formulate a diagnosis and exercise prescription. Despite the above-described limitations of the inspiratory muscle endurance tests, our rigorous review showed significant improvements in inspiratory muscle strength, exercise performance, decreased dyspnea and improved quality of life. Given the low-risk nature of this type of training, careful consideration of its potential effectiveness in the management plan of each of our patients is warranted.

Interprofessional education (IPE) research has found that students are able to increase their understanding of the roles of others and enhance group process skills in blended face-to-face and e-learning courses (Carbonaro et al., 2008; Cooper & Spencer-Dawe, 2006). This is appealing as a challenge with IPE is the difficulty scheduling events in overcrowded curricula. The Institute of Interprofessional Health Sciences Education (IIHSE) is a virtual learning center that overcomes scheduling barriers through asynchronous on-line learning. The IIHSE on-line learning modules were designed to ensure the contextual relevance of learning that is an essential component of IPE (Hammick, Freeth, Koppel, Reeves, & Barr, 2007). The modules incorporate a problem-based learning approach using patient scenarios as a stimulus for learning. Students come together in small groups as an on-line interprofessional team to share learning experiences and make clinical care decisions. A faculty facilitator role models collaborative practice and facilitates interprofessional interactions. The modules are designed for flexible delivery and can be used as a stand alone course, integrated within a course or combined with other modules. This report describes the evaluation of one IIHSE IPE learning module. The over-riding question was do students learn with, from and about each other through participation in an e-learning module on health care ethics?

Healthcare professionals often encounter moral dilemmas in clinical practice that require increased responsibility and accountability for ethical decision-making. This paper reports the results of a 6-year longitudinal study that explored changes in moral judgement of five consecutive cohorts of occupational therapy (OT) and physical therapy (PT) students over the course of their professional training. The training programme included an ethics education component. The Defining Issues Test (DIT) developed at the University of Minnesota was used to measure moral judgement. A total of 548 students participated in the study. At entry into their professional training, the DIT scores of the OT and PT students were similar but higher overall than the norms established for college level students or for graduates from professional programmes in the DIT standardization sample. At the time of graduation, results showed no significant differences in moral judgement scores between males and females, their chosen programme of study (OT or PT), year of entry, or previous education. Comparing entry scores to exit scores from both programmes for 288 students who provided data at both times, we found that moral judgement scores increased significantly in both OT and PT students over the 2-year programme of study. No differences were found in scores across gender, programme, year of entry, or previous education. Implications are discussed for including a formal ethics education component in the curricula of all health professional training programmes. Recommendations for future research are outlined.

PURPOSE To determine the effect of inspiratory muscle training (IMT) (alone or combined with exercise and/or pulmonary rehabilitation) and compare with other rehabilitation interventions among adults with chronic obstructive pulmonary disease (COPD). METHODS We conducted a systematic review, using Cochrane Collaboration protocol. We included randomized controlled trials, published in English, comparing IMT or combined IMT and exercise/pulmonary rehabilitation with other rehabilitation interventions among adults with COPD. Abstracts were reviewed independently by 2 investigators to determine study eligibility up to December 2005. Data were abstracted and methodological quality of included studies was assessed. RESULTS A total of 156 additional articles were retrieved. Two new studies met the inclusion criteria and were included with 16 studies in the original review. Results highlight updated subgroup analyses comparing (1) IMT versus exercise and (2) combined IMT and exercise versus exercise alone. Fourteen meta-analyses were performed for outcomes of inspiratory muscle strength, exercise tolerance, and quality of life. Results showed significant improvements in maximum inspiratory pressure and maximum exercise tidal volume favoring combined IMT and exercise compared with exercise alone. CONCLUSIONS Performing a combination of IMT plus exercise may lead to significant improvements in inspiratory muscle strength and one outcome of exercise tolerance for individuals with COPD.

The purpose of this study was to conduct a systematic review to determine the effect of inspiratory muscle training (IMT) on inspiratory muscle strength and endurance, exercise capacity, dyspnea and quality of life for adults with chronic obstructive pulmonary disease (COPD). A systematic review of the literature was conducted according the Cochrane Collaboration protocol using Medline and CINAHL. Nineteen of 274 extracted articles met the inclusion criteria and addressed comparisons of interest which included: IMT versus sham; IMT versus no intervention; low- versus high-intensity IMT; and two different modes of IMT. Thirteen meta-analyses were reported. Results indicate that targeted resistive or threshold IMT was associated with significant improvements in some outcomes of inspiratory muscle strength (PI(max) (cm H2O)) and endurance (Inspiratory Threshold Loading (kPa)), exercise capacity (Borg Scale for Respiratory Effort (modified Borg scale), Work Rate maximum (Watts)), and dyspnea (Transition Dyspnea Index), whereas IMT without a target or not using threshold training did not show improvement in these variables. There was no conclusive evidence regarding quality of life measures. IMT is effective for adults with COPD when using threshold or targeted devices that control or provide a target for training intensity.

