Reviewing the Diagnostic Classifications used for Low Back Pain in Physiotherapy-related Research.

Background: The evidence-to-practice gap, where clinical practice does not reflect the findings from research evidence, has been identified as a concern in allied health disciplines such as physiotherapy. Failure to provide care according to current (research) evidence raises the potential that patients are receiving care that is either not needed, is ineffective, less effective than current research indicates, or potentially harmful. For research evidence to be translatable to clinical practice, the research should be seen to be applicable, i.e. the clinician should be able to recognise that the research study sample reflects their patient population. Method: This study presents a pragmatic clinical review of patient sampling from high level primary research trials investigating physical therapy for low back pain. Only studies where full text copies were freely accessible to clinicians were reviewed. The review collated the characteristics of the study subjects and explored how they related to standard clinical practice. Results: A total of 63 full text randomised controlled trials papers were identified and reviewed. Across the studies reviewed, the clinical presentations of included subjects were variably described, with inconsistencies in the diagnostic labels used, the characteristics of the symptoms reported and the nature of the exclusion criteria applied. Of concern was the lack of reporting of patient’s clinical presentation according to standard clinical assessment findings to allow the clinician to gauge the applicability of the study. Conclusion: A core principle of clinical physiotherapy practice is the clinical assessment of the patient to identify the patient’s specific presentation to individualise rehabilitation and exclude serious pathology. To close the evidence-practice gap, we either need to revisit standard clinical practice or focus on the reporting of the research evidence to ensure its applicability

Next-generation Solutions for Indian Health Care: Strengthening the Impact of Allied Health

The contributions of allied health professionals to patient care is well recognized in developed countries. In developed countries, allied health providers can reach the general public easily and cater to the health care needs of the society. However, medical dominance in developing countries often curtails the autonomy of allied health professionals. The Public Health Foundation of India prepared a report in 2012 on allied health professionals in India. This report explained the role of the AHP in improving the health status of the country. The objective of this commentary is to provide a possible opportunity for better integrating the allied health professions in the provision of health care in India based on the report prepared by the Public Health Foundation of India

Non-steroidal anti-inflammatory drugs (NSAIDs): Physiotherapists' use, knowledge and attitudes

This paper reports on a survey regarding physiotherapists’ knowledge, use and attitudes to non–steroidal anti–inflammatory drugs (NSAIDs), some of which have recently been re–scheduled to non–prescription dispensing. A written survey instrument was developed and administered to 750 physiotherapists in South Australia, Tasmania and the Australian Capital Territory (50% of the registered physiotherapists). Responses were received from 285 physiotherapists. The survey identified opportunities for patient misuse and misadventures with NSAIDs in conjunction with physiotherapy management. Differences in physiotherapists’ understanding of the dosage and actions of oral and topic administrations of NSAIDs were highlighted, as were the moral and ethical responsibilities of physiotherapists to patients considering taking NSAIDs. The study identified the need for regular professional updates on quality use of NSAIDs

Health Profession Student’s Readiness Towards Online Learning as a Component of Blended Learning

Objectives: The objectives of this study were to identify the entry-level health profession students’ perception and readiness to adopt online learning as a component of blended learning (BL). Methods: A cross sectional survey using a structured questionnaire was administered using Google forms. Entry level Health professionals’ education (HPE) graduate students of a higher education institute in India completed the survey (N= 628). The questionnaire was developed from the literature and content validated by experts. Ethics clearance was obtained from the Institutional ethics committee. Results: Out of 628 responses, 603 fully completed questionnaires were included for analysis. Of the participants, 98 % owned a smartphone, whereas 67% possessed either a laptop or a stationary computer. 60 % of the respondents reported at least one hour of internet access per day for learning purposes. Most of the participants were comfortable in accessing online learning materials and interacting with peers. The majority of the participants (77.4%) were willing to spend 10 to 20 hours per week on online learning. Conclusion: Entry Level HPE graduate students were ready to adopt online learning as a component of BL. Providing necessary infrastructure and creating online learning materials needs to be considered

Extended scope physiotherapy roles for orthopedic outpatients: an update systematic review of the literature

