A combined strength and balance exercise program to decrease falls risk in dialysis patients : a feasibility study

People suffering end-stage kidney disease receiving hemodialysis have a greater risk of falling and suffering debilitating injuries. The purpose of this study was to examine the feasibility and impact of a combined strength and balance exercise intervention on falls risk in hemodialysis patients. Twenty-four adults (mean age = 67.8 yrs) from two Australian outpatient hemodialysis clinics completed the intervention. Falls risk was measured using the Physiological Profile Assessment (PPA). There was a significant reduction in the median overall falls risk z-score from 1.67 to .52 (z = -3.11, P<.008; r = .45). Median reaction time improved from .30 to .26 sec (z = -2.86, P<.008; r = .41). A strength and balance intervention to reduce the falls risk for dialysis patients is feasible and may reduce falls risk for at risk patients

Which learning activities enhance physical therapist practice? Part 2: Systematic review of qualitative studies and thematic synthesis

Objective. Post-professional physical therapy expertise requires career-long participation in learning activities. Understanding physical therapists’ lived experience of learning activities provides novel insight into how best to enhance physical therapist practice from the perspective of the learner. The purpose of this study was to explore qualified physical therapists’ experiences, beliefs, and perspectives with regard to learning activities and professional development. Methods. Eight databases were searched for studies published from inception through December 2018. Study selection included mixed-methods and qualitative studies exploring physical therapists’ experiences, perspectives, beliefs and attitudes. Thematic synthesis was performed, and the GRADE-Confidence in the Evidence from Reviews of Qualitative research (CERQual) was used to assess the level of confidence in the findings. Forty-one studies with 719 participants were included. Results. The key findings include physical therapists’ perceptions that worthwhile post professional learning requires more than attendance at professional development courses. Physical therapists perceived that worthwhile learning requires connection with others and being “taken out of ones’ comfort zone.” Sufficient time and accessible, trustworthy resources were also valued. Conclusions. Moderate- to low-level evidence suggests that the choice of professional development activities and education design for qualified physical therapists should consider the inclusion of connected activities, activities that take participants out of comfort zones, time to practice, and trustworthy resources that are easily accessible. Future research should evaluate the effectiveness of learning activities encompassing these factors, prioritizing those that minimize the barriers of time and distance. Impact. This study adds to the profession’s understanding of physical therapists’ lived experience of learning activities, providing novel insight into how best to enhance physical therapist practice from the perspective of the learner

Which learning activities enhance physical therapist practice? Part 1: Systematic review and meta-analysis of quantitative studies

Objective. Following graduation from professional education, the development of clinical expertise requires career-long participation in learning activities. The purpose of study was to evaluate which learning activities enhanced physical therapist practice. Methods. Eight databases were searched for studies published from inception through December 2018. Articles reporting quantitative data evaluating the effectiveness of learning activities completed by qualified physical therapists were included. Study characteristics and results were extracted from the 26 randomized controlled trials that met the inclusion criteria. Clinician (knowledge, affective attributes, and behavior) and patient related outcomes were extracted. Results: There was limited evidence that professional development courses improved physical therapist knowledge. There was low-level evidence that peer assessment and feedback was more effective than case discussion at improving knowledge (SMD = 0.35, 95%CI = 0.09-0.62). Results were inconsistent for the effect of learning activities on affective attributes. Courses with active learning components appeared more effective at changing physical therapist behavior. The completion of courses by physical therapists did not improve patient outcomes; however, the addition of a mentored patient interaction appeared impactful. Conclusions. Current evidence suggests active approaches, such as peer assessment and mentored patient interactions, should be used when designing learning activities for physical therapists. Further high-quality research focused on evaluating the impact of active learning interventions on physical therapist practice and patient outcomes is now needed. Impact. This study is a first step in determining which learning activities enhance clinical expertise and practice would enable the physical therapy profession to make informed decisions about the allocation of professional development resources

