A Pilot Study Exploring the Impact of Interprofessional Simulation on Role Clarity and Student Readiness for Collaborative Clinical Practice

Purpose: Interprofessional collaboration is recognized as a healthcare practice paradigm that may decrease overall costs and minimize errors. Yet it remains common for practitioners to provide care within silos, inadequately considering the impact of their decisions on other providers and overall costs, which ultimately may negatively impact the patient. Integrating interprofessional collaboration in school curricula can establish the importance of this approach to healthcare. For optimal efficacy, every professional in the healthcare team must recognize their unique role and the roles of others, to allow for seamless interprofessional collaboration. Simulation is a teaching tool that provides students with the opportunity to experience and reflect upon their responses to real-world clinical encounters in an environment that is safe to them and to patients. The purpose of this pilot study was to investigate the effect of interprofessional simulation on occupational therapy and physical therapy students’ role clarity and perceived readiness for collaborative practice. Method: A mixed methods study design was used with occupational and physical therapy students matriculated in the same college. Two surveys were given to the participants pre- and post-interprofessional simulation: the Readiness for Interprofessional Learning Scale (RIPLS; evaluates student readiness for interprofessional learning) and the Interdisciplinary Education Perception Scale (IEPS; evaluates student perceptions of interprofessional training). Focus groups followed the interprofessional simulation to explore the subjects’ experience. Results: Statistically significant changes were noted in the RIPLS pre-post simulation. Five themes emerged from the focus groups including: students value simulation; students value interprofessional education; interprofessional experience facilitates an understanding of role clarity; teamwork has value and challenges; and, students value providing patient centered care. Conclusion: Simulation is a teaching resource that may prepare occupational therapy and physical therapy students for interprofessional collaboration in patient care. The results of this study can inform interprofessional curricular development for both occupational therapy and physical therapy programs

Obesity is Associated with More Disability at Presentation and After Treatment in Low Back Pain but Not in Neck Pain: Findings from the OIOC Registry

Background: The influence on the treatment response in patients with low back pain (LBP) and neck pain (NP) is unknown. The aim of the study was to investigate the influence of body weight in patients with low back pain (LBP) and neck pain (NP) on baseline and end of treatment disability. Methods: Cross-sectional analysis of baseline factors. Longitudinal analysis of prospectively collected patient information at an outpatient physical therapy registry (data from June 2010 to December 2012). WHO-BMI classification was used: underweight, lean, overweight, obesity class I, obesity class II and III. The influence of body weight and a predefined set of confounders was analyzed by multiple regression models. Results: In LBP, disability increased with increasing BMI [lean = reference, obesity class I Beta 5.41 (95 % CI 0.75; 10.07), obesity class II-III Beta 7.58 (95 % CI 2.13; 13.03)]. Compared to lean patients, disability after treatment improved in overweight subjects [Beta −3.90 (95 % CI −7.4; −0.41)] but not in subjects with obesity class II–III [Beta 3.43 (95 % CI −3.81; 10.68)]. There were insufficient patients in the sample with severe obesity and therefore this trend has to be confirmed. The likelihood for meaningful important change (MID) was similar in all BMI subgroups. For patients with NP, BMI was not associated with baseline disability, and did not predict end of treatment disability or the likelihood of a MID. These findings must be interpreted with caution as BMI subgroups did not meet the required sample size. Conclusion: Overweight and obesity are associated with higher levels of disability before treatment in LBP patients, but not in NP. In severely obese patients class II–III with LBP the rate of MID was lowest indicating that these patients experienced the least treatment response compared to the other groups. Further studies should address the impact of severe obesity on the prognosis of LBP. In patients with LBP, severe obesity may be an important factor to consider during the physical therapy treatment. In particular, combined treatment strategies combining weight management, cardiovascular fitness, and low back pain rehabilitation should be investigated

The impact of low-cost, optimal-fidelity simulation on physical therapy students’ clinical performance and self-efficacy: a pilot study