Purpose: This systematic review updates one conducted in 2008 into extended scope practice (ESP) in physiotherapy in orthopedics. Methods: A comprehensive open-ended search was conducted using electronic library databases and Google Scholar to identify any primary study design reporting on physiotherapists working in ESP roles within orthopedic settings. Studies were allocated to the National Health and Medical Research Council hierarchy of evidence, although only studies in levels I, II, or III_1 were critically appraised using a purpose-built critical appraisal tool. Information was extracted on the country of origin, ESP tasks, relevant training, patient types, health, process, and cost measures. Results: 1071 studies were identified, and twelve were included in the review (including diagnostic and evaluative research). The hierarchy of evidence ranged from II to IV, from which only two diagnostic studies met the criteria for critical appraisal. ESP tasks included injection therapy, removing k-wires, and requesting investigations. The education of ESP physiotherapists varied widely, and included formal and informal training. The positive outcomes of ESP initiatives were reported, in diagnostic ability, reduced costs and waiting times, and improved health outcomes. Conclusion: Despite the positive results, the generally low level of evidence and the range of outcome measures reported, constrained clear conclusions regarding the health, process, and cost implications of ESP physiotherapy roles in orthopedic settings. The need for formalized, widely recognized training was highlighted, to give ESP physiotherapy roles credibility.Jessica Stanhope, Karen Grimmer-Somers, Steve Milanese, Saravana Kumar, Joanne Morri

Adolescent standing postural response to backpack loads: a randomised controlled experimental study

BACKGROUND: Backpack loads produce changes in standing posture when compared with unloaded posture. Although 'poor' unloaded standing posture has been related to spinal pain, there is little evidence of whether, and how much, exposure to posterior load produces injurious effects on spinal tissue. The objective of this study was to describe the effect on adolescent sagittal plane standing posture of different loads and positions of a common design of school backpack. The underlying study aim was to test the appropriateness of two adult 'rules-of-thumb'-that for postural efficiency, backpacks should be worn high on the spine, and loads should be limited to 10% of body weight. METHOD: A randomised controlled experimental study was conducted on 250 adolescents (12–18 years), randomly selected from five South Australian metropolitan high schools. Sagittal view anatomical points were marked on head, neck, shoulder, hip, thigh, knee and ankle. There were nine experimental conditions: combinations of backpack loads (3, 5 or 10% of body weight) and positions (backpack centred at T7, T12 or L3). Sagittal plane photographs were taken of unloaded standing posture (baseline), and standing posture under the experimental conditions. Posture was quantified from the x (horizontal) coordinate of each anatomical point under each experimental condition. Differences in postural response were described, and differences between conditions were determined using Analysis of Variance models. RESULTS: Neither age nor gender was a significant factor when comparing postural response to backpack loads or conditions. Backpacks positioned at T7 produced the largest forward (horizontal) displacement at all the anatomical points. The horizontal position of all anatomical points increased linearly with load. CONCLUSION: There is evidence refuting the 'rule-of-thumb' to carry the backpack high on the back. Typical school backpacks should be positioned with the centre at waist or hip level. There is no evidence for the 10% body weight limit

Fragmentation of care threatens patient safety in peripheral vascular catheter management in acute care--a qualitative study.

BACKGROUND: The use of peripheral vascular catheters (PVCs) is an extremely common and necessary clinical intervention, but inappropriate PVC care poses a major patient safety risk in terms of infection. Quality improvement initiatives have been proposed to reduce the likelihood of adverse events, but a lack of understanding about factors that influence behaviours of healthcare professionals limits the efficacy of such interventions. We undertook qualitative interviews with clinical staff from a large group of hospitals in order to understand influences on PVC care behaviors and subsequent patient safety. METHODS: Ten doctors, ten clinical pharmacists, 18 nurses and one midwife at a National Health Service hospital group in London (United Kingdom) were interviewed between December 2010 and July 2011 using qualitative methods. Responses were analysed using a thematic framework. RESULTS: FOUR KEY THEMES EMERGED: 1) Fragmentation of management and care, demonstrated with a lack of general overview and insufficient knowledge about expected standards of care or responsibility of different professionals; 2) feelings of resentment and frustration as a result of tensions in the workplace, due to the ambiguity about professional responsibilities; 3) disregard for existing hospital policy due to perceptions of flaws in the evidence used to support it; and 4) low-risk perception for the impact of PVC use on patient safety. CONCLUSION: Fragmentation of practice resulted in ill-defined responsibilities and interdisciplinary resentment, which coupled with a generally low perception of risk of catheter use, appeared to result in lack of maintaining policy PVC standards which could reduced patient safety. Resolution of these issues through clearly defining handover practice, teaching interdisciplinary duties and increasing awareness of PVC risks could result in preventing thousands of BSIs and other PVC-related infections annually

