Which learning activities enhance physical therapist practice? Part 1: Systematic review and meta-analysis of quantitative studies

Objective. Following graduation from professional education, the development of clinical expertise requires career-long participation in learning activities. The purpose of study was to evaluate which learning activities enhanced physical therapist practice. Methods. Eight databases were searched for studies published from inception through December 2018. Articles reporting quantitative data evaluating the effectiveness of learning activities completed by qualified physical therapists were included. Study characteristics and results were extracted from the 26 randomized controlled trials that met the inclusion criteria. Clinician (knowledge, affective attributes, and behavior) and patient related outcomes were extracted. Results: There was limited evidence that professional development courses improved physical therapist knowledge. There was low-level evidence that peer assessment and feedback was more effective than case discussion at improving knowledge (SMD = 0.35, 95%CI = 0.09-0.62). Results were inconsistent for the effect of learning activities on affective attributes. Courses with active learning components appeared more effective at changing physical therapist behavior. The completion of courses by physical therapists did not improve patient outcomes; however, the addition of a mentored patient interaction appeared impactful. Conclusions. Current evidence suggests active approaches, such as peer assessment and mentored patient interactions, should be used when designing learning activities for physical therapists. Further high-quality research focused on evaluating the impact of active learning interventions on physical therapist practice and patient outcomes is now needed. Impact. This study is a first step in determining which learning activities enhance clinical expertise and practice would enable the physical therapy profession to make informed decisions about the allocation of professional development resources

"This is hard to cope with" : the lived experience and coping strategies adopted amongst Australian women with pelvic girdle pain in pregnancy

Background: Women with pregnancy-related pelvic girdle pain (PPGP) report diminished ability to perform physical activities and experience higher rates of mood disorders, such as anxiety and depression, than pregnant women without PPGP. Despite these physical and psychological impacts, little is known about the lived experiences of PPGP amongst Australian women and the ways in which they cope. Situated within biographical disruption and social support theories, this study sought to gain a conceptual understanding of the experience and impact of PPGP on daily life, and how women cope with this condition during pregnancy. Methods: A qualitative research design, situated within a phenomenological framework, using individual, semi-structured interviews consisting of open-ended questions was used with a flexible and responsive approach. Purposive sampling of pregnant women attending a single hospital included 20 participants between 14 and 38 weeks gestation, classified with PPGP as per recommended guidelines, with a mean (SD) age of 31.37 (4.16) years. Thematic analysis was performed where interview data was transcribed, coded, grouped into meaningful categories and then constructed into broad themes. Results: Three themes were identified: 1. a transformed biography; 2. coping strategies; and 3. what women want. The pain experienced created a dramatic change in women's lives, making the pregnancy difficult to endure. Women utilised social support, such as family, to help them cope with pain, and a self-care approach to maintain a positive mindset and reduce stress. Although a few women received support from healthcare professionals, many reported a lack information on PPGP and limited societal recognition of the condition. Women wanted early education, personalised information and prompt referral to help them cope with PPGP. Conclusions: Findings from this study highlighted the complexity of living with PPGP as women attempted to deal with the unexpected impact on daily life by seeking support from partners and families, while also struggling with societal expectations. Although women with PPGP used a number of coping strategies, they sought greater support from healthcare professionals to effectively manage PPGP. These findings have important implications for the provision of health care to women living with PPGP

The effect of electrical stimulation on corticospinal excitability is dependent on application duration: a same subject pre-post test design

Background: In humans, corticospinal excitability is known to increase following motor electrical stimulation (ES) designed to mimic a voluntary contraction. However, whether the effect is equivalent with different application durations and whether similar effects are apparent for short and long applications is unknown. The aim of this study was to investigate whether the duration of peripheral motor ES influenced its effect on corticospinal excitability

Primary sensory and motor cortex excitability are co-modulated in response to peripheral electrical nerve stimulation

