Experiences of physiotherapists regarding a standard set of measurement instruments to improve quality of care for patients with chronic obstructive pulmonary disease: a mixed methods study

Abstract Rationale The quality of physiotherapy care for patients with chronic obstructive pulmonary disease (COPD) can be improved by comparing outcomes of care in practice. Aim To evaluate the experiences of physiotherapists implementing a standard set of measurement instruments to measure outcomes and improve the quality of care for patients with COPD. Methods This sequential explanatory mixed methods study was performed in two parts. In the quantitative part, a survey of 199 physiotherapists was conducted to evaluate their attitudes and knowledge, as well as the influence of contextual factors (i.e., practice policy and support from colleagues), in the implementation of the standard measurement set. In the qualitative part, 11 physiotherapists participated in individual interviews to elucidate their experiences using a thematical framework. Results The survey showed that, on average, 68.4% of the physiotherapists reported having a positive attitude about using the standard set, 85.0% felt they had sufficient knowledge of the measurement instruments, and 84.7% felt supported by practice policy and colleagues. In total, 80.3% of physiotherapists thought the standard set had added value in clinical practice, and 90.3% indicated that the measurement instruments can be valuable for evaluating treatment outcomes. The physiotherapists mentioned several barriers, such as lack of time and the unavailability of the entire standard set of measurement instruments in their practice. Moreover, the physiotherapists indicated that the measurement instruments have added value in providing transparency to policymakers through the anonymized publication of outcomes. Conclusion Physiotherapists support the use of the standard set of measurement instruments to improve the quality of physiotherapy treatment for patients with COPD

A giant limulid trackway (Kouphichnium lithographicum) from the lithographic limestones of Cerin (Late Kimmeridgian, France) : ethological and environmental implications

International audienceA well-preserved large limulid trackway related to Kouphichnium lithographicum is described from the Upper Kimmeridgian Lithographic Limestones of Cerin (Ain, France). It is three meters long and exhibits ten successive sets of imprints characterized by a pair of well-preserved tetradactyl external imprints of legs VI (named pushers) and a variable number (mostly three pairs) of straight thin intermediate imprints (legs III-V). The trackway is unusually wide and was probably made by a very large adult approximately 38 cm wide and 80 cm long when related to the proportions of the modern Limulus polyphemus. The straightness of the trackway, the great repeat distance (stride), the length of series of leg imprints, their slight angle to the mid-line, the well-marked pusher (= leg VI) imprints and the absence of groove made by the telson all indicate fast progression of a vigorous animal on the sea-floor. This walking trackway can be easily differentiated from other limulid crawling, ploughing, and dying trackways usually found in lithographic limestones or other deposits of the geological record. Main characteristics of these different limulid trackways are evidenced. The occurrence of a living adult in the Cerin restricted lagoon is probably related to a brief period of connection with the open sea. This occurrence indicates either a passive introduction of the animal into the lagoon or a spawning behaviour