Pain Viewed from the Outside: A Response to Verpaelst

Commentaire / CommentaryLa douleur est une expérience subjective. Tenter de comprendre le quotidien des personnes vivant avec la douleur est important pour les cliniciens, les professeurs et les chercheurs. Être exposé(e) à des œuvres d’art créées par des personnes qui vivent avec la douleur est une façon d’aider à comprendre ces expériences vécues.Pain is a subjective experience. Gaining insight from persons in pain into what it is to live with pain is important for clinicians, teachers and researchers. Being exposed to art created by persons in pain is one way to help understand these lived experiences

Pratiques interprofessionnelles de physiothérapeutes qui oeuvrent dans le secteur privé au Québec auprès de personnes présentant de la douleur lombaire

La collaboration entre intervenants a été fortement encouragée au cours des dernières décennies afin d’améliorer l’efficacité et l’efficience des services de santé. À ce jour, on en sait toutefois peu sur les pratiques interprofessionnelles des physiothérapeutes du secteur privé. Cette thèse avait trois objectifs principaux qui se sont traduits par la réalisation d’une étude à devis mixte qualitatif/quantitatif comportant trois volets. Le premier volet, qualitatif descriptif, avait pour objectif principal d’explorer les expériences et les perceptions de physiothérapeutes qui œuvrent dans le secteur privé dans le cadre de leurs interventions auprès de personnes avec de la douleur lombaire. Selon les résultats des entrevues semi-structurées réalisées auprès de 13 physiothérapeutes, les pratiques interprofessionnelles incluaient des processus tels que l’échange d’information et la référence, étaient influencées par des facteurs liés aux patients, aux intervenants, aux organisations et aux systèmes, et avaient principalement des effets positifs. Les deuxième et troisième volets, quantitatifs, avaient respectivement pour objectif principal de tracer un portrait 1) des organisations où œuvrent les physiothérapeutes dans le secteur privé au Québec (volet 2) et 2) des pratiques interprofessionnelles de ces physiothérapeutes dans le cadre de leurs interventions auprès de personnes ayant de la douleur lombaire (volet 3). Les données associées à ces deux volets ont été récoltées via une enquête transversale provinciale auprès de 327 physiothérapeutes sélectionnés de façon aléatoire (participation: 67,7%) œuvrant dans 243 organisations. Ces deux volets ont permis de décrire les pratiques interprofessionnelles, d’identifier les perceptions qu’en ont les physiothérapeutes, ainsi que d’explorer si certaines variables organisationnelles étaient associées à l’intensité des pratiques interprofessionnelles. De plus, le volet 3 a permis un apport méthodologique par l’adaptation d’un instrument mesurant l’intensité des pratiques interprofessionnelles et l’évaluation de certaines de ses propriétés métrologiques, les résultats indiquant que l’instrument était prometteur. Ayant examiné les pratiques interprofessionnelles des physiothérapeutes, un sujet encore peu étudié, cette thèse fournit des connaissances d’intérêt pour les physiothérapeutes et d’autres intervenants, les gestionnaires, les décideurs, ainsi que les associations et les ordres professionnels, et ce, en vue d’améliorer ou d’étendre les pratiques interprofessionnelles impliquant des physiothérapeutes lorsque pertinent.Collaboration between health care providers has been greatly encouraged in recent decades to improve effectiveness and efficiency of health services. However, to this day, little is known of private sector physiotherapists’ interprofessional practices. This thesis had three main objectives that were addressed by conducting a three-part mixed-methods qualitative/quantitative project. The main objective of the first part, a qualitative descriptive study, was to explore experiences and perceptions of private sector physiotherapists regarding their interventions with adults with low back pain. Results of semi-structured interviews with 13 physiotherapists showed that, for physiotherapists, interprofessional practices included processes such as sharing information and referring, they were influenced by factors related to patients, providers, organizations, and wider systems and were mostly viewed as having positive effects. The second and third parts of the project were quantitative. Their main objectives were respectively to draw portraits of 1) the organizations where physiotherapists work in the private sector in Québec (part 2), and 2) of the interprofessional practices of these physiotherapists in the context of their interventions with adults with low back pain (part 3). Data were obtained through a cross-sectional provincial survey with 327 randomly-selected physiotherapists (participation: 67,7 %) working in 243 organizations. Parts 2 and 3 allowed to describe physiotherapists’ interprofessional practices, to identify physiotherapists’ perceptions regarding these practices, as well as to explore organizational and provider-related variables associated with the intensity of interprofessional practices. In addition, part 3 was associated with a methodological contribution by the adaptation of an instrument measuring the intensity of the interprofessional practices and the evaluation of a few of its psychometric properties, the results having indicated it was a promising instrument. This thesis offers new knowledge of physiotherapists’ interprofessional practices, an understudied subject, which is of interest to physiotherapists and other providers, managers, decision-makers and professional boards and associations, with the goal of improving or extending interprofessional practices involving physiotherapists when relevant