The Left Hand Second to Fourth Digit Ratio (2D:4D) Does Not Discriminate World-Class Female Gymnasts from Age Matched Sedentary Girls

INTRODUCTION: The second to fourth-digit-ratio (2D:4D), a putative marker of prenatal androgen action and a sexually dimorphic trait, has been suggested to be related with sports performance, although results are not univocal. If this relation exists, it is most likely to be detected by comparing extreme groups on the continuum of sports performance. METHODS: In this study the 2D:4D ratio of world-class elite female artistic gymnasts (n = 129), competing at the 1987 Rotterdam World-Championships was compared to the 2D:4D ratio of sedentary age-matched sedentary girls (n = 129), alongside with other anthropometric characteristics including other sexually dimorphic traits such as an androgyny index (Bayer & Bayley) and Heath-Carter somatotype components (endomorphy, mesomorphy, ectomorphy) using AN(C)OVA. 2D:4D was measured on X-rays of the left hand. RESULTS: Left hand 2D:4D digit ratio in world class elite female gymnasts (0.921±0.020) did not differ significantly from 2D:4D in age-matched sedentary girls (0.924±0.018), either with or without inclusion of potentially confounding covariates such as skeletal age, height, weight, somatotype components or androgyny index. Height (161.9±6.4 cm vs 155.4±6.6 cm p<0.01), weight (53.9±7.6 kg vs 46.2 6.3 kg p<0.01), BMI (20.51±2.41 kg/m(2) vs 19.05±1.56 kg/m(2)), skeletal age (15.2±1.1 y vs 14.5±1.2 y p>0.01), somatotype components (4.0/3.0/2.9 vs 1.7/3.7/3.2 for endomorphy (p<0.01), mesomorphy (p<0.01) and ectomorphy (p<0.05) respectively) all differed significantly between sedentary girls and elite gymnasts. As expressed by the androgyny index, gymnasts have, on average, broader shoulders relative to their hips, compared to the reference sample. Correlations between the 2D:4D ratio and chronological age, skeletal age, and the anthropometric characteristics are low and not significant. CONCLUSION: Although other anthropometric characteristics of sexual dimorphism were significantly different between the two samples, the present study cannot discriminate sedentary girls from world-class female gymnasts by means of the left hand 2D:4D ratio

Does Ability to do Proactive Stepping Reflect Ability to do Reactive Stepping?

Stepping is the strategy used in standing to prevent fall. Reactive stepping is made when perturbed to fall. Reactive stepping is less assessed in clinical setting, instead, proactive stepping is assessed to measure the risk of fall. Reactive stepping is commonly tested in research settings. This study was done to find relationship between proactive stepping and reactive stepping in healthy adults. We found that proactive stepping ability did not reflect reactive stepping ability. The study suggests that outcomes of proactive stepping measures must be used with caution to understand individual’s ability to do reactive stepping and prevent falling

Profiling physiotherapy student preferred learning styles within a clinical education context

Objectives: This study investigated the preferred learning styles, related to clinical education of a cohort of final year physiotherapy students.\ud \ud Design: A cross sectional observation study using a questionnaire survey.\ud \ud Setting: Undergraduate physiotherapy program at James Cook University, Townsville, Queensland.\ud \ud Participants: 48 final year physiotherapy students representing 89% of the total cohort (48/54).\ud \ud Interventions: Survey questionnaire using Kolb's Learning Style Inventory (Version 3.1).\ud \ud Results: The preferred learning styles were spread uniformly across the three learning styles of Converging, Assimilating and Accommodating, with the least preferred method of learning style the Diverging style. This suggests that in the clinical environment this student cohort are least likely to prefer to develop their learning from actually experiencing the scenario i.e. in front of a real life patient (concrete experience), and were more likely prefer this learning to come from a theoretical perspective, allowing them to consider the problem/scenario before experiencing it. When transforming this experience into knowledge, they prefer to use it on a 'real life' patient (active experimentation).\ud \ud Conclusion: Whilst understanding learning styles have been promoted as a means of improving the learning process, there remains a lack of high level evidence. The findings of this study reinforce those of other studies into the learning styles of physiotherapy students suggesting that physiotherapy students share common learning style profiles