L’auto-référencement en physiothérapie : la mise de l’avant d’une culture éthique pour encadrer la pratique organisationnelle

Commentaire / CommentaryL’auto-référencement en physiothérapie, soit le fait pour un professionnel de la santé de référer un patient vers une clinique privée de physiothérapie dans laquelle ce même professionnel possède des intérêts financiers, comporte des implications éthiques importantes de nature organisationnelle. Cet article propose des pistes de solutions à cette pratique éthiquement condamnable. En plus de miser sur des stratégies législatives et déontologiques, les cliniques privées doivent adopter des balises et des activités formelles visant à améliorer la culture éthique de leur entreprise, en impliquant les propriétaires, les actionnaires et les employés.Self-referral in physiotherapy, that is, a healthcare professional referring a patient to a private physiotherapy clinic in which the same professional has a financial interest, presents significant organizational ethical implications. This article offers potential solutions to this ethically reprehensible practice. In addition to focusing on legislative and ethical strategies, private clinics should adopt guidelines and formal activities to improve the ethical culture of their company, by involving owners, shareholders and employees

Le développement de la conscience épilinguistique et l'apprentissage précoce de la lecture

Québec Université Laval, Bibliothèque 201

Physiothérapie pour les travailleurs blessés indemnisés : exploration des enjeux éthiques, organisationnels et systémiques dans trois provinces canadiennes

Organismes subventionnaires ayant contribué à la réalisation de la thèse: Instituts de recherche en santé du Canada (IRSC), Fonds de recherche du Québec – Santé (FRQ-S), Faculté de médecine et École de réadaptation de l'Université de Montréal, Fondation de physiothérapie du Canada, Programme MENTOR (IRSC-REPAR).Au Canada, les physiothérapeutes sont grandement impliqués dans les soins offerts aux travailleurs souffrant de blessures musculosquelettiques qui sont supportés par une commission d’indemnisation du travail. Dans le cadre de leur pratique auprès de ces patients, les physiothérapeutes rencontrent de nombreux défis, incluant des défis de nature éthique, qui peuvent influencer l’offre de soins pour cette clientèle. Toutefois, les expériences de soins des physiothérapeutes travaillant dans ce contexte restent encore peu étudiées. Cette thèse vise donc à rencontrer deux objectifs principaux : 1) explorer de façon empirique et approfondie les tensions éthiques vécues par les physiothérapeutes lorsqu’ils soignent des travailleurs blessés supportés par une commission d’indemnisation du travail au Canada et 2) examiner comment les politiques mises en place par les commissions d’indemnisation du travail et par les cliniques de physiothérapie influent sur les soins de physiothérapie offerts à ces patients. Pour répondre à ces objectifs, nous avons employé un devis qualitatif désigné sous le nom de description interprétative. Dans un premier temps, nous avons réalisé deux groupes de discussion auprès de six physiothérapeutes et de sept thérapeutes en réadaptation physique du Québec. Dans un deuxième temps, nous avons conduit des entrevues individuelles auprès de 30 physiothérapeutes et de 10 leaders et administrateurs œuvrant au sein de groupes professionnels ou de commissions d’indemnisation du travail, dans trois provinces canadiennes (Colombie-Britannique, Ontario et Québec). Dans le premier volet de la thèse, les résultats démontrent que les physiothérapeutes souhaiteraient offrir aux travailleurs blessés des soins qui soient équitables, compétents et dans le respect de leur autonomie professionnelle, mais que de nombreux défis limitent l’actualisation de ces trois valeurs dans leur travail (objectif 1). Parmi ces défis, on retrouve la difficulté pour les physiothérapeutes de gérer certains aspects liés au processus de retour au travail, leur manque de connaissances à propos du système d’indemnisation, les obstacles au partage des responsabilités professionnelles avec d’autres intervenants ou encore la nécessité de résister aux préjugés auxquels font face les travailleurs blessés. Dans le deuxième volet de la thèse, les résultats illustrent, au moyen de divers exemples, comment les politiques actuelles des commissions d’indemnisation du travail et des cliniques de physiothérapie viennent moduler l’organisation des soins et la pratique des physiothérapeutes auprès des travailleurs blessés (objectif 2). Les participants ont mis en lumière certaines politiques permettant, selon eux, d’optimiser la prise en charge et le suivi des patients. Toutefois, plusieurs politiques ayant un effet néfaste sur les soins de physiothérapie prodigués ont également été identifiées. Somme toute, cette thèse fournit des connaissances nouvelles portant sur les dimensions éthiques, politiques, organisationnelles et systémiques des soins de physiothérapie offerts aux travailleurs blessés indemnisés par une commission d’indemnisation du travail au Canada. Les résultats présentés permettent de jeter un regard riche et nouveau sur les expériences de soins des physiothérapeutes œuvrant auprès de cette clientèle, tout en fournissant des pistes de recommandations pouvant servir à soutenir l’élaboration de politiques futures et à améliorer la pratique clinique dans ce domaine.In Canada, physiotherapists play significant roles in the care of injured workers with musculoskeletal injuries who are supported by a workers’ compensation board. As part of their practice with these patients, physiotherapists face many challenges, including ethical ones that can influence the provision of care. However, the experiences of physiotherapists working with this clientele remain underexamined. This thesis has two main objectives: 1) conduct an in-depth empirical exploration of ethical tensions experienced by physiotherapists when treating injured workers supported by a workers’ compensation board; and 2) examine how policies from workers’ compensation boards and physiotherapy clinics influence physiotherapy care for these patients. To meet these objectives, we used a qualitative framework called Interpretive Description. We first conducted two focus groups with six physiotherapists and seven physiotherapy technicians from Quebec. Next, we conducted individual interviews with 30 physiotherapists and 10 leaders or administrators working with professional groups or workers’ compensation boards in three Canadian provinces (British Columbia, Ontario and Quebec). In the first section of the thesis, results demonstrate that physiotherapists would like to offer care that is equitable, competent and respectful of their professional autonomy, but that many challenges limit the actualization of these three values in their practice with injured workers (objective 1). These challenges include the difficulty for physiotherapists to manage some aspects of the return to work process, their lack of knowledge about the compensation system, barriers to sharing professional responsibilities with other providers, and the need to resist stereotypes regarding injured workers. In the second section of the thesis, results illustrate how current workers’ compensation boards and physiotherapy clinics’ policies modulate the organization of care and physiotherapists’ practices with injured workers (objective 2). Participants highlighted policies that they viewed as contributing to better patient care and also those that had a detrimental effect on the care they provide. In sum, this thesis provides new insights into the ethical, political, organisational and systemic dimensions of physiotherapy care for injured workers supported by workers’ compensation boards in Canada. These analyses provide a new and rich understanding of the experiences of physiotherapists working with this clientele. The study results also support several recommendations that can be used to inform future policy development and support clinical practice in this area