L'accord patient-physiothérapeute et son influence sur l'intensité de la douleur lombaire et les incapacités fonctionnelles à court terme

Ces travaux de maîtrise visaient à décrire le niveau d’accord entre les perceptions des patients présentant une douleur lombaire et celles de leur physiothérapeute respectif, à identifier les facteurs associés à l’accord, et à évaluer son impact sur l’évolution des patients à court terme. Soixante-dix-huit patients et neuf physiothérapeutes ont participé à cette étude à devis mixte. Les perceptions d’intensité de la douleur et d’incapacités fonctionnelles des patients et des physiothérapeutes étaient mesurées après l’évaluation initiale. Les perceptions des patients étaient réévaluées au téléphone après quatre semaines. Cette étude a révélé des différences importantes entre les perceptions des patients et des physiothérapeutes. Plus l’intensité de la douleur et les incapacités fonctionnelles des patients étaient élevées, plus les perceptions divergeaient. L’accord patient-physiothérapeute a eu un certain impact sur la récupération de la douleur lombaire. Des recherches futures permettront de valider ces résultats et de vérifier l’importance clinique de l’accord patient-physiothérapeute.The objectives of this master’s project were to describe patient-physiotherapist agreement for low back pain intensity and functional limitations, to identify correlates of agreement and to assess the impact of agreement on short-term changes in low back pain. Seventy-eight patients and nine physiotherapists participated in this mixed-design study. Patients’ and physiotherapists’ perceptions of pain intensity and functional limitations were measured at baseline after the initial physiotherapy assessment. Patients’ perceptions were reassessed over the phone four weeks later. Overall, the results of this study indicate that there are important discrepancies between patients’ and physiotherapists’ perceptions. Higher ratings by the patients for pain and functional limitations were related to higher differences in perceptions between patients and physiotherapists. This report also reveals that patient-physiotherapist agreement has some impact on the short-term outcome of low back pain. Further research will allow to validate these findings and to verify the clinical implications of patient-physiotherapist agreement

A physician-physiotherapist collaborative model in a family medicine teaching clinic

Persons with musculoskeletal disorders frequently seek care in family medicine clinics. However, musculoskeletal education provided in medical schools is often considered insufficient. The implementation of a collaborative model that integrates physiotherapists into teaching clinics may benefit the musculoskeletal training of medical residents. This paper describes a model developed in a family medicine teaching clinic by examining the interprofessional educational and collaborative activities implemented in this model. The model allowed to provide physiotherapy services, involve the physiotherapist in the training of family medicine residents and enhance interprofessional collaboration, particularly for the management of persons with musculoskeletal disorders._____Les personnes ayant des troubles musculosquelettiques consultent fréquemment en cliniques de médecine de famille. Cependant, l’enseignement musculosquelettique dispensé dans les programmes de médecine est souvent considéré comme insuffisant. L’implantation d’un modèle de collaboration qui intègre les physiothérapeutes aux cliniques d’enseignement pourrait améliorer la formation des médecins résidents. Cet article décrit un modèle développé dans une clinique d’enseignement en médecine familiale en examinant les activités interprofessionnelles d’éducation et de collaboration implantées dans ce modèle. Le modèle a permis d’offrir des services de physiothérapie, d’impliquer le physiothérapeute dans la formation des médecins résidents et d’améliorer la collaboration interprofessionnelle, particulièrement pour la prise en charge des personnes ayant des troubles musculosquelettiques

Ethics teaching in rehabilitation: results of a pan-Canadian workshop with occupational and physical therapy educators

