Workplace musculoskeletal problems in occupational therapy students

Background: Workplace musculoskeletal disorders are the leading cause of morbidity and disability in the Australian workforce. Over one in five occupational therapists report workplace musculoskeletal disorders, with almost half reporting workplace musculoskeletal symptoms. In other health professions, students and novice clinicians (≤5 years practice) experience greater risk but little is known about occupational therapy students. Methods: In this cross-sectional study, a survey including the self-reported Standardised Nordic Musculoskeletal Questionnaire was administered to occupational therapy students post work-based training. Musculoskeletal problems were defined as aches, pains, numbness or discomfort. Questions explored body sites affected, prevalence, impact on activity, need for medical assistance, demographic and workplace information. Prevalence was reported using descriptive statistics. Factors associated with workplace musculoskeletal problems over the previous 12 months and last 7 days were examined using logistic regression modelling. Results: Response rate was 53% (n = 211/397). One-third of respondents (33.6%, n = 71/211) reported a workplace musculoskeletal problem over 12 months. Nearly half (47.9%, n = 34/71) of these students reported a problem over the last 7 days. Neck was the most commonly affected area reported for musculoskeletal problems over the past 12 months (24.2%, n = 51/211) and shoulder areas affected over the past 7 days (10.9%, n = 23/211). Musculoskeletal problems preventing daily activities were reported most commonly from lower back problems over 12 months (23.9%, n = 17/71) and for shoulder problems over the last 7 days (21.9%, n = 7/32). Shoulders and knees were the most common body areas requiring medical attention. Previous musculoskeletal problems and female gender were associated with reported problems over 12 months and last 7 days (p < 0.05). Non-standard joint mobility (OR = 3.82, p = 0.002) and working in psychosocially focused caseloads (including mental health or case management) (OR = 3.04, p = 0.044) were also associated with reporting musculoskeletal problems over the last 7 days. Conclusions: One in three occupational therapy students already experience workplace musculoskeletal problems impacting daily activities and requiring medical assistance prior to graduation. High prevalence of musculoskeletal problems in this study calls for educators and researchers to find sustainable strategies to address these problems, with particular consideration to the impact of previous disorders and working in psychosocially focused caseloads on musculoskeletal health

Aboriginal people's perceptions of patient-reported outcome measures in the assessment of diabetes health-related quality of life

Background: Patient-reported outcome measures (PROMs) provide clinicians and consumers a platform to inform and improve healthcare planning and management. Aboriginal people experience disproportionately high rates of chronic diseases, including type 2 diabetes. Treatment and management require holistic approaches that draw on culturally relevant resources and assessment tools. This study explored perceptions of Aboriginal people about two diabetes management-related PROMs (PROMIS-29, PAID Scale). Methods: Twenty-nine Aboriginal people living with diabetes in the Shoalhaven discussed two PROMs in one of four focus groups or at an individual interview. Preliminary data coding was conducted by clinician researchers, with thematic analysis overseen by Aboriginal co-researchers. Subsequent individual interviews with participants were undertaken to seek further feedback and articulate what is needed to improve methods of evaluating Aboriginal people's self-reported quality of life and diabetes management. Results: The PROMs did not capture information or knowledge that Aboriginal people considered relevant to their diabetes-related health care. Participants' recommendations included adapting survey materials to be more culturally sensitive; for example, by improving the alignment of measures with common day-to-day activities. This study also describes a genuine collaborative, Aboriginal community-guided approach to evaluate 'fit-for-purpose' diabetes management tools. Conclusions: Appropriate evaluation methods are paramount to address the disproportionate burden of diabetes experienced by Aboriginal peoples and overcome inverse diabetes care. Our learnings will contribute to development of tools, resources or methods that capture culturally tailored outcome measures. Study findings are relevant to clinicians and researchers using and/or developing Patient Reported Measures, particularly in relation to the practicality of tools for First Nations peoples

Advisory panel review on the feasibility of three intervention programmes for children with autism spectrum disorder

