Cardiorespiratory physiotherapy education – are we achieving the vision?

This action research project comprised a broad macro situational analysis type review targeting clinicians conducting cardiorespiratory placements and those providing mentoring/supervision for the The University of Notre Dame Australia. The intent was to gain a perspective from the clinicians and supervisors whether current curriculum content and design was effectively preparing students for the real world of cardiorespiratory physiotherapy. By inference, an avenue for reflection on teaching skill and performance was provided

Profiling Physiotherapy in Australian and New Zealand Intensive Care

Physiotherapy for ICU patients is considered essential by many health professionals and professional bodies, yet the evidence base for this service is insufficient. No published research outlining optimal management of this service exist. Effective evaluation and implementation of best practice ‘critical-care physiotherapy’ requires knowledge of the current profile of ICU physiotherapists’. Leslie, K., & Patman, S. (2008). Profiling physiotherapy in Australian and New Zealand intensive care. Anaesthesia and Intensive Care, 36(6), 897. ISSN: 0310-057

Benchmarking Intensive Care Physiotherapy Staffing in Australian Tertiary Hospitals

Physiotherapy is an important component in the management of patients in the Intensive Care Unit (ICU). Existing guidelines on ICU physiotherapy staffing represent European settings and are not contemporary. With no specific recommendations in Australia, medical and nursing staffing guidelines reflected the need to have designated physiotherapy services available and accessible 24 hours a day in ICU. Therefore, this study aimed to pinpoint a guideline for ICU physiotherapy staff allocation by examining the current physiotherapy staff levels in ICU of Australian tertiary hospitals and comparing it with staff levels desired by senior physiotherapy leaders

Systematic Review of Physiotherapy during Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD)

In COPD patients, acute exacerbations are important events. Reviews of studies investigating treatment during AECOPD focus on medical management, with little discussion of physiotherapy. Therefore a systematic review was undertaken of the studies pertaining to physiotherapy during AECOPD. Methods: Studies were identified by searching databases and scanning reference lists. Appropriate studies were reviewed by two independent investigators. Data were extracted using a standardized form. Where possible, a score was assigned using the PEDro scale for assessment of study quality. HIll, K., Patman, S., & Brooks, D. (2008). Systematic review of physiotherapy during Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD). American Journal of Respiratory and Critical Care Medicine, 177, Abstracts Issue, A137. ISSN: 1073-449

Critically appraised paper: Preoperative physiotherapy education halved postoperative pulmonary complications in patients after upper abdominal surgery [commentary]

No abstract available for this paper

Mental wellbeing in non-ambulant youth with neuromuscular disorders: What makes the difference?

The physical and social challenges associated with neuromuscular disorders may impact mental wellbeing in non-ambulant youth during the more vulnerable period of adolescence. This cross-sectional survey investigated non-ambulant youths’ mental wellbeing and relationships with physical health, participation and social factors. The conceptual model was the International Classification of Functioning, Disability and Health (ICF). Thirty-seven youth aged 13 – 22 years old (mean age 17.4 years; n = 30 male; n = 24 Duchenne Muscular Dystrophy) and their parents provided biopsychosocial data through a comprehensive self-report questionnaire. The primary outcome measure was the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS). Relationships between mental wellbeing and variables within and across each ICF domain were explored using linear regression models. Mean WEMWBS scores (55.3/70 [SD 8.1]) were higher than for typically developing youth and comparable to youth with other chronic conditions. Over half of youth reported severe co-morbidities across all body systems. Multivariable modelling indicated that mental wellbeing was independently associated with academic achievement and perceived family support but not with physical health variables. Beyond management of physical co-morbidities, enabling youths’ educational attainment and attending to social support likely optimises youth’s wellbeing

Referral patterns to continence physiotherapy services for patients with chronic respiratory conditions

