Fysioterapeutin suoravastaanotto tuki- ja liikuntaelinpotilaiden hoidossa : työnjako ja kokemuksia

VertaisarvioituLähtökohdat Fysioterapeuttien suoravastaanotot ovat yleistyneet nopeasti. Tarkastelimme muutoksen vaikutusta lääkärien ja fysioterapeuttien työnjakoon. Menetelmät Selvitimme työnjakoa suoravastaanottotoiminnassa kirjallisuushaulla ja Suomessa myös verkkokyselyllä. Tulokset Kirjallisuuskatsauksen mukaan potilaat olivat tyytyväisiä ja pääsivät nopeammin hoitoon. Toimintamallin ei ole todettu lisänneen fysioterapiapalvelujen tarpeetonta käyttöä eikä heikentäneen potilasturvallisuutta tai hoidon jatkuvuutta. Suomessa suoravastaanotolle ja lääkärille ohjautumisen kriteerit vaihtelivat erityisvastuualueilla. Potilaiden omahoitoisuuden ja yksikön toiminnan arvioitiin parantuneen huomattavasti suoravastaanoton ansiosta. Lääketieteellinen tuki fysioterapeuteille ei aina ollut toimivaa. Päätelmät Kokemusten mukaan fysioterapeuttien suoravastaanottotoiminta on vaikuttavaa.Lisätutkimusta kuitenkin tarvitaan.Peer reviewe

Fysioterapeutin suoravastaanotto tuki- ja liikuntaelinpotilaiden hoidossa : työnjako ja kokemuksia

VertaisarvioituLähtökohdat Fysioterapeuttien suoravastaanotot ovat yleistyneet nopeasti. Tarkastelimme muutoksen vaikutusta lääkärien ja fysioterapeuttien työnjakoon. Menetelmät Selvitimme työnjakoa suoravastaanottotoiminnassa kirjallisuushaulla ja Suomessa myös verkkokyselyllä. Tulokset Kirjallisuuskatsauksen mukaan potilaat olivat tyytyväisiä ja pääsivät nopeammin hoitoon. Toimintamallin ei ole todettu lisänneen fysioterapiapalvelujen tarpeetonta käyttöä eikä heikentäneen potilasturvallisuutta tai hoidon jatkuvuutta. Suomessa suoravastaanotolle ja lääkärille ohjautumisen kriteerit vaihtelivat erityisvastuualueilla. Potilaiden omahoitoisuuden ja yksikön toiminnan arvioitiin parantuneen huomattavasti suoravastaanoton ansiosta. Lääketieteellinen tuki fysioterapeuteille ei aina ollut toimivaa. Päätelmät Kokemusten mukaan fysioterapeuttien suoravastaanottotoiminta on vaikuttavaa.Lisätutkimusta kuitenkin tarvitaan.Peer reviewe

Hyvänlaatuisen niskakivun hoito perusterveydenhuollossa

Niskakivun spesifiset ja vakavat syyt sekä kipua pitkittävät tekijät on tärkeä tunnistaa. Kipua provosoiviin mekaanisiin ja psykologisiin kuormitustekijöihin kannattaa puuttua jo varhain. Yksilöllinen potilasinformaatio ja terapeuttinen harjoittelu ovat hoidon kulmakiviä. Passiivisilla hoidoilla ei ole pitkäaikaisvaikuttavuutta. Hyvä vuorovaikutus edistää potilaan toipumista ja vähentää kipuun liittyvää pelkoa.</p

