Consideration of Executive Functioning for Physiotherapy Rehabilitation: Studies of Physiotherapists’ Knowledge, Normative Data, and a Practice Application

Executive functioning (EF) refers to cognitive abilities involved in decision-making and self-regulation and can be impaired in many patients referred for physiotherapy, including older adults and people living with chronic pain. This dissertation aimed to determine what physiotherapists understood about EF, to summarize normative data for application in physiotherapy practice, and to provide an assessment of feasibility for studying EF impairments in people living with chronic pain. Study one surveyed what physiotherapists understood about EF as a concept, what EF assessments they used, and if this was influenced by their primary area of practice. Respondents (N = 262) subjectively reported that they understood what EF is, but this only moderately correlated with objective understanding, r = 0.43 (p \u3c 0.001).Physiotherapists reported an awareness of some measures of EF; however, were unsure about interpreting patient scores among the multiple sets of available normative data. Study two presented summarized normative data (N = 35) for three assessments of EF in older adults based on a systematic review. Normative data were stratified by age, education, and sex in summary tables for accessible referencing by physiotherapists. Study three described the feasibility of recruitment and data collection in females living with Chronic Pelvic Pain, a musculoskeletal chronic pain condition not examined in previous EF research. Results (N = 35) indicated impaired EF, high central sensitization, pain catastrophizing, depression, anxiety, and stress. These findings demonstrated impaired EF in a patient population treated by physiotherapists, revealing an overlooked variable with the potential to impact physiotherapy rehabilitation outcomes

Why can’t patients last the wait? Decreasing substance abuse treatment waiting list attrition

One million people in North America are currently waiting for publicly funded substance use treatment. Unfortunately, long waiting times have been listed as the number one reason for not seeking treatment for substance use problems. While it is possible that successful abstinence during the waiting period convinces patients that they do not need treatment at all, more emphasis must be placed on interventions that can bridge the gap between initial contact by patients for substance use treatment and treatment intake. Recommendations in this review include: (1) decreasing the length of time between a patient’s initial contact for treatment and the pre-intake interview, (2) initiating regular phone contact with patients, and (3) decreasing resentful demoralization in patients who are ready for change but who are forced to wait for treatment

Vicarious trauma and secondary traumatic stress in health care professionals

Three-quarters of Canadians are exposed to a traumatic event sufficient to cause psychological trauma in their lifetime. In fact, post-traumatic stress disorder is a global health issue with a prevalence as high as 37%. Health care professionals trained to provide mental health treatment for these individuals are at risk of developing vicarious trauma and secondary traumatic stress, both of which result in adverse symptoms for the health care provider that often mimic post-traumatic stress disorder (PTSD). Vicarious trauma develops over time as the clinician is continually exposed to their clients’ traumatic experiences, while clinicians experiencing secondary traumatic stress begin to experience the symptoms of PTSD due to secondary exposure of the traumatic event. Both vicarious trauma and secondary traumatic stress cause mental, physical, and emotional issues for health care professionals that include burnout and decreased self-worth. Health care systems and administration should aim to develop training and professional education for health care providers. This review will emphasize what factors lead to the development of vicarious trauma and secondary traumatic stress, and what aids or supports can be implemented to treat the symptoms. The implications for policy development and training will be discussed

The role of nurses in inpatient geriatric rehabilitation units: A scoping review

Abstract Aims (1) To review and synthesize research on the contributions of nurses to rehabilitation in inpatient geriatric rehabilitation units (GRUs), and (2) to compare these reported contributions to the domains of international rehabilitation nursing competency models. The roles and contributions of nurses (e.g. Registered Practical Nurses, Registered Nurses and Licensed Practical Nurses) in GRUs are non‐specific, undervalued, undocumented and unrecognized as part of the formal Canadian rehabilitation process. Design Arksey and O'Malley's methodological framework for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Extension for Scoping Reviews guidelines were used. Methods Six databases were searched for relevant literature: MEDLINE, PsychINFO, CINAHL, EMBASE, SCOPUS and Nursing and Allied Health. English articles were included if they examined nursing roles or contributions to inpatient geriatric rehabilitation. Integrated synthesis was used to combine the qualitative and quantitative data, and thematic analysis was used for coding. Three sets of international competency models were amalgamated to explore how different nurse roles in geriatric rehabilitation were portrayed in the included literature. Results Eight studies published between 1991 and 2020 were included in the review. Five main geriatric rehabilitation nursing roles were generated from synthesis of the domains of international rehabilitation nursing competency models: conserver, supporter, interpreter, coach and advocate. Conclusions Nurses working in inpatient geriatric rehabilitation are recognized more for their role in conserving the body than their roles in supporting, interpreting, coaching and advocacy. Interprofessional team members appear to be less sure of the nurses' role in the rehabilitation unit. Nurses themselves do not acknowledge the unique rehabilitation aspects of care for older adults. Enhancing formal education, or adding continuing education courses, to facilitate role clarity for nurses in geriatric rehabilitation could improve nurses' and interprofessional healthcare team members' understandings of the possible contributions of nurses working in rehabilitation settings