Objective: We performed a systematic review to determine the effect of inspiratory muscle training (IMT) on inspiratory muscle strength and endurance, exercise capacity, dyspnoea and quality of life for adolescents and adults living with cystic fibrosis. Data sources: MEDLINE, EMBASE and CINAHL electronic databases were searched up to January 2008. Review methods: We performed a systematic review using the methodology outlined in the Cochrane Collaboration protocol. Articles were included if: (1) participants were adolescents or adults with cystic fibrosis (>13 years of age); (2) an IMT group was compared to a sham IMT, no intervention or other intervention group; (3) the study used a randomized controlled trial or cross-over design; and (4) it was published in English. Data were abstracted and methodological quality was assessed independently by two reviewers. Results: The search strategy yielded 36 articles, of which two met the inclusion criteria. Both studies used a targeted or threshold device for IMT. Meta-analyses were limited to forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), which showed no difference in effect between the IMT group and the sham and/or control group. Individual study results were inconclusive for improvement in inspiratory muscle strength. One study demonstrated improvement in inspiratory muscle endurance. Conclusion: The benefit of IMT in adolescents and adults with cystic fibrosis for outcomes of inspiratory muscle function is supported by weak evidence. Its impact on exercise capacity, dyspnoea and quality of life is not clear. Future research should investigate the characteristics of the subgroup of people with cystic fibrosis that might benefit most from IMT.

Purpose: To determine whether aerobic exercise training improves inspiratory muscle strength and/or endurance in adults with stable chronic obstructive pulmonary disease (COPD). Methods: A systematic review was conducted according to the Cochrane Collaboration protocol. MEDLINE, EMBASE, and CINAHL electronic databases were searched to December 2005. Articles were independently reviewed by 2 reviewers to determine inclusion. Criteria included: randomized control trials, adults with stable COPD, comparing aerobic exercise to another comparison group that measured outcomes of inspiratory muscle strength and/or endurance, and published in English. Standardized procedures were used to abstract data from included articles. Methodological quality was assessed. Results: One hundred fifty six (156) articles were retrieved. Nine met inclusion criteria. Participants were predominately male, with moderate to severe COPD and mean age from 49 to 72 years. Meta-analyses were performed for outcomes of inspiratory muscle strength (maximum inspiratory pressure - Pimax) and endurance (respiratory muscle endurance time - RMET). Results showed no effect of aerobic exercise training on Pimax (p=0.55) and RMET (p=0.59) as compared to control. Conclusions: Based on this review, aerobic exercise alone, performed at least 3 times per week for at least 6 weeks in individuals with stable COPD does not improve inspiratory muscle function. If improvement in inspiratory muscle strength or endurance is desired, additional modalities such as inspiratory muscle training could be considered.

Purpose: The purpose of this qualitative study was to examine physical therapy students' learning about disability through an Exploring Perspectives on Disability (EPOD) learning event that was developed by the School of Rehabilitation Science, McMaster University. EPOD consists of two scheduled classes discussing disability, a shadowing experience with an individual with a disability living in the community, and writing a reflective summary assignment about their learning. The EPOD was developed to broaden students' perspectives regarding disability, promote a positive attitude about disability, and facilitate best practice approaches in community-based care. Method: Fifty-seven students in the first semester of a Master's entry level physical therapy program completed the EPOD event. In the reflective summary, they were asked to describe and reflect on their experiences and observations about the individual they shadowed. The summaries were transcribed into NUD* IST, a computerized software program for qualitative data management. Each summary was read by two of four investigators who independently read, coded, and categorized the entries, and then worked together to identify themes. Results: Three major themes were identified: (1) students' assumptions about disability were challenged; (2) their understanding about supports and barriers for people with disability was enhanced; and (3) they acknowledged the professional growth and learning that occurred. Conclusions: Through the EPOD learning event, students gained new knowledge about disability and their attitudes about people with disability were influenced. The EPOD was important in broadening their perspectives concerning disability and promoting a positive attitude about disability.

"Educating for Moral Action: A Sourcebook in Health and Rehabilitation EthicsRuth B. Purtillo, Gail M. Jensen, Charlotte Brasic Royeen, Editors." Physiotherapy Canada, 58(3), pp. 237–238

"Educating for Moral Action: A Sourcebook in Health and Rehabilitation EthicsRuth B. Purtillo, Gail M. Jensen, Charlotte Brasic Royeen, Editors." Physiotherapy Canada, 58(3), pp. 237–238

Purpose: The objective of this study was to describe the current practice of Canadian physical therapists (PTs) using inspiratory muscle training (IMT) in the management of patients with cervical spinal cord injury (CSCI) or chronic obstructive pulmonary disease (COPD). Method: A postal survey was sent to all Canadian acute-care hospitals (. 250 beds) and to all centres providing rehabilitation for patients with CSCI or COPD. PTs were asked whether they used IMT and, if so, to describe patients for whom IMT was appropriate, as well as the devices and training protocols used. They were asked to list any contraindications to IMT. Results: One hundred nineteen questionnaires were sent to PTs treating patients with CSCI and 145 to PTs treating patients with COPD. The response rates were 70.6 per cent (CSCI) and 65.5 per cent (COPD). The rates of IMT use were 17.4 per cent (CSCI) and 4.7 per cent (COPD). The reasons for non-use included no knowledge about or training in IMT, a lack of resources, patients who were inappropriate for this treatment and no evidence of effectiveness. Conclusions: Few PTs are using IMT for patients with either CSCI or COPD. Little evidence exists of the effectiveness of IMT with CSCI patients, with stronger evidence of effectiveness in patients with COPD. A potentially effective modality for patients with COPD and CSCI, IMT appears to be underused by Canadian PTs.