Individualized Assessment of Patients with Non-Specific Low Back Pain

Opinnäytetyön tavoitteena oli kehittää ammattilaisille suunnattu koulutusmateriaali alaselkäkipupotilaan yksilöllisestä arvioinnista työterveyshuollossa ja selvittää koulutukseen osallistuneiden työfysioterapeuttien kokemuksia biopsykososiaalisesta lähestymistavasta. Potilasaineistosta (n=674) tutkimme, miten alaselkäkipupotilaat jakautuivat matalan, kohtalaisen ja korkean riskin luokkiin Örebron lyhyen kipukyselyn (ÖMPSQ-lyhyt) ja Start selkäkyselyn (SBT) perusteella sekä selvitimme, onko potilaiden koulutusalojen välillä eroja kipuun liittyvien psykososiaalisten tekijöiden esiintymisessä. Terveydenhuollon ammattilaiset rekrytoivat tutkimuksen potilasaineiston kahteen käynnissä olevaan kliinisen tutkimukseen liittyen. Potilaat vastasivat webropol-kyselyihin (SBT; ÖMPSQ-lyhyt) ja heiltä kerättiin perustiedot (ikä, sukupuoli, ammatti). SBT luokitteli 46 % miehistä matalan riskin, 38 % kohtalaisen riskin ja 16 % korkean riskin ryhmiin. Naisista vastaavasti 39 %, 57 % ja 15 %. ÖMPSQ-lyhyt luokitteli 50 % miehistä matalan, 22 % kohtalaisen ja 28 % korkean riskin ryhmään ja naisista vastaavasti 50 %, 21 % ja 29 %. Riskiryhmien jakautumisessa ei ollut tilastollisesti merkitsevää eroa potilaiden koulutusalojen välillä (SBT p=0.081; ÖMPSQ-lyhyt p=0.091). Pelko-välttämiskäyttäytyminen oli yleisempää tekniikan alalla (p = 0.015) ja palvelualalla (p = 0.038) kuin muissa ammateissa. Terveys- ja hyvinvointialan ammateissa toimivilla oli vähiten fyysiseen aktiivisuuteen liittyvää pelkoa (p = 0.025). Kipuun liittyvä katastrofointi oli yleisempää tekniikan aloilla kuin muissa ammateissa (p = 0.028) ja vähäisempää terveys- ja hyvinvointialojen ammateissa (p = 0.001). Kehitetty koulutusmateriaali helpotti ammattilaista potilaan yksilöllisen psykososiaalisen riskiprofiilin arvioimisessa ja auttoi kommunikoimaan työkyvyttömyyden riskitekijöistä validoivaa vuorovaikutusta hyödyntäen. Luottamuksellinen koulutusmateriaali on poistettu opinnäytetyön julkisesta raportista. Tulevaisuudessa sähköiset seulontakyselyt mahdollistavat hoidon kohdentamisen nykyistä paremmin haittaavan ja pitkittyvän alaselkäkivun riskissä oleville. Ammattilaiset tarvitsevat kuitenkin lisäkoulutusta alaselkäkipupotilaan yksilöllisen riskin arviointiin sekä biopsykososiaalisen työotteen käyttämiseen.The objective was to develop learning material of individualized assessment of patients with non-specific low back pain (LBP) and investigate how occupational physiotherapists experienced the biopsychosocial approach. Among patients with LBP (n=674), the aim was to investigate whether patients’ occupational education is associated with pain-related psychological factors according to two screening instruments. The health care professionals of two ongoing clinical trials recruited the patients. The patients answered to webropol questionnaires related to demographic data (gender and age); socioeconomic status including occupation; pain-related factors (the short form of the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ-short) and the STarT Back Tool (SBT)). The results indicated that the fear of physical activity was greatest in technical fields of occupation (p = 0.015) and services (p = 0.038), while patients working in health and welfare had least fear towards physical activity (p = 0.025). Pain catastrophizing was highest in technical fields of occupation (p = 0.028) and lowest in occupations of health and welfare (p = 0.001). The learning material described how to identify psychosocial risk factors for disabling LBP and helped occupational physiotherapists in communicating with patients belonging to high-risk group. The learning material is confidential and is not attached to the public document of thesis report. In the future, electronic screening will offer a potential to target better disabling LBP. However, professionals will need further education in biopsychosocial approach

Measuring the determinants of implementation behavior in multiprofessional rehabilitation