Peripheral electrical stimulation (PES) is a common clinical technique known to induce changes in corticomotor excitability; PES applied to induce a tetanic motor contraction increases, and PES at sub-motor threshold (sensory) intensities decreases, corticomotor excitability. Understanding of the mechanisms underlying these opposite changes in corticomotor excitability remains elusive. Modulation of primary sensory cortex (S1) excitability could underlie altered corticomotor excitability with PES. Here we examined whether changes in primary sensory (S1) and motor (M1) cortex excitability follow the same timecourse when PES is applied using identical stimulus parameters. Corticomotor excitability was measured using transcranial magnetic stimulation (TMS) and sensory cortex excitability using somatosensory evoked potentials (SEPs) before and after 30 min of PES to right abductor pollicis brevis (APB). Two PES paradigms were tested in separate sessions; PES sufficient to induce a tetanic motor contraction (30–50 Hz; strong motor intensity) and PES at sub motor-threshold intensity (100 Hz). PES applied to induce strong activation of APB increased the size of the N20-P25 component, thought to reflect sensory processing at cortical level, and increased corticomotor excitability. PES at sensory intensity decreased the size of the P25-N33 component and reduced corticomotor excitability. A positive correlation was observed between the changes in amplitude of the cortical SEP components and corticomotor excitability following sensory and motor PES. Sensory PES also increased the sub-cortical P14-N20 SEP component. These findings provide evidence that PES results in co-modulation of S1 and M1 excitability, possibly due to cortico-cortical projections between S1 and M1. This mechanism may underpin changes in corticomotor excitability in response to afferent input generated by PES.Siobhan M. Schabrun, Michael C. Ridding, Mary P. Galea, Paul W. Hodges and Lucinda S. Chipchas

Is there a future for electrophysical agents in musculoskeletal physiotherapy?

Electrophysical agents (EPAs) are part of the arsenal of techniques that manual therapists have at their disposal for the management of neuromusculoskeletal disorders. An argument can be made that when used judiciously and appropriately as one part of a multimodal approach to treatment, EPAs have the potential to enhance patient care. For the discerning manual therapist, there are several issues to reflect on when considering the use of EPAs as an adjunct to other techniques. One of the main criticisms levelled at EPAs has been that they have little to no evidence of effect. However, one could argue that the swing away from using EPAs in the last 20 years has been as little evidence-based as their prior overuse in the 1970 and 80s. Drill down into the evidence argument and there are many flaws and misconceptions. An evaluation of the Cochrane database and the research into transcutaneous electrical nerve stimulation (TENS) provides a good example

Inpatient Physiotherapy Management of Orthopaedic Surgery

This book will provide all junior physiotherapists with the skills necessary to begin their clinical work with patients who have just undergone orthopaedic surgery. This book: is thoroughly researched and well referenced providing you with all the evidence upon which to build your treatments and protocols; is very practical and has a step-by-step approach showing you how to plan your treatment regimes for your patients; will show you how to select the best treatment options; is well illustrated with clear diagrams and pictures explaining the points made in the text; will assist you and help you to develop your practical skills in addition to your clinical reasoning skills and your orthopaedic knowledge base. It is an essential text for those just beginning their clinical experience whether a student or newly qualified physiotherapist

Preparing occupational therapy and physiotherapy students for work-related practice : A clinical education initiative at one australian university

Purpose: Despite increasing numbers of novice occupational therapists (OTs) and physiotherapists (PTs) entering work-related practice since the early 2000s, clinical learning opportunities are often limited due to legal and insurance issues. In response, clinical educators at The University of Queensland, Australia, developed an industry consultancy service to provide clinical learning for students in this field. Students delivered injury prevention services with supervision from experienced educators. This paper describes the program and an evaluation of student learning. Method: Twenty-six students (10 OTs and 16 PTs) participated voluntarily in an evaluation of the program during 2008 and 2009. Surveys pre and post-placement included open and closed questions that sought students’ knowledge of work-related practice and perceptions of practitioner roles. Knowledge was assessed with 20 questions on work-related practice. Differences in knowledge before and after the placement were analysed with non-parametric statistics. Open ended responses were subject to manual thematic analysis. Results: Students demonstrated a good understanding of the roles and tasks undertaken by practitioners in this field pre-placement. Their knowledge of work-related practice significantly increased following the placement (p < 0.05). Half of the students reported that their expectations for the placement had been met. Open ended responses provided students’ perceptions of the program, both positive and negative. Conclusions: This clinical learning experience in work-related practice for OT and PT students provided a novel practical experience. Students demonstrated a good understanding of professional roles in the field and post-placement increased their understanding of work-related practice. The model provided a valuable method that ensures OT and PT students experienced work-related practice prior to graduation