Clinical Educator and Student Perceptions of iPad™ Technology to Enhance Clinical Supervision: The Electronically-Facilitated Feedback Initiative (EFFI)

Purpose: Growing demands placed upon healthcare systems require more health professionals to be trained. Clinical placement education is an integral component of health professional training, however accommodating increasing numbers of student placements is a challenge for health services. Personal digital assistants such as iPads™ may assist in delivery of clinical education, by facilitating transfer of knowledge and skills from clinical educators to health professional students, however such an initiative has not been formally investigated. The present study sought to explore perceptions of clinical educators and allied health students regarding the impact of an iPad™-based feedback delivery system on student reflection and learning. Methods: A pilot study was performed using iPads™ with specialised software to deliver electronic formative feedback to physiotherapy, occupational therapy and speech pathology students during clinical placements. Students and clinical educators completed a questionnaire exploring advantages and disadvantages of the technology. Results: Nine clinical educators and 14 students participated and completed the survey. Clinical educators largely (n=7, 78%) reported the electronic feedback system was easy to use and 67% (n=6) reported it improved the quality of feedback provided to students. Five (56%) clinical educators thought electronic feedback improved student performance. Most students (n=10, 71%) reported electronic feedback facilitated reflection upon performance, and 64% (n=9) reported improved performance as a result. Disadvantages included poor wireless internet access and software inefficiencies (n=7 [78%] clinical educators, n=7 [50%] students), and difficulties using iPads™ in settings requiring infection control (n=2 [22%] clinical educators). Conclusions: Clinical educators and students perceived electronic feedback as a positive adjunct to student learning on clinical placement, however technological and software interface factors need to be considered for implementation in some settings

Objective concurrent feedback on force parameters improves performance of lumbar mobilisation, but skill retention declines rapidly

Objective: To determine the optimum practice for students to apply lumbar mobilisations with force parameters consistent with an experienced therapist. Design: Thirty physiotherapy students attended three practice sessions over two weeks where they performed lumbar mobilisations on a fellow student. Students viewed feedback on their applied forces (measured using an instrumented treatment table) in real-time on a computer screen. Performance was tested before and after feedback at each practice session and at follow up sessions one week and three months later. Outcome measures: A greater accuracy in manual force application was defined as a smaller difference between each student-applied force parameter (mean peak force (N), force amplitude (N), and oscillation frequency (Hz)), and that previously applied by an expert. Test data from each session was analysed using Friedman's and Wilcoxon signed rank tests to determine student learning and retention. Results: Students were more accurate after feedback at Session 1 (median difference between student and expert force parameters 7.7 N, IQR 3.2–15.3) than before feedback (median 17.5, IQR 7.3–33.6, <i>P</i> < 0.001). Increased practice improved performance, with the greatest accuracy after feedback at Session 3 (median 7.0, IQR 3.5–11.9, <i>P</i> < 0.01). Retention however was poor, with performance at follow-up sessions no different to baseline. Conclusions: Students apply more consistent and accurate mean peak force, force amplitude and oscillation frequency after practising with objective, concurrent feedback. Additional practice sessions further improve performance, however retention is poor

Thumb pain in physiotherapists: potential risk factors and proposed prevention strategies

Work related injury to the thumb has become a recognised problem for physiotherapists who perform manual techniques in the treatment of patients with orthopaedic musculoskeletal disorders. Pain in the thumb often causes physiotherapists to alter their methods of treatment, which may decrease the effectiveness of physiotherapy services and lead to increased financial costs for patients and their funding agencies. Substantial numbers of physiotherapists have changed their specialty area or left the profession because of work-related injury, which further burdens education and healthcare systems. The extent of the influence of individual risk factors and preventive strategies on the development of thumb pain in physiotherapists has not been conclusively determined. This paper discusses the potential causes and consequences of thumb pain in physiotherapists, and reviews the supporting evidence on the incidence, risk, prevention, and treatment of this common occupational injury in physiotherapists

Measuring the posteroanterior stiffness of the cervical spine

An essential part of improving manual therapy treatment for cervical spine disorders is the identification of the mechanical effects of manual techniques. The aims of this research were to develop a reliable and safe instrument for measuring cervical spine stiffness, and to document stiffness in a group of asymptomatic individuals. A device for measuring cervical spine stiffness was designed and tested. The stiffness of the cervical spine of 67 asymptomatic individuals was measured at C2 and C7 on one or more occasions. Stiffness was defined as the slope of the linear region of the force–displacement curve (coefficient K). For C2, the linear region of the force–displacement curve was from 7 to 40 N, and for C7, 20–70 N. The mean stiffness (coefficient K) on the first measurement occasion at C2 was 4.58 N/mm (95% CI 4.30–4.85), and at C7 was 7.03 N/mm (95% CI 6.50–7.57). ICC(2,1) for repeated measurements was 0.84 (95% CI 0.74–0.90). Stiffness measurements in the cervical spine were generally lower than those previously reported for the lumbar spine. Age was positively associated with C2 stiffness (p=0.01). Males were stiffer at C7 than females (p<0.001). This research provides a basis for future studies investigating the effects of manual techniques on cervical spine stiffness, potentially leading to improved outcomes for patients treated by manual therapy

