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

"This is hard to cope with" : the lived experience and coping strategies adopted amongst Australian women with pelvic girdle pain in pregnancy

Background: Women with pregnancy-related pelvic girdle pain (PPGP) report diminished ability to perform physical activities and experience higher rates of mood disorders, such as anxiety and depression, than pregnant women without PPGP. Despite these physical and psychological impacts, little is known about the lived experiences of PPGP amongst Australian women and the ways in which they cope. Situated within biographical disruption and social support theories, this study sought to gain a conceptual understanding of the experience and impact of PPGP on daily life, and how women cope with this condition during pregnancy. Methods: A qualitative research design, situated within a phenomenological framework, using individual, semi-structured interviews consisting of open-ended questions was used with a flexible and responsive approach. Purposive sampling of pregnant women attending a single hospital included 20 participants between 14 and 38 weeks gestation, classified with PPGP as per recommended guidelines, with a mean (SD) age of 31.37 (4.16) years. Thematic analysis was performed where interview data was transcribed, coded, grouped into meaningful categories and then constructed into broad themes. Results: Three themes were identified: 1. a transformed biography; 2. coping strategies; and 3. what women want. The pain experienced created a dramatic change in women's lives, making the pregnancy difficult to endure. Women utilised social support, such as family, to help them cope with pain, and a self-care approach to maintain a positive mindset and reduce stress. Although a few women received support from healthcare professionals, many reported a lack information on PPGP and limited societal recognition of the condition. Women wanted early education, personalised information and prompt referral to help them cope with PPGP. Conclusions: Findings from this study highlighted the complexity of living with PPGP as women attempted to deal with the unexpected impact on daily life by seeking support from partners and families, while also struggling with societal expectations. Although women with PPGP used a number of coping strategies, they sought greater support from healthcare professionals to effectively manage PPGP. These findings have important implications for the provision of health care to women living with PPGP

Is there a future for electrophysical agents in musculoskeletal physiotherapy?

Electrophysical agents (EPAs) are part of the arsenal of techniques that manual therapists have at their disposal for the management of neuromusculoskeletal disorders. An argument can be made that when used judiciously and appropriately as one part of a multimodal approach to treatment, EPAs have the potential to enhance patient care. For the discerning manual therapist, there are several issues to reflect on when considering the use of EPAs as an adjunct to other techniques. One of the main criticisms levelled at EPAs has been that they have little to no evidence of effect. However, one could argue that the swing away from using EPAs in the last 20 years has been as little evidence-based as their prior overuse in the 1970 and 80s. Drill down into the evidence argument and there are many flaws and misconceptions. An evaluation of the Cochrane database and the research into transcutaneous electrical nerve stimulation (TENS) provides a good example

Healthcare equipment as a source of nosocomial infection : a systematic review

Nosocomial infections (NIs) result in significant financial and individual costs, with large numbers of patients acquiring infections annually. Healthcare equipment has been identified as a likely source of these infections, and research indicates that up to one-third of all NIs may be prevented by adequate cleaning of equipment. Thus, this systematic review aimed to determine levels of contamination on healthcare equipment, to identify viable cleaning protocols and to establish the methodological quality of current evidence. Published and unpublished studies from January 1972 to December 2004 were identified in eight major databases. Methodological quality was evaluated using the hierarchy of evidence and a quantitative critical appraisal tool. Data were extracted and analysed using five major outcome measures. Fifty studies were identified investigating a range of healthcare equipment, of which 23 were included in the review. Methodological quality ranged from 6.5 to 9.5 out of 14 for observational studies and from 6.5 to 9.5 out of 15 for repeated measures studies. The included studies reported that 86.8% of all sampled equipment was contaminated, with 70% alcohol reducing the levels of contamination on equipment by 82.1%. Healthcare equipment is a significant source of NI. High levels of contamination are present on a wide range of healthcare equipment. However, the majority of contamination and hence any risk of acquiring a NI can be reduced substantially by regular cleaning of equipment with 70% alcohol. Further research is required into the role of community healthcare equipment in NI

Foundations for work-related practice : occupational therapy and physiotherapy entry-level curricula