BACKGROUND: The Determinants of Implementation Behavior Questionnaire (DIBQ) measures facilitators or barriers of healthcare professionals’ implementation behaviors based on the current implementation research on practice and policy. The DIBQ covers 18 domains of the Theoretical Domains Framework and consists of 93 items. A previously tailored version (DIBQ-t) covering 10 domains and 28 items focuses on implementing best-practice low back pain care. AIM: To tailor a shortened version of DIBQ to multiprofessional rehabilitation context with cross-cultural adaptation to Finnish language. DESIGN: A two-round Delphi study. SETTING: National-level online survey. POPULATION: Purposively recruited experts in multiprofessional rehabilitation (N.=25). METHODS: Cross-cultural translation of DIBQ to Finnish was followed by a two-round Delphi survey involving diverse experts in rehabilitation (physicians, physiotherapists, occupational therapists, psychologists, nursing scientists, social scientists). In total, 25 experts in Round 1, and 21 in Round 2 evaluated the importance of DIBQ items in changing professionals’ implementation behavior by rating on a 5-point Likert Scale (1 = Strongly Disagree, 5 = Strongly Agree) of including each item in the final scale. Consensus to include an item was defined as a mean score of ≥4 by ≥75% of Delphi participants. Open comments were analyzed using inductive content analysis. Items with agreement of ≤74% were either directly excluded or reconsidered and modified depending on qualitative judgements, amended with experts’ suggestions. After completing an analogous second-round, a comparison with DIBQ-t was performed. Lastly, the relevance of each item was indexed using content validity index on item-level (I-CVI) and scale-level (S-CVI/Ave). RESULTS: After Round 1, 17 items were included and 48 excluded by consensus whereas 28 items were reconsidered, and 20 items added for Round 2. The open comments were categorized as: 1) ”modifying”; 2) ”supportive”; and 3) ”critical”. After Round 2, consensus was reached regarding all items, to include 21 items. After comparison with DIBQ-t, the final multiprofessional DIBQ (DIBQ-mp) covers 11 TDF domains and 21 items with I-CVIs of ≥0.78 and S-CVI/Ave of 0.93. CONCLUSIONS: A Delphi study condensed a DIBQ-mp with excellent content validity for multiprofessional rehabilitation context. CLINICAL REHABILITATION IMPACT: A potential tool for evaluating determinants in implementing evidence-based multiprofessional rehabilitation interventions.peerReviewe

Mistä pitkittynyt alaselkäkipu johtuu?

Tiivistelmä Alaselkäkivun kokemukseen ja siitä aiheutuvaan haittaan vaikuttavat biologiset, psykologiset ja sosiaaliset tekijät. Monet selkäkipuun liitetyt myytit, kuten ”huono ryhti”, ovat tutkimustiedon perusteella virheellisiä ja vanhentuneita käsityksiä. Liikunta on edelleen keskeinen osa selkäkivun ehkäisyä ja hoitoa, mutta yksikään liikuntamuoto tai harjoittelumenetelmä ei ole toista parempi. Hoidossa tulee tunnistaa kunkin potilaan yksilölliset riskitekijät. Useimpiin riskitekijöihin voidaan vaikuttaa kuntoutuksella.Abstract In low back pain, biological, psychological and social factors impact on both the experience of back pain and the associated disability. Many myths that exist regarding low back pain, such as “bad posture” and “weak deep abdominal and back muscles”, are not based on evidence. Physical activity is still an essential part of the prevention and treatment of low back pain, but no single form of physical activity is better than any other. In the treatment of low back pain, health care professionals should recognize patients’ individual risk factors. Most risk factors can be influenced by optimal rehabilitation

Effectiveness of training in guideline-oriented biopsychosocial management of low-back pain in occupational health services - a cluster randomized controlled trial

Objective: This study aimed to investigate the effectiveness of brief training in the guideline-oriented biopsychosocial management of low-back pain (LBP) in occupational health services using a cluster-randomized design. A small sample of physiotherapists and physicians from the intervention units (N=12) were given three- to seven-day training focusing on the biopsychosocial management of LBP, while professionals in the control units (N=15) received no such training. Methods: Eligible patients with LBP, with or without radicular pain, aged 18–65, were invited to participate. A web-based questionnaire was sent to all recruited patients at baseline, three months and one year. The primary outcome measure was disability (Oswestry Disability Index, ODI) over one year. Between-group differences were analyzed using linear and generalized linear mixed models adjusted for baseline-response delay as well as variables showing between-group imbalance at baseline. Results: The final study sample comprised 234 and 81 patients in the intervention and control groups, respectively at baseline, and 137 and 47 patients, respectively, at one year. At baseline, the mean duration of pain was longer in the intervention group (P=0.017), and pain-related fear concerning physical activity was lower (P=0.012). We observed no significant difference between the groups’ primary outcome measure (adjusted one-year mean difference in the ODI: 2.3; 95% confidence interval -1.0–5.7; P=0.175) or most secondary outcomes. Conclusions: Brief training in guideline-oriented biopsychosocial management of LBP for occupational health professionals did not appear to be effective in reducing patients’ symptom over one-year follow-up compared to treatment as usual.peerReviewe