Grit, resilience and mindset in health students

Background: Grit, resilience and a growth mindset are personal traits conducive to optimal learning and clinical readiness. These are important traits to consider with regards to whether a student thrives or struggles in challenging situations. Research with medical, nursing and pharmacy students demonstrates correlations of these traits with positive well-being and academic success. No research has investigated the traits of resilience, grit and mindset type together in health professional students to explore whether they are related, and none have focused on physiotherapy students. Methods: Cross-sectional study of final-year physiotherapy students (n = 134) aiming to describe the levels of these personal traits and to determine whether they are related to each other or demographic factors. Results: A proportion of physiotherapy students have low levels of resilience (25%), low academic resilience (19%) and low levels of grittiness (13%). Grit and resilience were positively related (p < 0.001). A smaller fraction of students had a fixed mindset in relation to intelligence (7%) and talent (10%). Having a mental health condition or disability and the number of hours spent in paid employment were related to personal traits. Discussion: This is the first study to document empirical evidence of physiotherapy students’ levels of grit, resilience and mindset type with a significant proportion of students having low levels of these attributes. Results have implications for clinical educators and universities seeking to improve student well-being in order to facilitate effective learning. Institutions need to consider best-practice approaches to managing and supporting these students to foster well-being for effective learning

Grit, Resilience, Mindset, and Academic Success in Physical Therapist Students: a Cross-Sectional, Multicenter Study

Objective: The purpose of this study was to determine the relationships between noncognitive traits (grit, resilience, and mindset-type), academic success, and clinical performance in physical therapist students. Methods: This cross-sectional study using self-administered surveys was undertaken with final-year physical therapist students enrolled in 4 Australian universities. Participants completed validated questionnaires measuring grit, resilience, and mindset type. Academic transcripts were obtained to quantify academic success and clinical performance. A multiple regression analysis explored predictors of academic success and clinical performance in relation to sociodemographic factors, grit, resilience, and mindset type. Results: A total of 266 students participated in the study (80% recruitment rate). Overall, 25% of students had low resilience, 20% had low grit, and 14% had a fixed mindset type. Grittiness was positively associated with academic success (r = 0.24) and clinical performance (r = 0.22) and negatively associated with failing a clinical placement (r =-0.20). Grit was an independent predictor of overall academic success (β = 0.24, P ≤. 01) and clinical performance (β = 0.15). Students with low grit were twice as likely to fail a clinical placement compared with students with moderate or high grit (risk ratio = 2.03, 95% CI = 1.06 to 3.89). Conclusion: Grit was an independent predictor for overall academic success and clinical performance in final-year physical therapist students. Low grit may impact negatively on learning and students' ability to cope with challenges associated with university studies and clinical education. Further studies should investigate interventions that best develop grit in health professional students and the overlapping nature of grit, resilience, and a growth mindset. Impact: This study helps universities and educators understand noncognitive factors predicting academic success and clinical performance in physical therapist students. Universities and clinical educators may consider screening and providing proactive strategies for students with low grit to improve success and general wellbeing

Hyperparathyroidism can be useful in the identification of primary aldosteronism due to aldosterone-producing adenoma.

Hyperparathyroidism represents as a novel feature of primary aldosteronism (PA). Its occurrence in patients with the surgically correctable aldosterone-producing adenoma (APA) and not in those with bilateral adrenal hyperplasia suggested that the measurement of parathyroid hormone could help in differentiating between these subtypes of PA. To test this hypothesis we measured the plasma levels of intact parathyroid hormone, Ca(2+), and several markers of calcium/phosphorus metabolism in 132 hypertensive patients, including 74 with primary (essential) hypertension and 58 consecutive PA patients. Of the latter, 46 were conclusively diagnosed as APA (by finding of lateralized aldosterone excess, pathology, correction of the hyperaldosteronism, and evidence of a fall of blood pressure after adrenalectomy) and 12 as bilateral adrenal hyperplasia. Based on these diagnoses we used the area under the receiver operator characteristic curve analysis to assess the accuracy of serum parathyroid hormone for identifying the PA cases in the whole group and for distinguishing between APA and bilateral adrenal hyperplasia. In this selected population of hypertensive patients for identifying PA cases, the accuracy of serum parathyroid hormone tended to be lower than that of the aldosterone:renin ratio. However, for discriminating between APA and bilateral adrenal hyperplasia patients it was better than that under the identity line and also that for the aldosterone:renin ratio for pinpointing APA cases among patients with PA. Hence, these findings indicate that raised serum parathyroid hormone levels are a feature of APA that can be useful for selecting the PA patients to be submitted to adrenal vein sampling