Aims/background: Occupational therapy (OT) and physiotherapy (PT) curricula content and preparedness for work-related practice and occupational health and safety (OHS) are not well documented. This study aimed to identify content and other elements of entry-level curricula in 23 OT and 17 PT programmes from Australia and New Zealand, and to identify educators’ perceptions of OT and PT graduates’ preparedness for work-related practice and OHS topics. Method: A telephone survey collected curricula content as well as teaching and assessment methods from 19 OT and PT work-related practice educators. Educators reported perceptions of new graduate preparedness for 22 topics in the field of work-related practice identified in an earlier study. Results included descriptive statistics and thematic analyses. Findings: Educators reported a high rate of inclusion (81%) of work-related practice topics in curricula. The main teaching method was theory (99.5%) and other methods included hands-on practical work with students and fieldwork with clients. Educators reported similar assessment processes across programmes. New graduates were prepared for practice with minimal supervision in the majority of topics (81%). Conclusions: Work-related practice content was included strongly and consistently in OT and PT entry-level curricula. However, as the majority of content was embedded in other courses, topics may not have been explicit and identifiable to students. New graduates were perceived to be prepared for practice with minimal supervision. This finding will assist employers to understand new graduates’ preparedness for practice and needs for further development. Preparedness for practice in this field was similar to expectations of preparedness for other practice areas

Effect of a low-dye application of Scotchcast Soft Cast on peak and mean plantar pressures in subjects with a navicular drop greater than 10 mm

Background: We investigated whether a low-Dye application of Scotchcast Soft Cast significantly altered plantar pressure distribution during gait in patients with a navicular drop greater than 10 mm. Methods: An experimental, same-subject, repeated-measures design was used. Thirty-two subjects aged 18 to 35 years were screened with the navicular drop test and were included if a navicular drop greater than 10 mm was established. The Emed-AT-2 platform system was used to measure the plantar pressure distribution under the right foot of each subject using the midgait method of data collection. Each subject performed six barefoot walks and six walks with Soft Cast applied to the right foot. Average peak and mean plantar pressure measurements were recorded for ten discrete areas (masks). The heel and midfoot were each divided into two masks, and the forefoot and toe regions were divided into three masks each. Paired t tests were used to detect differences in peak and mean plantar pressures for each mask. Results: Soft Cast significantly affected peak and mean plantar pressures in seven and nine of the ten masks, respectively. No significant change in peak or mean plantar pressure was found beneath the medial midfoot. Conclusion: Plantar pressure may represent dynamic foot and ankle joint motion. With further research, Soft Cast may provide an alternative to current management techniques in controlling foot pronation and reducing symptoms of lower-limb abnormalities

Preparing occupational therapy and physiotherapy students for work-related practice : a clinical education initiative at one Australian university

Purpose: Despite increasing numbers of novice occupational therapists (OTs) and physiotherapists (PTs) entering work-related practice since the early 2000s, clinical learning opportunities are often limited due to legal and insurance issues. In response, clinical educators at The University of Queensland, Australia, developed an industry consultancy service to provide clinical learning for students in this field. Students delivered injury prevention services with supervision from experienced educators. This paper describes the program and an evaluation of student learning. Method: Twenty-six students (10 OTs and 16 PTs) participated voluntarily in an evaluation of the program during 2008 and 2009. Surveys pre and post-placement included open and closed questions that sought students’ knowledge of work-related practice and perceptions of practitioner roles. Knowledge was assessed with 20 questions on work-related practice. Differences in knowledge before and after the placement were analysed with non-parametric statistics. Open ended responses were subject to manual thematic analysis. Results: Students demonstrated a good understanding of the roles and tasks undertaken by practitioners in this field pre-placement. Their knowledge of work-related practice significantly increased following the placement (p<0.05). Half of the students reported that their expectations for the placement had been met. Open ended responses provided students’ perceptions of the program, both positive and negative. Conclusions: This clinical learning experience in work-related practice for OT and PT students provided a novel practical experience. Students demonstrated a good understanding of professional roles in the field and post-placement increased their understanding of work-related practice. The model provided a valuable method that ensures OT and PT students experienced work-related practice prior to graduation