Measuring the determinants of implementation behavior in multiprofessional rehabilitation

Abstract Background: The Determinants of Implementation Behavior Questionnaire (DIBQ) measures facilitators or barriers of healthcare professionals’ implementation behaviors based on the current implementation research on practice and policy. The DIBQ covers 18 domains of the Theoretical Domains Framework and consists of 93 items. A previously tailored version (DIBQ-t) covering 10 domains and 28 items focuses on implementing best-practice low back pain care. Aim: To tailor a shortened version of DIBQ to multiprofessional rehabilitation context with cross-cultural adaptation to Finnish language. Design: A two-round Delphi study. Setting: National-level online survey. Population: Purposively recruited experts in multiprofessional rehabilitation (N.=25). Methods: Cross-cultural translation of DIBQ to Finnish was followed by a two-round Delphi survey involving diverse experts in rehabilitation (physicians, physiotherapists, occupational therapists, psychologists, nursing scientists, social scientists). In total, 25 experts in Round 1, and 21 in Round 2 evaluated the importance of DIBQ items in changing professionals’ implementation behavior by rating on a 5-point Likert Scale (1 = Strongly Disagree, 5 = Strongly Agree) of including each item in the final scale. Consensus to include an item was defined as a mean score of ≥4 by ≥75% of Delphi participants. Open comments were analyzed using inductive content analysis. Items with agreement of ≤74% were either directly excluded or reconsidered and modified depending on qualitative judgements, amended with experts’ suggestions. After completing an analogous second-round, a comparison with DIBQ-t was performed. Lastly, the relevance of each item was indexed using content validity index on item-level (I-CVI) and scale-level (S-CVI/Ave). Results: After Round 1, 17 items were included and 48 excluded by consensus whereas 28 items were reconsidered, and 20 items added for Round 2. The open comments were categorized as: 1) ”modifying”; 2) ”supportive”; and 3) ”critical”. After Round 2, consensus was reached regarding all items, to include 21 items. After comparison with DIBQ-t, the final multiprofessional DIBQ (DIBQ-mp) covers 11 TDF domains and 21 items with I-CVIs of ≥0.78 and S-CVI/Ave of 0.93. Conclusions: A Delphi study condensed a DIBQ-mp with excellent content validity for multiprofessional rehabilitation context. Clinical rehabilitation impact: A potential tool for evaluating determinants in implementing evidence-based multiprofessional rehabilitation interventions

Effectiveness of training in guideline-oriented biopsychosocial management of low-back pain in occupational health services:a cluster randomized controlled trial

Abstract Objective: This study aimed to investigate the effectiveness of brief training in the guideline-oriented biopsychosocial management of low-back pain (LBP) in occupational health services using a cluster-randomized design. A small sample of physiotherapists and physicians from the intervention units (N=12) were given three- to seven-day training focusing on the biopsychosocial management of LBP, while professionals in the control units (N=15) received no such training. Methods: Eligible patients with LBP, with or without radicular pain, aged 18–65, were invited to participate. A web-based questionnaire was sent to all recruited patients at baseline, three months and one year. The primary outcome measure was disability (Oswestry Disability Index, ODI) over one year. Between-group differences were analyzed using linear and generalized linear mixed models adjusted for baseline-response delay as well as variables showing between-group imbalance at baseline. Results: The final study sample comprised 234 and 81 patients in the intervention and control groups, respectively at baseline, and 137 and 47 patients, respectively, at one year. At baseline, the mean duration of pain was longer in the intervention group (P=0.017), and pain-related fear concerning physical activity was lower (P=0.012). We observed no significant difference between the groups’ primary outcome measure (adjusted one-year mean difference in the ODI: 2.3; 95% confidence interval -1.0–5.7; P=0.175) or most secondary outcomes. Conclusions: Brief training in guideline-oriented biopsychosocial management of LBP for occupational health professionals did not appear to be effective in reducing patients’ symptom over one-year follow-up compared to treatment as usual