Is there a dose response relationship between soft tissue manual therapy and clinical outcomes in fibromyalgia?

BackgroundCurrent clinical guidelines do not support the use of manual therapy (MT) interventions for Fibromyalgia (FM) patients, despite evidence of positive biochemical, mechanical and psychological effects, and the popularity of hands-on treatments amongst patients. An optimal dose for MT has not been established; this may explain the discrepancies found within the published literature. The aim of this systematic review was to determine whether there is a dose response relationship for MT leading to improvements in core domains of FM symptomology; Pain, Mood, Sleep, Global Measure of Impact (Functional Status & Quality of Life).MethodsWe searched six databases from 1990 to January 2018; studies were evaluated using the PEDro scale. Within-group (ES d) and between-group (ES g) Effect Sizes were calculated.ResultsWe identified and screened 4012 articles, 12 articles were critically appraised. Overall, there is moderate evidence that MT has positive effects on the four clinical outcomes investigated. However, there was no consistent dose response relationship observed across all studies.ConclusionsA dose of approximately 45 min MT, three to five times per week, for three to five weeks, totalling 11 h 15 min, should be considered a baseline generic protocol for treatment delivery and research trials. Further research is necessary to confirm domain specific, or patient specific optimal doses. Moderator variables such as treatment time, frequency, duration; and MT type also need to be explored to ensure optimal delivery of MT in future research and clinical care provision

Experiences of a student with a visual impairment transitioning to higher education: A narrative inquiry

Transition to higher education is a considerable period of change for students, and can be a particularly challenging time for students with a visual impairment. The aim of this study was to understand the transition experiences of an undergraduate student in Sport Rehabilitation with a visual impairment. A narrative inquiry was conducted with one participant purposively sampled due to being certified severely sight impaired. Data were collected using a semi-structured interview, and analysed by creating narrative threads within Clandinin and Connelly’s three-dimensional framework. The social influence of role models, peers, and staff were noted in relation to their impact on confidence and feeling of fitting in. Navigating the campus, teaching spaces, and demonstrations were all highlighted as spatial factors that affected independence and participation during transition. Time-related aspects such a personal development, proactivity, and pre-, during, and post-teaching session experiences were identified as key considerations. The narratives uncovered should serve as a tool to trigger reflection on previous teaching practice, and inform future direction. The findings and recommendations within this study will benefit transition and inclusivity for students with a visual impairment, particularly on Sport Rehabilitation or other healthcare programmes, allowing them to study and practice effectively

What factors influence physical activity participation in people with rheumatoid arthritis?

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by periods of inflammation and remission. Physical activity can reduce disease activity and lower the risks of associated co-morbidities such as cardiovascular disease. Despite the benefits, a high percentage of people with RA do not participate in regular physical activity.Objective: The purpose of this qualitative literature review was to explore and synthesize the experiences of people with RA to develop better insight of the factors that influence physical activity participation.Method: A systematic search was conducted across five online databases; MEDLINE, CINAHL, ScienceDirect, PsycINFO, Web of Science. Studies were assessed for quality, data were extracted and analyzed using thematic synthesis.Results: A total of 186 articles were identified and screened against inclusion/exclusion criteria. Seven studies met the criteria and were included in this review. Five key themes were identified as the most significant factors to physical activity participation: professional knowledge and guidance; part of a community; knowing me, knowing RA; what’s in it for me; and where, when, how much? Professional knowledge and guidance was the underpinning factor influencing physical activity participation.Conclusion: The results identify several internal and external factors that affect physical activity participation. To engage, facilitate and motivate patients to participate in physical activity, ongoing education and support from health care professionals is required. This will promote better symptom management and maintain functional independence. Additionally, health care professionals need to consider individual preferences and abilities when recommending physical activity

What are the views of musculoskeletal physiotherapists and patients on person-centred practice? A systematic review of qualitative studies