Introduction: The prevalence of children with autism spectrum disorder is increasing each year. Intervention programmes towards improving the occupational needs such as daily activities of these children are limited. This study aimed to collect opinions from advisory panel for the content validation of the three developed intervention programmes to be implemented among children with autism spectrum disorder aged between 6 to 12 years. The intervention programmes are; i) self-regulated learning, ii) sensory integration intervention and iii) activity-based intervention. Methods: A cross-sectional study was conducted. Twenty occupational therapists with more than three years’ experience working with children with autism spectrum disorders were recruited as advisory panel members. Re-searchers-developed questionnaire was used. The questionnaire consists of nine to eleven items. Each item consists of a five-point Likert scale for quantitative responses and open-ended questions for qualitative responses. Results: Advisory panel ratings of ‘Good’ to ‘Excellent’ was reported across most items in all three intervention programmes. Overall results suggested that the intervention programmes content was rated to be suitable for children with autism spectrum disorder. Constructive comments were adopted to clarify the activities and structure of the intervention programmes. Final development of the intervention programmes is presented. Conclusion: This study provides confidence for the interventions to be incorporated into the future randomised controlled trial

Does in-shoe pressure analysis to assess and modify medical grade footwear improve patient adherence and understanding? A mixed methods study

Background: Medical grade footwear (MGF) with demonstrated plantar-pressure reducing effect is recommended to reduce the risk of diabetes-related foot ulceration (DFU). Efficacy of MGF relies on high adherence (≥ 80%). In-shoe pressure analysis (IPA) is used to assess and modify MGF, however, there is limited evidence for the impact on patient adherence and understanding of MGF. The primary aim of this study was to determine if self-reported adherence to MGF usage in patients with previous DFU improved following IPA compared to adherence measured prior. The secondary aim was to determine if patient understanding of MGF improved following in-shoe pressure analysis. Methods: Patients with previous DFU fitted with MGF in the last 12 months were recruited. The first three participants were included in a pilot study to test procedures and questionnaires. MGF was assessed and modified at Week 0 based on findings from IPA using the Pedar system (Novel). Patients completed two questionnaires, one assessing patient adherence to MGF at Week 0 and Week 4, the other assessing patient understanding of MGF before and after IPA at week 0. Patient understanding was measured using a 5-point Likert scale (strongly disagree 1 to strongly agree 5). Patient experience was assessed via a telephone questionnaire administered between Weeks 0–1. Results: Fifteen participants were recruited, and all completed the study. Adherence of ≥ 80% to MGF usage inside the home was 13.3% (n = 2) pre-IPA and 20.0% (n = 3) at Week 4. Outside the home, ≥ 80% adherence to MGF was 53.3% (n = 8) pre-IPA, and 80.0% (n = 12) at Week 4. Change in scores for understanding of MGF were small, however, all participants reported that undergoing the intervention was worthwhile and beneficial. Conclusions: Self-reported adherence inside the home demonstrated minimal improvement after 4 weeks, however, adherence of ≥ 80% outside the home increased by 27%, with 80% of all participants reporting high adherence at Week 4. Participants rated their learnings from the experience of IPA as beneficial

Impact of online learning on sense of belonging among first year clinical health students during COVID‑19 : student and academic perspectives

Background: The need to belong is a fundamental human desire that provides the basis for relationships and community; it provides a sense of security that enables growth and development. This sense of belonging is pivotal to new University students, indeed, without it, students are at greater risk of failing or withdrawing from their studies. Yet developing a sense of belonging within a new cohort is complex and multi-faceted and further complicated by a sudden shift away from in-person to online learning. Using the situated-learning framework, our study explores first year clinical health students’ sense of belonging in the context of the rapid transition to online learning because of the COVID-19 pandemic. Methods: We utilised a current mixed-method approach including a survey incorporating previously validated tools, demographic and open-ended qualitative questions. Data was also gathered from three focus groups: two dedicated student groups and one academic focus group. Qualitative data was subjected to thematic analysis whilst descriptive statistics were used to describe the quantitative data. Results: 179 first year students complete the survey and four students, and five academics were involved in the focus groups. All participants were from clinical health science courses at an Australian university. Our qualitative results indicated a global theme of: Navigating belonging during the COVID-19 crisis: a shared responsibility; with four organising themes describing (1) dimensions of belonging, (2) individual experiences and challenges, (3) reconceptualising teaching and learning, and (4) relationships are central to belonging. Conclusion: While the rapid transition to online learning did not greatly impact knowledge acquisition of first-year students in this cohort, the lack of sense of belonging highlights the need for further research into development of this essential aspect of learning in the online domain. Although contextualised in the COVID-19 pandemic, it became clear that the findings will remain relevant beyond the current situation, as a student’s need to belong will always be present in the face of challenges or change