The Contribution of Conceptual Frameworks to Knowledge Translation Interventions in Physical Therapy

Context: There is growing recognition of the importance of knowledge translation activities in physical therapy to ensure that research findings are integrated in clinical practice, and increasing numbers of knowledge translation interventions are being conducted. Although various frameworks have been developed to guide and facilitate the process of translating knowledge into practice, these tools have been infrequently used in physical therapy knowledge translation studies to date. Problem and recommendation: Knowledge translation in physical therapy implicates multiple stakeholders and environments, and involves numerous steps. In light of this complexity, the use of explicit conceptual frameworks by clinicians and researchers conducting knowledge translation interventions is associated with a range of potential benefits. In this article, we argue that such frameworks are important resources to promote the uptake of new evidence in physical therapy practice settings. We identify four key benefits associated with the use of conceptual frameworks in designing and implementing knowledge translation interventions. We also consider limits related to their use. We then evaluate a sample of five conceptual frameworks and consider how they address common barriers to knowledge translation in physical therapy. The goal of this analysis is to provide guidance to physical therapists seeking to identify a framework to support the design and implementation of a knowledge translation intervention. Finally, we illustrate the use of a conceptual framework through a case example. Conclusion: Increased use of conceptual frameworks can have a positive impact on the field of knowledge translation in physical therapy and support the development and implementation of robust and effective knowledge translation interventions that help span the research-practice gap

Ethical Issues Raised by Private Practice Physiotherapy Are More Diverse than First Meets the Eye: Recommendations from a Literature Review

Purpose: Physiotherapy in private practice differs from physiotherapy practised in a public setting in several ways, the most evident of which is the for-profit nature of private physiotherapy clinics; these differences can generate distinct and challenging ethical issues. The objectives of this article are to identify ethical issues encountered by physiotherapists in private practice settings and to identify potential solutions and recommendations to address these issues. Method: After a literature search of eight databases, 39 studies addressing ethical issues in a private practice context were analyzed. Results: A total of 25 ethical issues emerging from the included studies were classified into three main categories: (1) business and economic issues (e.g., conflicts of interests, inequity in a managed care context, lack of time affecting quality of care); (2) professional issues (e.g., professional autonomy, clinical judgment, treatment effectiveness, professional conduct); and (3) patients’ rights and welfare issues (e.g., confidentiality, power asymmetries, paternalism vs. patient autonomy, informed consent). Recommendations as to how physiotherapists could better manage these issues were then identified and categorized. Conclusions: The physiotherapy community should reflect on the challenges raised by private practice so that professionals can be supported – through education, research, and good governance – in providing the best possible care for their clients

Commotions cérébrales chez les enfants et les adolescents : influence du genre sur la récupération et le retour au jeu