PurposeThere is a growing expectation of physiotherapists to adopt a person-centred approach to their practice. Person-centredness for musculoskeletal physiotherapy, however, remains an under-researched area. A synthesis of the findings from qualitative studies exploring perceptions of person-centredness in musculoskeletal physiotherapy was conducted to inform future clinical practice.MethodsENTREQ and PRISMA guidelines were used to develop a protocol for a qualitative systematic review registered with PROSPERO (registration number: CRD42020170762). Five electronic databases were searched to identify relevant primary studies. Studies were assessed for quality and data extracted. Data were analysed using thematic synthesis.ResultsA total of 3250 studies were identified and screened. Nine studies met the inclusion criteria. Four main themes emerged from the data: treating each patient as a unique person, the importance of communication for achieving a therapeutic alliance, necessary physiotherapist traits for person-centredness, and supporting patient empowerment.ConclusionEmpowerment of patients in musculoskeletal physiotherapy contexts might be improved through a more narrative approach to assessment, with clinical bravery recognised as a specific person-centred physiotherapy trait able to facilitate this. Physiotherapists should also consider the meaningfulness of any treatment activities they provide to maximise the person-centredness of their approach.IMPLICATIONS FOR REHABILITATIONEmpowerment of patients in musculoskeletal physiotherapy contexts might be improved through a more narrative approach to assessment.Clinical bravery is a person-centred physiotherapy trait that facilitates certain conversational freedom to elicit the true patient narrative.Person-centred physiotherapists should reflect on how meaningful their treatment activities are for individual MSK outpatients

Student expectations of teaching and learning when starting university: a systematic review

Student expectations are complex constructs that can influence adaptability, engagement, achievement, satisfaction and retention. A number of individual studies have been published on the expectations of students when starting university, however none that synthesise student expectations of teaching and learning. Therefore, the aim of this systematic review was to understand student expectations of teaching and learning when starting university. A systematic search strategy identified 2950 studies, of which nine met all eligibility criteria. Relevant data was extracted and a narrative synthesis conducted, revealing four key themes: additional study, self-managing learning, teaching and learning activities, and accessibility. Students expect to complete additional study and take responsibility for their own learning, but may be unsure how to manage this. They expect to have to attend all sessions and commonly expect lectures, but thoughts on other methods of teaching and learning vary. Students also have high expectations of teaching staff, particularly with regards to access and resources. This knowledge is important in enabling teaching staff to better align preconceived ideas of university teaching and learning with reality, support a positive university experience, and improve satisfaction and retention. Future research should further investigate student expectations of teaching and learning independently, perhaps from a qualitative perspective, as well as exploring interventions to help manage these expectations when necessary

An exploration of person-centredness among emergency department physiotherapists: a mixed methods study

Purpose: There is a growing number of primary contact physiotherapists based in United Kingdom emergency departments (ED) who are expected to deliver person-centred practices. Perceptions of physiotherapists working in these high-pressure environments on person-centredness are currently unknown. A mixed methods exploration of person-centredness among ED physiotherapists targeted this knowledge gap to inform future clinical practice. Methods: Online survey and semi-structured interviews followed a convergent mixed methods design with sequential explanatory features. Data sets were analysed separately using descriptive statistics and thematic analysis, respectively, before merged analysis using joint display. Results: Twenty-six surveys and 11 in-depth interviews were completed. The three overarching themes of ED patients, ED physiotherapists, and ED environment were generated. Themes were integrated and analysed alongside quantitative survey findings. This produced three novel contributions that further our understanding of person-centred practices among ED physiotherapists. Conclusion: ED physiotherapists were mindful of an apparent, yet unspoken struggle between the competing philosophies of biomedicine and person-centredness. The results here support entering a patient’s world as a person-centred approach to help navigate the line between what an ED attender wants and the clinical need of their visit

‘You must have lived it’: learning from the views of physiotherapists who worked during the COVID-19 pandemic

Background: The COVID-19 pandemic has resulted in a total of 676 million cases of infection and 6.9 million deaths. During a pandemic, healthcare workers are exposed to psychological stressors such as high risk of infection, inadequate protection, and isolation, which could have implications for their wellbeing. Aims: The purpose of this qualitative literature review carried out systematically was to examine the views of physiotherapists who worked with COVID-19 patients during the COVID-19 pandemic to identify how physiotherapy services might be better prepared for future pandemics. Methods: A systematic search was carried out across four databases (CINAHL, MEDLINE, PsycINFO, SPORTDISCUS) to identify relevant studies. Studies were assessed for quality and data extracted and analysed using thematic synthesis. Results: A total of 631 studies were identified through the search strategy and screened against the inclusion/exclusion criteria. Six papers met the inclusion criteria. Four themes were identified from the perspective of the physiotherapy participants: lack of resources; emotional impact; coping strategies and integration; and value within the multidisciplinary team. Conclusion: Overall qualitative evidence around the views of physiotherapists who worked during the COVID-19 pandemic is limited. An insight into the views of participants may help healthcare organisations support physiotherapy services to be better prepared in the event of a future pandemic, specifically addressing the need to strengthen supply chains, advocating for physiotherapy as a profession in low-income counties and psychological resilience. Future research should focus on identifying the most effective support options and strategies to build psychological resilience before a crisis occurs

