Promoting Physical Activity and Exercise in Daily Practice: Current Practices, Barriers, and Training Needs of Physiotherapists in Eastern Nigeria

PURPOSE: To investigate current practices, barriers, and training needs for the promotion of physical activity (PA) in physiotherapy practices in eastern Nigeria. METHODS: A total of 141 fully licensed physiotherapists in southeast Nigeria were invited to participate in a cross-sectional survey consisting of 23 questions in five key sections, focusing mainly on risk-factor management practices of physiotherapists. RESULTS: A total of 103 questionnaires were returned. Respondents ranged in age from 20 to 54 years and reported a mean of 11 (SD 10) years of clinical experience. Respondents reported that they regularly assess and advise their clients on PA but rarely give written prescriptions. Although they are confident in assessing and advising their clients on PA and consider including PA intervention as a priority in daily practice, lack of time and lack of access to materials were reported as barriers to effective PA intervention. CONCLUSION: Findings showed the potential for physiotherapists to address physical inactivity and highlighted several barriers. Strategies are needed to improve contact time with clients and make material promoting PA available to practising physiotherapists.Department of HE and Training approved lis

Discharge plan to promote patient safety and shared decision making by a multidisciplinary team of healthcare professionals in a respiratory unit

Patients with chronic obstructive pulmonary disease (COPD) often require frequent hospitalization due to worsening symptoms. Preventing prolonged hospital stays and readmission becomes a challenge for healthcare professionals treating patients with COPD. Although the integration of health and social care supports greater collaboration and enhanced patient care, organizational structure and poor leadership may hinder the implementation of patient-oriented goals. This paper presents a case of a 64-year-old chronic smoker with severe COPD who was to be discharged on long-term oxygen therapy (LTOT). It also highlights the healthcare decisions made to ensure the patient’s safety at home and further provides a long-lasting solution to the existing medical and social needs. The goal was accomplished through a discharge plan that reflects multidisciplinary working, efficient leadership, and change management using Havelock’s theory. While COPD is characterized by frequent exacerbation and hospital readmission, it was emphasized that most failed discharges could be attributed to bureaucratic organizational workflow which might not be in the patient’s best interest. It was further demonstrated that healthcare professionals are likely to miss the window of opportunity to apply innovative and long-lasting solutions to the patient’s health condition in an attempt to remedy the immediate symptoms of COPD

Mapping Evidence From the Literature About the Experience of Internationally Educated Health Professionals to Canadian Professional Competency Profiles of Physiotherapists, Occupational Therapists, Physicians, and Pharmacists.

Abstract Purpose: To review experiences of internationally educated healthcare professionals (physiotherapists, occupational therapists, physicians and pharmacists) in their new country and to map these experiences using a competency framework. Method: Database (Medline, EMBASE, CINAHL, and PsycINFO ) were systematically searched to include articles published between 2000 and 2017 and described the experiences of internationally educated healthcare professionals (IEHPs) in physiotherapists, occupational therapists, physicians and pharmacist in attaining registration in new country. The data were synthesised using conventional content analysis. Emerging themes were mapped across a competency framework based on the profiles of the selected professions. Result: Thirteen articles were included; most were conducted in Canada and among internationally educated medical doctors. Themes were mapped to all the roles in the professional competency profiles except the Health Advocate role. Communicator role was the most frequently discussed; internationally educated healthcare professionals often needed to improve in culture-specific communication including verbal and non-verbal cues during assessment, documentation and treatment of clients. A pictorial representation was created for describing internationally educated healthcare professionals’ deficiencies in roles/ competencies for professional practice. In this representation, cultural-language and confidence deficits contribute to the deficiencies seen in roles and competencies among internationally educated healthcare professionals in their new country. Conclusion: Internationally educated healthcare professionals’ ability to fulfill the explicit roles in the competency profiles may depend largely on having good cultural-language competence as well as confidence. Exposing the internationally educated healthcare professionals to local practice is one of the strategies for cultural-language and confidence enhancement, consistent with findings reported in the nursing profession

Exercise therapy in routine management of peripheral arterial disease and intermittent claudication: a scoping review

