Development and Validity of the Questionnaire of Patients’ Experiences in Postacute Outpatient Physical Therapy Settings

Background: Patient feedback surveys are increasingly seen as a key component of 2 healthcare quality monitoring and improvement. Objective: To describe the 3 development and initial psychometric evaluation of a fixed-length questionnaire of 4 Patients’ Experiences undergoing physical therapy treatment in a Post-Acute 5 Outpatients settings (PEPAP-Q). Design: An instrument development study with 6 validity and reliability testing. Methods: A total of 465 patients from three 7 rehabilitation centres for musculoskeletal conditions completed the questionnaire. A 8 cognitive pretest was applied to the draft version (n=94), and a revised version was 9 tested for test-retest reliability (n=90). Analyses to evaluate variance and non-response 10 rates to items, the factor structure of the questionnaire and the metric properties of 11 multi-item scales were conducted. Results: Exploratory factor analyses yielded 12 evidence for a seven-factor structure to the PEPAP-Q, with three factors that may be 13 conceptually viewed as professionals’ attitudes and behaviour (providing information 14 and education, sensitive manners to patients’ changes and emotional support) and four 15 factors conceptually reflecting organizational environment (attendance duration, 16 interruptions during care delivery, waiting times and patient safety). Item scale 17 correlations ranged from 0.70 to 0.93. The percentage of scaling success was 100% for 18 all the scales. Cronbach’s alpha coefficient ranged from 0.70 to 0.87. Intraclass 19 correlation coefficients ranged from 0.57 to 0.80 (median=0.68). Limitations: 20 Generalization to other patients is not known. Conclusion: The PEPAP-Q is a reliable 21 test-retest and the scales have internal consistency and convergent and discriminant 22 validity. All the scales are distinct and unidimensional.Actividad Física y DeporteMedicinaTerapia y Rehabilitació

Model biopsychicalsocial in the syndromes of vertebral pain: implications for the protocolize

[Resumen] De forma tradicional el modelo biomédico ha predominado en la práctica asistencial. A diferencia de éste, el modelo biopsicosocial considera a la persona como un todo y hace énfasis sobre la función en lugar de centrarse exclusivamente en el alivio del dolor. En este sentido, la Fisioterapia para el tratamiento de los problemas de espalda, y en concreto para la cervicalgia, tiene que considerar, además del alivio del dolor, la cronicidad y la recurrencia como elementos a considerar en el diseño de actividades protocolizadas.[Abstract] In a traditional way the biomedical model has prevailed in the health care. Against it the biopsychicalsocial pattern considers to the person as a whole and it makes emphasis on the function instead of being centered exclusively in the relief of the pain. In this sense, Physiotheraphy for the treatment of the back problems and in this case for the neck pain, it has to consider besides the relief of the pain, the chronic and the new episodies like elements to consider in the design of protocolized activities

Communication abilities in the clinical interview

[Resumen] Las habilidades comunicacionales constituyen una parte importante de la entrevista clínica. Para una mejor comprensión pueden dividirse en los siguientes apartados: contexto, escucha, comprensión, estrategia y resumen general. Se detallan en cada uno de ellos (a excepción del contexto por haber sido bordado en otro artículo) una serie de técnicas o consideraciones de interés que facilitan una mejora en la interacción del profesional de la salud (fisioterapeuta) con el consultante. Esta mejora repercute tanto en una mayor calidad de los resultados como a nivel afectivo y emocional en ambos protagonistas de la relación.[Abstract] The communication skills are an important part of the clinical interview. To get a better comprehension they can be divided into the following steps: context, listening, acknowledgement, strategy and summary. Some techniques or interesting considerations which can improve health care provider (physiotherapist) patient relationship are explained in each one (but the context because it has been considered in another article). This improvement is involved with not only better clinical outcomes, but also affective and emotional level for both relationship's main character

Predictive factors of adherence to frequency and duration components in home exercise programs for neck and low back pain: an observational study