Purpose: Ethical practice is an essential competency for occupational and physical therapists. However, rehabilitation educators have few points of reference for choosing appropriate pedagogical and evaluation methods related to ethics. The objectives of this study were to: 1) identify priority content to cover in ethics teaching in occupational therapy (OT) and physical therapy (PT) programs and 2) explore useful and innovative teaching and evaluation methods. Method: Data for this qualitative descriptive study were collected during a one-day knowledge exchange workshop focused on ethics teaching in rehabilitation. Results: Twenty-three educators from 11 OT and 11 PT Canadian programs participated in the workshop. They highlighted the importance of teaching foundational theoretical/philosophical approaches and grounding this teaching in concrete examples drawn from rehabilitation practice. A wide range of teaching methods was identified, such as videos, blogs, game-based simulations and role-play. For evaluation, participants used written assignments, exams, objective structured clinical examinations and reflective journals. The inclusion of opportunities for student self-evaluation was viewed as important. Conclusion: The CREW day provided ethics educators the opportunity to share knowledge and begin creating an on-line community of practice. This space for dialogue could be expanded to international rehabilitation ethics educators, to facilitate a broader network for sharing of tacit and experiential knowledge.

Prioritization of Referrals in Outpatient Physiotherapy Departments in Québec and Implications for Equity in Access

In the context of long waiting time to access rehabilitation services, a large majority of settings use referral prioritization to help manage waiting lists. Prioritization practices vary greatly between settings and there is little consensus on how best to prioritize referrals. This paper describes the prioritization processes for physiotherapy services in Québec and its potential implications in terms of equity in access to services. This is a secondary analysis of a survey of outpatient physiotherapy departments (n=98; proportion of participation was 99%) conducted in 2015 across publicly funded hospitals in Québec. In many settings, persons with acute orthopaedic conditions were prioritized while chronic conditions were given a lower priority. There were 72 different combinations of prioritization criteria used in outpatient physiotherapy departments. Variability was also observed in the type of personnel involved in the prioritization process, the number of priority levels used to rank the referrals and the source of information used to prioritize referrals. These results highlight potential issues regarding equity in access to physiotherapy services: the prioritization of persons with acute conditions to the detriment of those with chronic conditions, the lack of consensus on a fair prioritization process and the importance to adequately assess patients’ needs for treatment. Further research and interventions on prioritization criteria and processes are needed to ensure equitable access to physiotherapy services, especially in the public sector

Supporting ethics educators in Canadian occupational therapy and physical therapy programs: A national interprofessional knowledge exchange project

Ethics education is the cornerstone of professional practice, fostering knowledge and respect for core ethical values among healthcare professionals. Ethics is also a subject well-suited for interprofessional education and collaboration. However, there are few initiatives to gather experiences and share resources among ethics educators in rehabilitation. We thus undertook a knowledge exchange project to 1) share knowledge about ethics training across Canadian occupational and physical therapy programs, and 2) build a community of educators dedicated to improving ethics education. The objectives of this paper are to describe this interprofessional knowledge exchange project involving ethics educators (with a diversity of professional and disciplinary backgrounds) from Canadian occupational and physical therapy programs as well as analyze its outcomes based on participants’ experiences/perceptions. Two knowledge exchange strategies were employed: an interactive one-day workshop and a wiki platform. An immediate post-workshop questionnaire evaluated the degree to which participants’ expectations were met. Structured telephone interviews nine to ten months after the workshop collected participants’ perceptions on whether (and if so, how) the project influenced their teaching or led to further interprofessional collaborations. Open-ended questions from the post-workshop questionnaires and individual interviews were analyzed using qualitative methods. Of 40 ethics educators contacted, 23 participated in the workshop and 17 in the follow-up interview. Only 6 participants logged into the wiki from its launch to the end of data collection. Five themes emerged from the qualitative analysis: 1) belonging and networking; 2) sharing and collaborating; 3) changing (or not) ways of teaching ethics; 4) sustaining the network; and 5) envisioning the future of ethics education. The project attained many of its goals, despite encountering some challenges. While the wiki platform proved to be of limited benefit in advancing the project goals, the interactive format and collaborative nature of the one-day workshop were described as rewarding and effective in bringing together occupational therapy and physical therapy educators to meet, network, and share knowledge.Anne Hudon is supported by a doctoral fellowship from the Fonds de recherche du Québec-Santé (FRQ-S) and was supported by a scholarship from the MENTOR program in collaboration with the Canadian Institutes of Health Research (CIHR) and the Quebec Research Rehabilitation Network (REPAR) at the time of the study. Maude Laliberté held a doctoral fellowship from the FRQ-S. Matthew Hunt is supported by a research scholar award from the FRQ-S. This project was funded by the Canadian Institutes of Health Research (CIHR-EOG-120255), the Edith Strauss Rehabilitation Research Project Foundation, the Canadian Council of Physiotherapy University Programs (CCPUP & CPA), the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), and the Faculty of Medicine at the University of Montreal

Strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities : a systematic literature review

Objective: Identifying effective strategies to reduce waiting times is a crucial issue in many areas of health services. Long waiting times for rehabilitation services have been associated with numerous adverse effects in people with disabilities. The main objective of this study was to conduct a systematic literature review to assess the effectiveness of service redesign strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities. Methods: We conducted a systematic review, searching three databases (MEDLINE, CINAHL and EMBASE) from their inception until May 2021. We identified studies with comparative data evaluating the effect of rehabilitation services redesign strategies on reducing waiting times. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies. A narrative synthesis was conducted. Results: Nineteen articles including various settings and populations met the selection criteria. They covered physiotherapy (n = 11), occupational therapy (n = 2), prosthetics (n = 1), exercise physiology (n = 1) and multidisciplinary (n = 4) services. The methodological quality varied (n = 10 high quality, n = 6 medium, n = 3 low); common flaws being missing information on the pre-redesign setting and characteristics of the populations. Seven articles assessed access processes or referral management strategies (e.g. self-referral), four focused on extending/modifying the roles of service providers (e.g. to triage) and eight changed the model of care delivery (e.g. mode of intervention). The different redesign strategies had positive effects on waiting times in outpatient rehabilitation services. Conclusions: This review highlights the positive effects of many service redesign strategies. These findings suggest that there are several effective strategies to choose from to reduce waiting times and help better respond to the needs of persons experiencing physical disabilities

Development of a National Pain Management Competency Profile to Guide Entry-Level Physiotherapy Education in Canada

Background National strategies from North America call for substantive improvements in entry-level pain management education to help reduce the burden of chronic pain. Past work has generated a valuable set of interprofessional pain management competencies to guide the education of future health professionals. However, there has been very limited work that has explored the development of such competencies for individual professions in different regions. Developing profession-specific competencies tailored to the local context is a necessary first step to integrate them within local regulatory systems. Our group is working toward this goal within the context of entry-level physiotherapy (PT) programs across Canada. Aims This study aimed to create a consensus-based competency profile for pain management, specific to the Canadian PT context. Methods A modified Delphi design was used to achieve consensus across Canadian university-based and clinical pain educators. Results Representatives from 14 entry-level PT programs (93% of Canadian programs) and six clinical educators were recruited. After two rounds, a total of 15 competencies reached the predetermined endorsement threshold (75%). Most participants (85%) reported being “very satisfied” with the process. Conclusions This process achieved consensus on a novel pain management competency profile specific to the Canadian PT context. The resulting profile delineates the necessary abilities required by physiotherapists to manage pain upon entry to practice. Participants were very satisfied with the process. This study also contributes to the emerging literature on integrated research in pain management by profiling research methodology that can be used to inform related work in other health professions and regions

Does patient-physiotherapist agreement influence the outcome of low back pain? A prospective cohort study

BACKGROUND: Recent research suggests that agreement between patients' and health professionals' perceptions may influence the outcome of various painful conditions. This issue has received little attention in the context of low back pain and physiotherapy interventions. The current study aimed at exploring the relationship between patient-physiotherapist agreement on baseline low back pain intensity and related functional limitations, and changes in patient outcomes four weeks later. METHODS: Seventy-eight patient-physiotherapist dyads were included in the study. At baseline, patients and physiotherapists completed a Numerical Rating Scale and the Roland-Morris Disability Questionnaire. Patients' perceptions were reassessed over the phone at follow-up. RESULTS: Using multiple regression, baseline level of patient-physiotherapist agreement on pain intensity was associated with both outcome measures at follow-up. Agreement on functional limitations had no impact on outcomes. CONCLUSION: The results of this study indicate that patient-physiotherapist agreement has some impacts on the short-term outcomes of low back pain. Further research is needed to confirm these findings