Chronic respiratory conditions are a widely recognised risk factor for urinary incontinence and current chronic respiratory condition management guidelines state that patients should be screened for urinary incontinence and referred to continence physiotherapists for treatment. This study aimed to firstly confirm anecdotal sentiment that referrals of these patients to continence physiotherapists are low; and, secondly, to investigate barriers to the referral of these patients. Two online de novo surveys were disseminated across the metropolitan area of Perth, Western Australia: one to continence physiotherapists (Survey A) to investigate referral rates, and the other to respiratory physiotherapists, respiratory physicians and general practitioner clinics (Survey B) to investigate barriers to referral for continence management. Survey A received 30 responses and confirmed the expected low referral rate. Survey B received 41 responses, with 31% of respondents stating they “never” or “rarely” inquired about incontinence with these patients. Reported referral barriers included time constraints (50%) and a lack of prioritisation of urinary incontinence (53%). Survey findings also indicated urinary incontinence continues to carry a stigma among clinicians and patients; therefore, more should be done in order to promote an open discussion of urinary incontinence. Clinicians also require support to prioritise management of urinary incontinence with their patients. This study is one of the first to explore barriers to screening and referral in this patient group, and the issue appears to be multifactorial. Further research needs to be directed at exploring the issue further and developing strategies to address the identified barriers

Incidence and prevalence of falls in adults living with an intellectual disability living in the community: A systematic review

Review question/objective: The objective of this review is to synthesize the best available evidence to determine the incidence and prevalence of falls in adults with intellectual disability living in the community

Clinical validation of expert consensus statements for respiratory physiotherapy management of invasively ventilated adults with community-acquired pneumonia: A qualitative study

Objectives: To conduct multidisciplinary peer-review of expert consensus statements for respiratory physiotherapy for invasively ventilated adults with community-acquired pneumonia, to determine clinical acceptability for development into a clinical practice guideline. Research methodology: A qualitative study was undertaken using focus groups (n = 3) conducted with clinician representatives from five Australian states. Participants were senior intensive care physiotherapists, nurses and consultants. Thematic analysis was used, with a deductive approach to confirm clinical validity, and inductive analysis to identify new themes relevant to the application of the 38 statements into practice. Setting: Adult intensive care. Findings: Senior intensive care clinicians from physiotherapy (n = 16), medicine (n = 6) and nursing (n = 4) participated. All concurred that the consensus statements added valuable guidance to practice; twenty-nine (76%) were deemed relevant and applicable for the intensive care setting without amendment, with modifications suggested for remaining nine statements to enhance utility. Overarching themes of patient safety, teamwork and communication and culture were identified as factors influencing clinical application. Cultural differences in practice, particularly related to patient positioning, was evident between jurisdictions. Participants raised practicality and safety concerns for two statements related to the use of head-down patient positioning. Conclusion: Multidisciplinary peer-review established clinical validity of expert consensus statements for implementation with invasively ventilated adults with community-acquired pneumonia

Minimum standards of clinical practice for physiotherapists working in critical care settings in Australia and New Zealand: A modified Delphi technique

<p><b><i>Objective:</i></b> Achieving competency in critical care in entry-level physiotherapy courses across Australia and New Zealand is not essential, and accredited training for qualified physiotherapists working in critical care units is lacking. As a result, practice standards and training may vary. The objective was to establish consensus-based minimum clinical practice standards for physiotherapists working in critical care settings in Australia and New Zealand. <b><i>Design:</i></b> A modified Delphi technique, which consisted of three rounds of questionnaires, was used to obtain consensus on items. <b><i>Setting:</i></b> Australian and New Zealand critical care settings. <b><i>Participants:</i></b> A panel (<i>n</i> = 61) was invited from a pool of eligible physiotherapists throughout Australia and New Zealand (<i>n</i> = 93). Eligibility criteria were defined <i>a-priori</i> on the basis of possession of expertise and experience in the practice and teaching of critical care physiotherapy clinical skills. <b><i>Main Outcome Measure:</i></b> Questionnaires were disseminated electronically (either via email, or SurveyMonkey^®). Items were designated by participants as being ‘Essential/Unsure/Not Essential’. Consensus for inclusion was achieved when items were ranked ‘Essential’ by more than 70% of participants. <b><i>Results:</i></b> Fifty physiotherapists consented and participated in the initial Delphi round, of whom 45 (90%) completed all rounds. Consensus was reached on 199 (89%) items. The panel agreed that 132 (58%) items were ‘Essential’ items for inclusion in the final framework. <b><i>Conclusions:</i></b> This is the first study to develop a consensus framework of minimum standards of practice for physiotherapists working in critical care. The clinical utility of this framework now requires assessment.</p