Development of a framework for person-centred physiotherapy

BackgroundThere is a growing call for healthcare to focus on person-centred practice. This can lead to improved outcomes for patients in terms of physical and psychological health. Challenges exist around how person-centredness is understood in physiotherapy. Having a physiotherapy framework would help support a shared understanding of the meaning of person-centred physiotherapy.AimThe aim of this study was to locate and synthesise studies which have a conceptualisation of person-centred physiotherapy practice. These were used to develop an overarching conceptual framework for person-centred physiotherapy practice.MethodsThe framework was developed through a systematic process involving a systematic literature search, screening studies against eligibility criteria, data extraction, data synthesis, naming and defining core constructs of person-centred physiotherapy practice, and generation of a pictorial representation of an overarching conceptual framework.ResultsThe person-centred physiotherapy framework is comprised of four constructs: physiotherapist characteristics, which focuses on the knowledge and skills for clinical proficiency, attributes of the physiotherapist, reflection and self-awareness; person-physiotherapist interaction(s), which focuses on partnership, empowerment and self-management; the environment, which focuses on coordinated healthcare delivery, culture of the organisation and practice environment, and the physical environment; and the ongoing unique journey of the person and self-management. The relationships between the constructs reflect the complex nature of person-centred practice.ConclusionsThe framework presented can be used to better understand person-centred physiotherapy with a view to enhancing practice. The framework needs to be tested further through empirical research to establish its utility

Impact of contextual factors on patient outcomes following conservative low back pain treatment: systematic review

Background and objectiveChronic low back pain is pervasive, societally impactful, and current treatments only provide moderate relief. Exploring whether therapeutic elements, either unrecognised or perceived as implicit within clinical encounters, are acknowledged and deliberately targeted may improve treatment efficacy. Contextual factors (specifically, patient’s and practitioner’s beliefs/characteristics; patient-practitioner relationships; the therapeutic setting/environment; and treatment characteristics) could be important, but there is limited evidence regarding their influence. This research aims to review the impact of interventions modifying contextual factors during conservative care on patient’s pain and physical functioning.Databases and data treatmentFour electronic databases (Medline, CINAHL, PsycINFO and AMED) were searched from 2009 until 15th February 2022, using tailored search strategies, and resulted in 3476 unique citations. After initial screening, 170 full-text records were potentially eligible and assessed against the inclusion–exclusion criteria. Thereafter, studies were assessed for methodological quality using a modified Downs and Black scale, data extracted, and synthesised using a narrative approach.ResultsTwenty-one primary studies (N = 3075 participants), were included in this review. Eight studies reported significant improvements in pain intensity, and seven in physical functioning, in favour of the contextual factor intervention(s). Notable contextual factors included: addressing maladaptive illness beliefs; verbal suggestions to influence symptom change expectations; visual or physical cues to suggest pain-relieving treatment properties; and positive communication such as empathy to enhance the therapeutic alliance.ConclusionThis review identified influential contextual factors which may augment conservative chronic low back pain care. The heterogeneity of interventions suggests modifying more than one contextual factor may be more impactful on patients’ clinical outcomes, although these findings require judicious interpretation

'It was all in your voice' - Tertiary student perceptions of alternative feedback modes (audio, video, podcast, and screencast): A qualitative literature review.

BACKGROUND: Feedback is an integral part of teaching and learning with written comments being one of the most widely used methods of providing student feedback. From the student perspective, written feedback has been seen as limited in terms of its quality, vague nature and lack of clear examples with feed-forward. Alternative feedback modes (including audio, video, podcasts, and screencast feedback) have been suggested as a means of enhancing feedback. OBJECTIVE: The purpose of this qualitative literature review is to synthesise the views of tertiary students on alternative feedback modes. REVIEW METHODS: Searches were carried out in five online scientific databases (ERIC, Education Source, PsycINFO, Teacher Reference Center, and CINAHL Complete). Potentially relevant studies were screened against the inclusion/exclusion criteria. Data were extracted using customised data extraction forms. The qualitative findings section of each included study underwent thematic synthesis. RESULTS: A total of 450 studies were identified through the search strategy. Ten studies met the inclusion criteria. Five themes were identified: belonging; greater comprehension from non-verbal aspects of communication; individualised and personal; technical/practical technology aspects; and circumstances and context. CONCLUSION: Alternative feedback modes help students achieve a greater level of comprehension of feedback, with feedback that was more personalised. The alternative feedback modes promote a sense of belonging in relation to the programme of study and in relation to teaching staff. Educators should consider the use of innovative media approaches which could enhance and improve the quality of the student feedback experience