Calibration of an instrumented treatment table for measuring manual therapy forces applied to the cervical spine

Manual therapy techniques are commonly used to treat musculoskeletal neck disorders, but little is known about the manual forces applied during cervical spine treatment. Forces may vary between practitioners, and this may affect patient outcomes. This Study reports the development of an instrumented treatment table and its calibration for measuring posteroanterior-directed forces applied during cervical spine mobilisation. A treatment table surface was instrumented with seven biaxial load cells to measure manually applied forces in three planes. Accuracy of the system was evaluated using known weights (unloaded and loaded to represent a patient's body weight), selected to be consistent with the level of forces expected to be applied during cervical mobilisation. Recorded force values strongly correlated with known weights (Pearson's r = 0.999 to 1.000 for forces applied in different directions and locations, unloaded and loaded). The accuracy of forces in the unloaded condition was very good for vertical forces (mean absolute error 1.1 N, SD 1.5), and reasonably good for horizontal forces (2.8 N, SD 2.4 for mediolateral, 3.4 N, SD 1.5 for caudad-cephalad). In the loaded condition absolute error increased slightly for horizontal forces. The accuracy of measured forces indicates the instrumented table is acceptable for measuring cervical mobilisation forces. Using it allows practitioners to perform manual techniques using their usual clinical technique, however interpretation of force data is limited because it represents force applied to the table rather than at a specific joint

Manual forces applied during posterior-to-anterior spinal mobilization: a review of the evidence (literature review)

Objective: The objective of this review was to evaluate the evidence for the consistency of force application by manual therapists when carrying out posterior-to-anterior (PA) mobilization techniques, including the factors that influence the application and measurement of mobilization forces. Methods: Studies were identified by searching 6 electronic databases up to April 2005, screening the reference lists of retrieved articles, and contacting experts by e-mail. Relevant articles were defined as those that described the measurement of forces applied during spinal mobilization or discussed the reliability of measurement of manual forces. Results: Twenty studies described the quantitative measurement of applied force during a PA mobilization technique, with most focusing on the lumbar spine. When defined by magnitude, frequency, amplitude, and displacement, PA mobilization forces are extremely variable among clinicians applying the same manual technique. Variability may be attributed to differences in techniques, measurement or reporting procedures, or variations between therapists or between patients. Conclusions: The inconsistency in manual force application during PA spinal mobilization in existing studies suggests that further studies are needed to improve the clinical standardization of manual force application. Future research on mobilization should include forces applied to the cervical and thoracic spines in addition to the lumbar spine while thoroughly describing force parameters and measurement methods to facilitate comparison between studies

Predictors of calf cramping in rugby league

Exercise-associated muscle cramps (EAMC) in the calf are common in rugby league. To date, the etiology and predictors of calf cramping are poorly understood. The aim of this study was to undertake a prospective investigation to identify predictors of calf cramping in rugby league players. Demographic and anthropometric data and calf cramp and injury history were collected in the preseason. Hydration status, number of games played, and calf cramps were recorded on game days. Male rugby league players (n = 103, mean age 18.8 ± 4.1 years) were classified as either EAMC (experienced at least 1 incident of calf cramps in the season) or no EAMC (no calf cramps). The following were investigated as possible predictors of EAMC using logistic regression modeling: competition level, age, ethnicity, playing position, history of cramping, precramping, low back pain, foot orthotic usage, foot posture, foot strike, muscle flexibility, calf girth, hydration status, and number of games played. Half the players, n = 52, experienced at least 1 incidence of calf cramping. Playing in a senior competition level (odds ratio: 0.21; 95% confidence interval: 0.06-0.75; p = 0.016), a history of calf cramping (10.85; 2.16-54.44; p = 0.004), and a history of low back pain resulting in missed field minutes (4.50, 1.37-14.79; p = 0.013) were found to predict EAMC. This study suggests that there is a high incidence of calf cramping in rugby league, especially at senior competition levels, and supports preseason screening in senior players to idetify those at risk of calf cramping and the development of possible preventative strategies