<p>Abstract</p> <p>Background</p> <p>Evidence suggests that to facilitate physical activity sedentary people may adhere to one component of exercise prescriptions (intensity, duration or frequency) without adhering to other components. Some experts have provided evidence for determinants of adherence to different components among healthy people. However, our understanding remains scarce in this area for patients with neck or low back pain. The aims of this study are to determine whether patients with neck or low back pain have different rates of adherence to exercise components of frequency per week and duration per session when prescribed with a home exercise program, and to identify if adherence to both exercise components have distinct predictive factors.</p> <p>Methods</p> <p>A cohort of one hundred eighty-four patients with chronic neck or low back pain who attended physiotherapy in eight primary care centers were studied prospectively one month after intervention. The study had three measurement periods: at baseline (measuring characteristics of patients and pain), at the end of physiotherapy intervention (measuring characteristics of the home exercise program) and a month later (measuring professional behaviors during clinical encounters, environmental factors and self-efficacy, and adherence behavior).</p> <p>Results</p> <p>Adherence to duration per session (70.9% ± 7.1) was more probable than adherence to frequency per week (60.7% ± 7.0). Self-efficacy was a relevant factor for both exercise components (p < 0.05). The total number of exercises prescribed was predictive of frequency adherence (p < 0.05). Professional behaviors have a distinct influence on exercise components. Frequency adherence is more probable if patients received clarification of their doubts (adjusted OR: 4.1; p < 0.05), and duration adherence is more probable if they are supervised during the learning of exercises (adjusted OR: 3.3; p < 0.05).</p> <p>Conclusion</p> <p>We have shown in a clinic-based study that adherence to exercise prescription frequency and duration components have distinct levels and predictive factors. We recommend additional study, and advise that differential attention be given in clinical practice to each exercise component for improving adherence.</p

No increase in 6-week treatment effect of Mechanical Diagnosis and Therapy with the use of the LUMBOback in people with non-acute non-specific low back pain and a directional preference of extension: a pilot randomized controlled trial.

Objectives: To pilot the methods for a randomized controlled trial (RCT) to investigate whether the treatment effect of Mechanical Diagnosis and Therapy (MDT) is enhanced with the LUMOback. Design: Assessor blinded RCT with 3 and 6-week follow-ups. Setting: An outpatient clinic. Participants: Primary eligibility criteria were: a directional preference of lumbar extension, ≥18 years of age, and non-specific low back pain lasting for ≥1 month. ACCEPTED MANUSCRIPT 2 Interventions: The MDT group undertook extension exercises (10 reps/3h) and postural correction using a lumbar roll at home. The MDT+LUMOback group also wore the LUMOback daily, providing a vibration alert in a slouched posture. Main outcome measures: The Global Rating of Change Scale (GRCS) (0-6), recruitment rate per month, treatment sessions, compliance rate of wearing the LUMOback, participants’ adherence with treatment, dropout rate and the stage of the MDT program at six weeks. Results: Twenty-two participants were included for 20 months (a recruitment rate of 1.1 patients/month). Dropout rate was 9%. The mean (SD) of the GRCS of the MDT and MDT+LUMOback groups were 4.7 (0.8) and 4.7 (0.5) at the 3-week follow-up and were both 4.9 (0.5) at the 6-week follow-up. The patients undertook a mean of 6.7 sessions for six weeks and exercises with mean of 3.7 set/day in each group. The mean compliance rate of wearing the LUMOback was 88%. Nobody was discharged from the intervention with full recovery within six weeks. Conclusions: Data indicated a promising method for the full RCT, but a rationale for the full RCT was not justified. Clinical Trial Registration number: UMIN000018380 Contribution of paper It was the ultimate aim to investigate if the treatment effect of Mechanical Diagnosis and Therapy (MDT) could be enhanced with the use of real-time feedback with the LUMOback in patients with a directional preference of lumbar extension. Regarding the methodology to achieve that aim, recruitment of participants in multiple centers was considered necessary, because of the low recruitment rate in the current study. ACCEPTED MANUSCRIPT 3 However, further investigation in a multi-center trial using the current methods is not justified due to the lack of difference in the treatment effect of MDT within six weeks, with or without the use of the LUMOback for assisting postural correction. Keywords: back pain; exercise therapy; lumbosacral region; manipulative therapies; posture; proprioceptive feedbac

Proyecto de innovación educativa en fundamentos de fisioterapia

[SPA] Se presenta un proyecto dirigido a estructurar de manera general el contenido de la asignatura “Fundamentos de Fisioterapia” perteneciente al primer curso de Grado en Fisioterapia. Tras las diversas reuniones del grupo de trabajo, se creó material audiovisual para apoyo de la docencia que combinado con los recursos complementarios y el programa de los contenidos se adaptó al formato OCW (Open Course Ware). El proyecto se desarrolló durante el curso académico 2012/2013 consiguiendo material docente de nueva creación, mayor divulgación de los conocimientos de la asignatura en el contexto educativo y profesional y un incremento del contacto de los estudiantes con la plataforma de e-learning universitaria facilitando el acceso al conocimiento desde cualquier lugar. [ENG] A project to structure “Basics in Physiotherapy” subject belonging to the first degree course in Physiotherapy is presented. Following several meetings of the working group it was created audiovisual material to support teaching combined with complementary resources. All the content was adapted to OCW format (Open Course Ware). The project was developed during the 2012/2013 academic year getting newly created teaching materials, greater dissemination of knowledge of the subject in the educational and professional context and increased student contact with the universtity e-learning platform facilitating access to knowledge from anywhere