Purpose: Patient simulation has emerged as a useful tool to refine cognitive, psychomotor, and affective skills in realistic yet controlled settings. However, the cost associated with simulation labs can be a barrier. The purpose of this pilot study was to 1) assess the feasibility of a low-cost optimal-fidelity simulation lab integrated into an academic course and 2) assess the effectiveness of a low-cost optimal-fidelity patient simulation on self-efficacy and clinical performance of Doctor of Physical Therapy (DPT) students. Methods: This prospective study utilized a repeated measures quasi-experimental research design. Subjects were recruited through convenience sampling from two branches of the same accredited program run separately on different campuses. Students from one campus served as the experimental group and students from the other campus served as the control group. The control group received usual training for a course on patient assessment. Simultaneously, the experimental group received usual training with the addition of simulation. The Jones and Sheppard self-efficacy questionnaire was administered at baseline (T0), after simulation (T1), and after the subjects’ first clinical experience (T2). The PT Clinical Performance Instrument (CPI) assessed clinical performance. Faculty time, space, equipment, and funds were recorded for descriptive analysis Results: A low-cost optimal-fidelity simulation lab was developed in a 360 square feet room with approximately $500 of supplies. Mann–Whitney independent sample tests demonstrated no statistical significance between groups at each of the data collection points. Within group changes in self-efficacy were statistically significant from T0 to T1 in the experimental group only. No statistically significant changes in CPI scores were noted between groups at the midterm or final assessment. A small-to-moderate effect size (d = 0.386) was noted. Conclusion: The feasibility of the low-cost optimal-fidelity simulation was demonstrated by the limited cost and space requirements. Exposure to one simulated patient encounter appeared to accelerate the development of self-efficacy prior to a first clinical placement compared to usual training in this pilot study

Improving the Quality of Consumer Health Information on Wikipedia: Case Series.

BACKGROUND: Wikipedia is one of the most consulted health resources in the world. Since the public is using health information from Wikipedia to make health care decisions, improving the quality of that health information is in the public interest. The open editable content design of Wikipedia and quality control processes in place provide an opportunity to add high-value, evidence-based information and take an active role in improving the health care information infrastructure. OBJECTIVE: The aim of this project was to enhance Wikipedia health pages using high-quality, current research findings and track the persistence of those edits and number of page views after the changes to assess the reach of this initiative. METHODS: We conducted Wikipedia Editathons with 3 different cohorts of Physical Therapy (PT) students to add high-quality health information to existing Wikipedia pages. Students synthesized best evidence information and updated and/or corrected existing Wikipedia entries on specific health pages. To evaluate the impact of these contributions, we examined two factors: (1) response to our contributions from the Wikipedia editing community, including number and type of subsequent edits as well as persistence of the student contributions and (2) number of page views by the public from the time of the page edits. RESULTS: A total of 98 PT students in 3 different cohorts engaged in Editathons, editing 24 health pages. Of the 24 edits, 22 persisted at the end of the observation period (from time of entry to May 31, 2018) and received nearly 8 million page views. Each health page had an average of 354,724 page views. CONCLUSIONS: The Wikipedia Editathon is an effective way to continuously enhance the quality of health information available on Wikipedia. It is also an excellent way of bridging health technology with best-evidence medical facts and disseminating accurate, useful information to the public

Prognostic factors in complex regional pain syndrome 1: a systematic review

OBJECTIVE: The aim of this systematic review was to merge and summarize the current evidence about prognostic factors relevant to the course of complex regional pain syndrome 1. METHODS: MEDLINE, Embase, PsychINFO, CENTRAL and screened reference lists of included studies were searched for studies of parameters associated with the prognosis of the condition. Studies investigating stroke-related complex regional pain syndrome were excluded. RESULTS: Searches retrieved 2,577 references, of which 12 articles were included in the study. The preferred diagnostic criteria were the Veldman and the International Association for the Study of Pain criteria. The mean level of study quality was insufficient. A total of 28 prognostic factors was identified. Sensory disturbances and cold skin temperature appear to represent parameters associated with poor prognosis in complex regional pain syndrome 1. For many parameters the evidence is contradictory. CONCLUSION: Evidence about prognostic factors for complex regional pain syndrome 1 is scarce, which prevents firm conclusions being drawn. Further high-quality aetiological and clinical research is needed