The physical therapy profile questionnaire (PTPQ): development, validation and pilot testing

<p>Abstract</p> <p>Background</p> <p>Country by country similarities and differences in physical therapy practice exists. Therefore, before updates in practice can be provided, such as trainings in evidence-based practice, it is necessary to identify the profile and nature of practice in a given country or setting. Following a search of the international literature, no appropriate tool was identified to collect and establish data to create the profile of physical therapy practice in the Philippines. We therefore developed, validated and pilot tested a survey instrument which would comprehensively describe the practice of physical therapy in the Philippines</p> <p>Findings</p> <p>We used a mixed methods design to answer our study aims. A focus group interview was conducted among a group of physical therapists to establish the content and contexts of items to be included in the survey instrument. Findings were amalgamated with the information from the literature on developing survey instruments/questionnaires. A survey instrument was drafted and named as the Physical Therapy Profile Questionnaire (PTPQ). The PTPQ was then validated and pilot tested to a different group of physical therapists.</p> <p>The final version consisted of five separate parts namely (A) <it>General information and demographics, (B) Practice Profile, (C) Treatment Preferences, (D) Bases for clinical work and (E) Bases for educational/research work</it>. At present the PTPQ is relevant to the Philippines and could be used by any country which has a similar nature of practice with the Philippines.</p> <p>Conclusion</p> <p>The <it>Physical Therapy Practice Questionnaire (PTPQ) </it>was shown to have good face and content validity among the Filipino physical therapists and their context of practice. It has also been found to be useful, easy to administer tool and in a format appealing to respondents. The PTPQ is expected to assist comprehensive data collection to create a profile of physical therapy practice in the Philippines.</p

A Systematic Review on the Effectiveness of Mental Practice with Motor Imagery in the Neurologic Rehabilitation of Stroke Patients

Background: Mental practice with motor imagery entails an individual to symbolically rehearse a physical activity within working memory in the absence of overt body movement. It has been proven to be useful in sports training and other skills training. However, much is yet to be determined if the same promising results may be gained when this training method is used with persons with brain lesions, like stroke patients. Objectives: The aim of the study is to investigate evidence for the effectiveness of mental practice with motor imagery in the neurological rehabilitation of stroke patients in improving their impairments and functional limitations, and to identify variations in mental practice protocols (duration, type of imagery employed, etc) and characteristics of participants, (age of subjects, duration of stroke prior to intervention) that may have affected the results gathered. Methods: Literature search was accomplished with electronic databases such as Science Direct, Pub Med, Proquest, MEDLINE, CINAHL, Cochrane Library for Systematic Reviews and OVID. Criteria used in selecting articles included (1) Clinical controlled trials or RCTs, (2) adult stroke patients, except with cerebellar or basal ganglia pathology, (3) intervention given was mental practice with motor imagery without external aids. Two peer reviewers individually rated the quality of each study using checklists used by JBI. Results:. A total of 7 articles were included for this systematic review after quality appraisal. This included 5 randomized controlled trials and 2 CCTs. All studies reported improvement of UE function after the intervention. Conclusion Although researches done with this intervention have yielded equivocal results, a relatively small body of evidence for mental practice with motor imagery in rehabilitation of UE of stroke patients still exists. Future studies employing quality research endeavors with research designs at the upper levels of the hierarchy of evidence are recommended to strengthen the present evidence

A Pilot Study of the Evidence Based Practice Training Program for Filipino Physiotherapists: Emerging Evidence on Outcomes and Acceptability

Background: The use of evidence to guide clinical practice has been challenging for health professionals across the globe. Issues of implementing the evidence become even more challenging among health professionals in developing countries because of cultural and contextual issues which compound the existing implementation barriers reported in the literature. An evidence based practice (EBP) training was developed for physiotherapists in a developing country (the Philippines) based on the literature and preliminary exploratory studies. The training program aimed to address issues of barriers to EBP and the nature of practice in a developing country. This study reports the process and findings of pilot testing the training program (EBP for FilPTs). Objectives: The objectives of the pilot study were to, 1) Estimate the effect size of the EBP training program in enhancing knowledge and skills in EBP, 2) Determine the sample size for a subsequent RCT, 3) Test the acceptability of the EBP training program, and, 4) Refine the components of the intervention (training program) as needed. Methods: Seven physiotherapists purposively sampled from one training institution which does not provide training on evidence-based practice were randomly allocated to the intervention (EBP for FilPTs) and the waitlist control groups. Pre-post intervention measures of knowledge and skills associated with EBP were assessed using the Adapted Fresno test. Participants and observers completed an evaluation summary and commented on the program Results and Conclusion: The EBP training program resulted in significant and large improvement (Effect Size = 0.8) in knowledge and skills. It was considered by participants to be an effective, acceptable, and practical medium to teach EBP to physiotherapists

Evidence on Effectiveness of Upper Neck Irradiation Versus Whole Neck Irradiation as Elective Neck Irradiation in Node-Negative Nasopharyngeal Cancer: A Meta-Analysis