A double-blind placebo-controlled investigation into the effects of interferential therapy on experimentally induced pain using a cross-over design

Objectives: To investigate the analgesic effect of interferential therapy (IFT) on experimentally induced anterior knee pain. Methods: A double-blind placebo-controlled investigation was undertaken on 10 healthy subjects. Anterior knee pain was induced by an injection of hypertonic saline into the medial infrapatellar fat pad. Immediately, following the injection, subjects received 20 minutes of each of the following conditions: control, placebo IFT, 4 Hz IFT, or 100 Hz IFT, in random order on four separate days. Pain severity and the size of the painful region every 30 seconds were recorded until pain ceased. The location of the pain was recorded at 2, 7, and 12 minutes after the painful injection using a standardized figure of the knee divided into nine segments. Results: There was no effect of condition on pain severity, size of painful area, maximum reported pain severity, maximum size of painful area, duration of pain, total pain severity, and the total size of the painful area (all P > 0.09). There was no interaction between time and condition on pain severity and size of painful area (P > 0.05). However, the location of pain was more dispersed at 7 minutes in the control condition (8/9 segments) compared with the placebo, 4 and 100 Hz conditions (2/9, 1/9, and 3/9 segments, respectively). Discussion: This preliminary study indicates that IFT is not effective at reducing acute experimentally induced pain when the severity or size of the painful area is measured. However, IFT may be effective by limiting pain spreading from the source. Further research with a larger sample size is required

The effect of whole body vibration in common neurological conditions : a systematic review

Background: Whole body vibration (WBV) is a new therapeutic tool used to improve muscle strength, power and postural control in various healthy and pathological populations. Aim: The aim of this systematic review was to summarise and evaluate the available literature on the effectiveness of WBV in neurological conditions. Method: A systematic review of the literature was performed to identify randomised controlled trials (RCTs) examining the effect of WBV on common neurological conditions. The methodological quality of the studies was systematically assessed using the PEDro rating scale. Reported outcomes were assessed for differences between the experimental and control groups and effect sizes were calculated. Results: Five RCTs and two pseudo RCTs were included. Methodological scores ranged from 1 to 9 (maximum 11) with a mean score of 5.71 (SD 2.69). There is weak to moderate evidence for positive effects on postural control, mobility, motor function and strength following the single application of WBV in neurological populations. A paucity of available literature into repeated WBV training prevents the drawing of firm conclusions regarding long-term treatment effectiveness. Conclusion: Despite being a new technique, there is early evidence that WBV applied to neurological populations has positive effects on postural control, mobility, motor function and strength. Further studies into the effectiveness of WBV in neurological populations are warranted

The long-term effectiveness of pain management programs : a systematic review and meta-analysis

The short-term efficacy of pain management programs (PMPs) is well established. However, their ability to demonstrate long-term benefits for people with chronic pain remains a key question for both the application and evolution of PMPs. Objective: To evaluate the long-term treatment gains of pain management program (PMP) interventions on self-efficacy, catastrophic thinking, and pain perceptions in patients with chronic pain. Methods: Electronic databases, key journals and reference lists of included studies were scrutinized for inclusion. The search process revealed a total of eleven studies for inclusion. Assessment of study quality was made based on length of follow-up period, the validity of measures used and information regarding the intervention. Results: Six studies included a 12 month follow-up, four studies included a 6 month follow-up, and a single study included a 9 month follow-up. Meta-analyses revealed treatment gains across pain perceptions are maintained at 12 months post-treatment. However, gains in self-efficacy significantly decreased at 12 months follow-up. There were significant improvements in pain-perception, self-efficacy and pain perceptions at 6 month follow-up compared to baseline. Conclusion: The review provides some support for the long-term efficacy of PMP interventions. There is a need for pragmatically designed follow-up studies to measure the long-term efficacy of PMPs on psychological variables, especially self-efficacy. Further research is warranted into the observed loss in treatment gains in self-efficacy over time; booster sessions delivered at 6 months post-treatment aimed at enhancing self-efficacy may help aid self-management of chronic pain