Health literacy : implications for shoe choices promoting foot health in children

Optimal health behaviors developed during childhood are considered fundamental health foundations for the entire lifespan. Appropriate footwear choices are part of this mix minimizing the impact of foot disorders, foot pain and mobility limitations. However, while parents may intuitively want to provide their child with the best shoe choices for a healthy start to life, footwear knowledge can be limiting. Informed health decisions require an appropriate level of health literacy and application. Limitations in health literacy are associated with poor health outcomes including reductions in physical and mental health, poor treatment adherence and poor self-management. Comprehensive strategies are needed to tailor health information and understanding to promote and encourage healthy choices. Integral to health education and health literacy is the development of a common language around healthy choices. People however do not necessarily share the same interpretation or conceptual understanding of health-related terminology. This paper broadly introduces the topic of health literacy and focuses on a specific and emerging area of footwear literacy to highlight the importance of addressing language comprehension, which has and implications for children’s footwear choices

Reducing plantar pressure in rheumatoid arthritis : a comparison of running versus off-the-shelf orthopaedic footwear

Background. Foot pain in patients with rheumatoid arthritis is common and can be associated with excessive forefoot plantar pressure loading. Running and off-the-shelf orthopaedic footwear are commonly recommended to manage foot pain and discomfort in these patients. The aim of this study was to evaluate the effect of running footwear as an alternative to off-the-shelf orthopaedic footwear on plantar pressure loading characteristics in people with forefoot pain associated with rheumatoid arthritis. Methods. Twenty participants diagnosed with rheumatoid arthritis reporting chronic forefoot pain participated in this experimental, randomised, single-blind, cross-over trial of three footwear conditions: control, running and off-the-shelf orthopaedic. Outcome measures included measurement of peak pressure and pressure-time integral, with an in-shoe plantar pressure measurement system, beneath the total foot, forefoot, midfoot and rearfoot. Furthermore, perceived comfort and footwear acceptability were determined for each footwear condition. Findings. Compared to the control footwear, forefoot peak pressures were reduced by 36% in the running footwear and by 20% in the orthopaedic footwear, compared to the control (P < 0.001). Forefoot pressure-time integrals were reduced by 33% in the running footwear and by 23% in the orthopaedic footwear (P < 0.001). The largest reductions were achieved with the running footwear across the whole plantar surface of the foot. Perceived comfort did not differ between running and orthopaedic footwear, although both were significantly more comfortable than the control footwear. Overall, more participants nominated the running footwear as the most acceptable footwear condition. Interpretation. The results of this preliminary study show that running footwear was most effective at reducing plantar pressure loading and was regarded as a comfortable and acceptable footwear alternative by participants with forefoot pain associated with rheumatoid arthritis

Acupuncture for the treatment of lower limb diabetic peripheral neuropathy : a systematic review

Objective: To examine evidence for acupuncture interventions in the management of diabetes-related peripheral neuropathy (DPN) symptoms. Methods: Five electronic databases were searched up to June 2017 for studies that included participants with symptoms of DPN, used an acupuncture intervention, and reported before-and-after DPN-related outcome measures. Two reviewers independently performed the data extraction. The level of homogeneity was assessed, and studies were appraised using the Cochrane Risk of Bias tool, the STRICTA guidelines for acupuncture reporting and the NICMAN scale for acupuncture quality. Results: Ten studies with 432 participants were included: three randomised controlled trials (RCTs), two pilot RCTs, three uncontrolled clinical trials, one quasi-RCT and one prospective case series. Improvements in DPN pain symptoms were reported by all studies. Heterogeneity of outcome measures prevented a meta-analysis. Variations were found in needle retention time and point selection, as well as total number and frequency of treatments. Common acupuncture point selections were ST36 and SP6. Half of the studies used local point selection. Studies conducted outside China had better acupuncture reporting and quality according to the STRICTA checklist and NICMAN scales, respectively. Risk of bias was high or unclear in the majority of studies for all domains except attrition bias. Conclusions: Acupuncture for DPN appears to improve symptoms. However, the application of acupuncture varies greatly, and the quality of included studies was generally low. Available studies have varying methodologies and different outcome measures. Further, suitably powered studies using appropriate DPN outcome measures are required