Purpose: Nasopharyngeal carcinoma (NPC) is a central tumor with a rich lymphatic network and a propensity for bilateral cervical lymph node metastasis. There is an orderly pattern of lymph node involvement in NPC. There is no current standard for prophylactic neck irradiation in node-negative or limited retropharyngeal (RP) node–positive NPC. This study aims to synthesize the current evidence on upper neck irradiation (UNI) versus whole neck irradiation (WNI) as prophylactic neck irradiation in node-negative or limited RP node–positive NPC. Materials and Methods: A search of relevant articles was done from 2000 to October 2015. Critical appraisal and meta-analysis of the eligible studies were undertaken to assess the effectiveness of UNI versus WNI as prophylactic neck irradiation in node-negative or limited involved RP node NPC. Results: Only one randomized controlled trial investigated the use of prophylactic UNI versus WNI and showed no confirmed nodal relapse in both arms. Pooled analysis of four retrospective studies showed no significant difference in nodal recurrence, whether in-field or out-of-field recurrence. There was also no significant difference in terms of 5-year distant metastasis–free and overall survival. Conclusion: In node-negative or limited RP node–positive NPC, the current evidence shows the possibility of treating only the upper neck (levels II, III, and VA) without compromising nodal control, distant metastasis, and overall survival. As a result of the scarcity of data, more randomized clinical trials are warranted in this subset of patients

Protocol for audit of current Filipino practice in rehabilitation of stroke inpatients

Background: Stroke is one of the leading medical conditions in the Philippines. Over 500,000 Filipinos suffer from stroke annually. Provision of evidence-based medical and rehabilitation management for stroke patients has been a challenge due to existing environmental, social, and local health system issues. Thus, existing western guidelines on stroke rehabilitation were contextualized to draft recommendations relevant to the local Philippine setting. Prior to fully implementing the guidelines, an audit of current practice needs to be undertaken, thus the purpose of this audit protocol. Methods: A clinical audit of current practices in stroke rehabilitation in the Philippines will be undertaken. A consensus list of data items to be captured was identified by the audit team during a 2-day meeting in 2012. These items, including patient demographics, type of stroke, time to referral for rehabilitation management, length of hospital stay, and other relevant descriptors of stroke management were included as part of the audit. Hospitals in the Philippines will be recruited to take part in the audit activity. Recruitment will be via the registry of the Philippine Academy of Rehabilitation Medicine, where 90% of physiatrists (medical doctors specialized in rehabilitation medicine) are active members and are affiliated with various hospitals in the Philippines. Data collectors will be identified and trained in the audit process. A pilot audit will be conducted to test the feasibility of the audit protocol, and refinements to the protocol will be undertaken as necessary. The comprehensive audit process will take place for a period of 3 months. Data will be encoded using MS Excel®. Data will be reported as means and percentages as appropriate. Subgroup analysis will be undertaken to look into differences and variability of stroke patient descriptors and rehabilitation activities. Conclusion: This audit study is an ambitious project, but given the “need” to conduct the audit to identify “gaps” in current practice, and the value it can bring to serve as a platform for implementation of evidence-based stroke management in the Philippines to achieve best patient and health outcomes, the audit team is more than ready to take up the challenge

Protocol for audit of current Filipino practice in rehabilitation of stroke inpatients

Background: Stroke is one of the leading medical conditions in the Philippines. Over 500,000 Filipinos suffer from stroke annually. Provision of evidence-based medical and rehabilitation management for stroke patients has been a challenge due to existing environmental, social, and local health system issues. Thus, existing western guidelines on stroke rehabilitation were contextualized to draft recommendations relevant to the local Philippine setting. Prior to fully implementing the guidelines, an audit of current practice needs to be undertaken, thus the purpose of this audit protocol. Methods: A clinical audit of current practices in stroke rehabilitation in the Philippines will be undertaken. A consensus list of data items to be captured was identified by the audit team during a 2-day meeting in 2012. These items, including patient demographics, type of stroke, time to referral for rehabilitation management, length of hospital stay, and other relevant descriptors of stroke management were included as part of the audit. Hospitals in the Philippines will be recruited to take part in the audit activity. Recruitment will be via the registry of the Philippine Academy of Rehabilitation Medicine, where 90% of physiatrists (medical doctors specialized in rehabilitation medicine) are active members and are affiliated with various hospitals in the Philippines. Data collectors will be identified and trained in the audit process. A pilot audit will be conducted to test the feasibility of the audit protocol, and refinements to the protocol will be undertaken as necessary. The comprehensive audit process will take place for a period of 3 months. Data will be encoded using MS Excel®. Data will be reported as means and percentages as appropriate. Subgroup analysis will be undertaken to look into differences and variability of stroke patient descriptors and rehabilitation activities. Conclusion: This audit study is an ambitious project, but given the “need” to conduct the audit to identify “gaps” in current practice, and the value it can bring to serve as a platform for implementation of evidence-based stroke management in the Philippines to achieve best patient and health outcomes, the audit team is more than ready to take up the challenge