A systematic review of measures of self-reported adherence to unsupervised home-based rehabilitation exercise programmes, and their psychometric properties

BACKGROUND: Adherence is an important factor contributing to the effectiveness of exercise-based rehabilitation. However, there appears to be a lack of reliable, validated measures to assess self-reported adherence to prescribed but unsupervised home-based rehabilitation exercises. OBJECTIVES: A systematic review was conducted to establish what measures were available and to evaluate their psychometric properties. DATA SOURCES: MEDLINE, EMBASE, PsycINFO CINAHL (June 2013) and the Cochrane library were searched (September 2013). Reference lists from articles meeting the inclusion criteria were checked to ensure all relevant papers were included. STUDY SELECTION: To be included articles had to be available in English; use a self-report measure of adherence in relation to a prescribed but unsupervised home-based exercise or physical rehabilitation programme; involve participants over the age of 18. All health conditions and clinical populations were included. DATA EXTRACTION: Descriptive data reported were collated on a data extraction sheet. The measures were evaluated in terms of eight psychometric quality criteria. RESULTS: 58 studies were included, reporting 61 different measures including 29 questionnaires, 29 logs, two visual analogue scales and one tally counter. Only two measures scored positively for one psychometric property (content validity). The majority of measures had no reported validity or reliability testing. CONCLUSIONS: The results expose a gap in the literature for well-developed measures that capture self-reported adherence to prescribed but unsupervised home-based rehabilitation exercises

How do care-provider and home exercise program characteristics affect patient adherence in chronic neck and back pain: a qualitative study

<p>Abstract</p> <p>Background</p> <p>The aim of this study is to explore perceptions of people with chronic neck or low back pain about how characteristics of home exercise programs and care-provider style during clinical encounters may affect adherence to exercises.</p> <p>Methods</p> <p>This is a qualitative study consisting of seven focus groups, with a total of 34 participants presenting chronic neck or low back pain. The subjects were included if they were receiving physiotherapy treatment and were prescribed home-based exercises.</p> <p>Results</p> <p>Two themes emerged: home-based exercise programme conditions and care provider's style. In the first theme, the participants described their positive and negative experiences regarding time consumption, complexity and effects of prescribed exercises. In the second theme, participants perceived more bonding to prescribed exercises when their care provider presented knowledge about the disease, promoted feedback and motivation during exercise instruction, gave them reminders to exercise, or monitored their results and adherence to exercises.</p> <p>Conclusions</p> <p>Our experiential findings indicate that patient's adherence to home-based exercise is more likely to happen when care providers' style and the content of exercise programme are positively experienced. These findings provide additional information to health care providers, by showing which issues should be considered when delivering health care to patients presenting chronic neck or back pain.</p

Factors associated with adherence to self-managed aphasia therapy practice on a computer—a mixed methods study alongside a randomized controlled trial

Background: Aphasia is a communication disorder often acquired after a stroke. Independent use of specialist aphasia software on a home computer is a form of asynchronous tele-rehabilitation that can provide increased opportunity for practice of rehabilitation exercises. This study aimed to explore the factors associated with adherence to self-managed aphasia computer therapy practice. Method: A mixed methods exploration of adherence was conducted alongside the Big CACTUS randomized controlled trial [ISRCTN: 68798818]. The trial evaluated the clinical effectiveness of self-managed aphasia computer therapy. This study reports secondary analysis of data from participants randomized to the computer therapy group to investigate whether any demographic, clinical or intervention variables were associated with adherence to therapy practice. A sub-sample of the same participants took part in qualitative interviews exploring the factors perceived to influence the amount of aphasia computer therapy practice undertaken. Interviews were analyzed thematically. A convergence-coding matrix was used to triangulate the two sets of findings. Results: Data from 85 participants randomized to the computer therapy group were included in the quantitative analyses. At a clinical level, a greater length of time post-stroke was associated with higher adherence to self-managed aphasia therapy practice on a computer. At an intervention level, length of computer therapy access and therapist time supporting the participant were associated with greater adherence to computer therapy practice. Interviews with 11 patients and 12 informal carers identified a multitude of factors perceived to influence engagement with tele-rehabilitation by people with aphasia. The factors grouped around three themes: capability to use the computer therapy, having the opportunity to practice (external influences and technological issues) and motivation (beliefs, goals and intentions vs. personality, emotions, habit and reinforcement). Triangulation demonstrated convergence for the finding that participants' practiced computer-based therapy exercises more when they received increased support from a speech and language therapist. Conclusion: Clinicians delivering asynchronous tele-rehabilitation involving self-management of aphasia therapy practice on a computer should consider the factors found to be associated with engagement when deciding which patients may be suited to this option, as well as how they can be supported to optimize the amount of practice they engage in