Background: Little is known about the extent to which routine care management of peripheral arterial disease (PAD) and intermittent claudication (IC) align with best practice recommendations on exercise therapy. We conducted a scoping review to examine the published literature on the availability and workings of exercise therapy in the routine management of patients with PAD and IC, and the attitude and practice of health professionals and patients. Methods: A systematic search was conducted in February 2018. The Cumulative Index of Nursing and Allied Health Literature, Ovid MEDLINE, Allied and Complementary Medicine Database, ScienceDirect, Web of Science and the Directory of Open Access Repositories were searched. Hand searching of reference lists of identified studies was also performed. Inclusion criteria were based on study aim, and included studies that reported on the perceptions, practices, and workings of routine exercise programs for patients with IC, their availability, access, and perceived barriers. Results: Eight studies met the eligibility criteria and were included in the review. Studies conducted within Europe were included. Findings indicated that vascular surgeons in parts of Europe generally recognize supervised exercise therapy as a best practice treatment for IC, but do not often refer their patients for supervised exercise therapy due to the unavailability of, or lack of access to supervised exercise therapy programs. Available supervised exercise therapy programs do not implement best practice recommendations, and in the majority, patients only undergo one session per week. Some challenges were cited as the cause of the suboptimal program implementation. These included issues related to patients’ engagement and adherence as well as resource constraints. Conclusion: There is a dearth of published research on exercise therapy in the routine management of PAD and IC. Available data from a few countries within Europe indicated that supervised exercise is underutilized despite health professionals recognizing the benefits. Research is needed to understand how to improve the availability, access, uptake, and adherence to the best exercise recommendations in the routine management of people with PAD and IC

Promotion of healthy nutrition in clinical practice: a cross-sectional survey of practices and barriers among physiotherapists in southeast Nigeria

AbstractBackgroundHealthy diet counselling is an important concept in health promotion. Physiotherapists are well positioned to initiate or support healthy nutrition in addition to physical activity counselling, in routine patient consultation.ObjectiveTo determine the practices about and barriers to diet counselling practices among physiotherapists in Southeast Nigeria.MethodsIn this cross-sectional survey, a total of 140 questionnaires were distributed among physiotherapists.ResultsOverall, 103 physiotherapists responded. Physiotherapists are confident and consider the incorporation of dietary counselling very important and of high priority in their daily clinical work. They, however, assessed and counselled on dietary status opportunistically in patients. Notwithstanding, physiotherapists believed that the diet counselling they give could be effective in helping patients change their unhealthy dieting practices. Patients were also amenable to physiotherapists advocating on diet issues as part of their consultation. Several barriers to incorporating diet counselling into physiotherapy practice were identified, including lack of access to a dietician/health promotion staff/counsellors, lack of proper patient education materials, lack of expertise in relation to dietary risk factors' assessment and management, and uncertainty about what dietary services to provide.ConclusionAlthough physiotherapists consider it important to incorporate diet counselling in their daily clinical practice, development and implementation of strategies to improve physiotherapists' diet counselling knowledge, competence, skills, and practice are warranted

Walking Behaviour of Individuals with Intermittent Claudication Compared to Matched Controls in Different Locations: An Exploratory Study

Individuals with intermittent claudication (IC) are less physically active than their peers, but how this varies with location is unclear. Individuals with IC and matched controls [sex, age ±5 years, home < 5 miles] wore an activity monitor (activPAL) and carried a GPS device (AMOD-AGL3080) for 7 days. GPS data categorised walking events as occurring at home (<=50 m from home coordinates) or away from home, and indoors (signal to noise ratio <= 212 dB) or outdoors. Number of walking events, walking duration, steps and cadence were compared between groups and each location pair using mixed model ANOVAs. In addition, the locus of activity (distance from home) at which walking was conducted was compared between groups. Participants (n = 56) were mostly male (64%) and aged 54-89 years. Individuals with IC spent significantly less time walking and took fewer steps than their matched controls at all locations, including at home. Participants spent more time and took more steps away from home than at home, but were similar when walking indoors and outdoors. The locus of activity was significantly smaller for individuals with IC, suggesting that it is not just physical capacity that influences walking behaviour, and other factors (e.g., social isolation) may play a role

Factors associated with fatigue in hip and/or knee osteoarthritis: a systematic review and best evidence synthesis

Objective: The aim was systematically to identify and evaluate factors related to fatigue in individuals with hip and/or knee OA. Methods: A systematic literature search was conducted using AMED, CINAHL, MEDLINE, ProQuest and Web of Science Core Collections databases. Inclusion criteria comprised cross-sectional, case-control or longitudinal studies on patients with a diagnosis of hip and/or knee OA that included self-reported fatigue measures. Study quality was assessed using the National Heart, Lung and Blood Institute quality appraisal tool, and factors were synthesized within a bio-behavioural framework. Study designs and quality were combined to determine current evidence levels using best evidence synthesis grading. The full review protocol is available from PROSPERO (PROSPERO 2019: CRD42019138571). Results: Twenty-four studies were included, of which 19 were high, 4 moderate and 1 low quality. There was strong evidence of an association between poor self-reported physical function and high depressive symptoms with higher fatigue. Moderate evidence of an association was found between severe pain, high numbers of co-morbidities and low physical activity levels with higher fatigue. There was moderate or limited evidence of no association between most sociodemographic factors and radiographic OA severity with fatigue. Conclusion: Targets for fatigue management might include improving physical function, reducing depressive symptoms, pain and co-morbidities, and increasing physical activity levels. There is a need for more rigorous longitudinal studies to understand the causal effect of fatigue determinants within the hip and knee OA populations