Travail d'intégration réalisé dans le cadre du cours PHT-6113.Objectif : Comparer l’impact du genre sur le retour au jeu, la récupération et les niveaux d’efficacité personnelle suite à un traumatisme crânio-cérébral léger (TCCL) chez une population pédiatrique. Méthode : Un groupe de 16 filles et de 26 garçons entre 6 et 17 ans furent inclus dans cette étude. La récupération post-TCCL, l’efficacité personnelle dans les sports et le niveau de participation aux activités physiques furent évalués à 2, 12, 31 et 52 semaines post-blessure à l’aide d’outils standardisés. Résultats : Les enfants des deux groupes présentaient des profils de symptômes similaires au moment de la blessure excepté pour le niveau d’étourdissement qui semblait plus élevé chez les garçons (p=0.025). Au niveau de la récupération, les deux groupes d’enfants s’amélioraient au fil du temps, surtout entre 12 et 31 semaines mais les filles retournaient au jeu plus tard, présentaient davantage de symptômes de nature physique (p=0.01) et des niveaux plus bas d’efficacité personnelle que les garçons (p=0.003). Conclusion : L’existence de différences entre les genres suite à un TCCL devrait être prise en compte lors de la prise en charge des enfants et adolescents

Cell-specific DNA methylation signatures in asthma

Asthma is a complex trait, often associated with atopy. The genetic contribution has been evidenced by familial occurrence. Genome-wide association studies allowed for associating numerous genes with asthma, as well as identifying new loci that have a minor contribution to its phenotype. Considering the role of environmental exposure on asthma development, an increasing amount of literature has been published on epigenetic modifications associated with this pathology and especially on DNA methylation, in an attempt to better understand its missing heritability. These studies have been conducted in different tissues, but mainly in blood or its peripheral mononuclear cells. However, there is growing evidence that epigenetic changes that occur in one cell type cannot be directly translated into another one. In this review, we compare alterations in DNA methylation from different cells of the immune system and of the respiratory tract. The cell types in which data are obtained influences the global status of alteration of DNA methylation in asthmatic individuals compared to control (an increased or a decreased DNA methylation). Given that several genes were cell-type-specific, there is a great need for comparative studies on DNA methylation from different cells, but from the same individuals in order to better understand the role of epigenetics in asthma pathophysiology

Mindfulness and psychoeducation to manage stress in amnestic mild cognitive impairment : a pilot study

Objectives: Amnestic mild cognitive impairment (aMCI) often corresponds to the prodromal stage of Alzheimer disease (AD). The aMCI stage represents a crucial time window to apply preventive interventions in an attempt to delay cognitive decline. Stress, one of AD’s modifiable risk factors frequently co-occurring with aMCI, stands out as a key intervention target. The goal of this study was to assess the impacts of two nonpharmacological interventions, mindfulness and psychoeducation, on stress at the psychological and physiological levels among aMCI older adults. Methods: Forty-eight aMCI participants were randomized between a mindfulness-based intervention (MBI) and a psychoeducation-based intervention (PBI) for eight weekly sessions. Anxiety symptoms, perceived stress levels, cortisol awakening response (CAR), and coping strategies were assessed pre- and post-intervention. Mindfulness attitudes and time dedicated to at-home meditative practices were evaluated in the MBI group. Results: The main results revealed a slight reduction of the CAR among MBI participants who practiced meditation at home the most and a decrease in perceived stress levels in the PBI group. Both interventions enhanced problem-focused coping strategies. Conclusion: In sum, this pilot study supports the potential of MBI and PBI to reduce stress at the physiological and psychological level, respectively, and increase coping strategies in older adults at risk for AD

Validation of a French-language version of the health education impact Questionnaire (heiQ) among chronic disease patients seen in primary care : a cross-sectional study

Background The Health Education Impact Questionnaire (heiQ) allows for the evaluation of the effects of education interventions provided to patients with chronic diseases. This study describes the process for the cross-cultural adaptation and validation of the heiQ into French (heiQ-Fv). Methods We undertook a systematic translation process followed by a validation study based on the secondary analysis of cross-sectional data from a longitudinal study. Participants in the validation study were adult patients from primary care clinics in Quebec, Canada, with one or more of the following diseases: diabetes, asthma, chronic obstructive pulmonary disease, cardiovascular disease; or one or more risk factors for these diseases. Main outcomes of the study were the French version of the heiQ-Fv and the validation analyses that included internal consistency, test-retest reliability, confirmatory factor analysis (CFA) and concomitant validity. Results The validation analysis was conducted on results from 332 participants. Cronbach’s alphas (internal consistency) for seven domains of the heiQ-Fv varied from 0.80 to 0.89; one domain scored 0.69. The test-retest analysis (n = 50) yielded intra-class correlation coefficients from 0.66 to 0.86. The CFA of the eight heiQ domains with the hypothesis of no correlation between the domains yielded a model that did not exhibit acceptable fit values. A model with the hypothesis of all domains correlated exhibited acceptable fit values (scaled chi-square = 1210.15, degrees of freedom = 712, p < 0.001; CFI = 0.98; RMSEA = 0.06; SRMR = 0.065). Results show a moderate correlation (concomitant validity) between five domains of the heiQ-Fv and the Self-Efficacy for Managing Chronic Diseases. We also found a moderate to strong correlation between the Emotional Wellbeing domain of the heiQ and the Kessler Psychological Distress Scale (K6) (r = 0.61; 95 % CI: 0.52 –0.69, p < 0.01). Conclusions The heiQ was translated into French using a rigorous translation process; the French-language version showed good psychometric properties. Health professionals and researchers in primary care settings may use the heiQ-FV to evaluate the impact of educational programs on patients with chronic diseases