Exploring the role and skill set of physiotherapy clinical educators in work integrated learning

Clinical educators are under increasing pressures in the workplace to provide quality education of healthcare students within varying supervision frameworks. Along with facilitating the teaching of clinical skills, clinical educators play a support role for students and so require more than expert clinical abilities in their vital position linking institutions and the healthcare environment. Twelve physiotherapy clinical educators attended one of two focus groups exploring their opinions on the role and skill set of clinical educators in work-integrated learning (WIL).Clinical educators described their role, their skills, challenges they faced supporting the needs of students, as well as future training requirements. The focus group results highlighted the important role of soft skills in the clinical educator role. The development of this skill set is essential to ensure quality supervision through optimal interactions between clinical educators and students in WIL

The prevalence, characteristics, impact and management of headache in people with schizophrenia and schizoaffective disorder: A cross sectional cohort study

Headache is the most common pain problem reported by people with schizophrenia, with 12 month prevalence rates of around 50%. Despite this little research has been conducted into the characteristics, impact and management of headaches in this population. There is evidence to support the efficacy of physiotherapy treatment of cervicogenic headache and tension type headache and determining the prevalence, impact and current management of these types of headache was of particular interest. A pilot study was first undertaken to identify and refine an appropriate headache questionnaire, develop an algorithm to use for classification of headache and test the repeatability and reliability of using the algorithm to classify headache types. A previously validated questionnaire was identified and slightly modified for the mental health population. A two part algorithm, which utilized information from the questionnaire, was designed to classify headaches into cervicogenic (CGH), migraine (MH) or tension type (TTH) headache against the International Classification of Headache Disorder criteria. Participants whose headache characteristics did not enable them to be classified into one of these three categories were coded as Other Headache (OH) type. A convenience sample of 12 chronic headache suffers not currently receiving care for their headache completed the questionnaire on two occasions, separated by 6-weeks. On each occasion two independent reviewers used the algorithm to characterise the headache type. The algorithm was shown to have high inter rater reliability (weighted-κ=.827) and moderate test re-test reliability (weighted-κ=.636). A cross-sectional observational cohort study of people with schizophrenia or schizoaffective disorder was then undertaken to determine the prevalence, characteristics, impact and management of headache in this population. Using the validated headache questionnaire, data was collected about headache prevalence and characteristics from 100 consecutive people diagnosed with schizophrenia or schizoaffective disorder. Headaches were classified using the algorithm by two independent reviewers and any disagreement settled by consensus. Clinical information, demographic data and information on current management of headache was collected and questions from the SF-36 questionnaire were included to assess quality of life. Males made up 66% of the sample cohort. The mean age of participants was 38.8 years and on average participants had been diagnosed with schizophrenia or schizoaffective disorder for 14.6 years. The most common comorbid physical illness was diabetes. All participants were taking antipsychotic medication, with 66/100 people taking some form of medication that listed headache as a common or very common side effect. Twelve month prevalence of headache (57%) was slightly higher than in the general population (46%). The two reviewers demonstrated excellent agreement on headache classification (weighted-κ=.85). Prevalence of CGH (5%) and MH (18%) were comparable to the general population and TTH had a much lower prevalence (16%) than that found in the general population (42%). OH was the most prevalent (19%). When considering the whole population we found no evidence of a relationship between mental health clinical characteristics and the presence of headache. The presence of any headache was not related to inpatient/outpatient status (OR=2.07, 95% CI [0.92-4.68]), length of time from diagnosis of mental illness (OR=0.99, 95% CI [0.95-1.03])) or taking medication with a side effect of headache (OR=0.94, 95% CI [0.40-2.19]). Similarly, there was no relationship between clinical status and the individual specific headache types. These data suggest that the specific headache types are independent of the mental health problem. We did find an association between OH type and medication use (OR=0.32, 95% CI [0.11-0.90]) and inpatient/outpatient status (OR=5.76, 95% CI [1.74-19.07]), suggesting those whose headache is not classifiable using International Headache Society (IHS) criteria might be suffering from headache which is secondary to their mental health problems. A similar analysis was undertaken utilising only data from the headache population. These data suggest that there is a relationship between age and CGH (OR=1.14, 95% CI [1.01–1.29]), medication use and MH (OR=6.14, 95% CI [1.24-30.44]) and inpatient/outpatient status and TTH (OR=0.28, 95% CI [0.08-0.95]) when considering only those people who suffer from headache. The quality of life of headache sufferers in this cohort was lower than seen in healthy populations. Importantly, the frequency of headache was shown to be negatively correlated with Social Functioning (ρ=-.44, p\u3c.001), Bodily Pain (r=-.44, p\u3c.001) and Role Physical (ρ=-.32, p=.01), suggesting that headache may contribute to the reduced quality of life experienced by people with mental health problems. It was evident that very few people were receiving appropriate treatment for their headache. No participant with MH had been prescribed migraine specific medication and physiotherapy was not included in the management of headache of any participant with CHG or TTH. It is recommended that better education is provided for both patients and mental health workers about headache and its management as well as the role of physiotherapy in managing the physical health and mental wellbeing of people accessing mental health services

Undergraduate reflective journaling in work integrated learning: Is it relevant to professional practice?

This paper presents the research findings from a study reviewing graduates’ opinions on completing online reflective journaling tasks during work integrated learning as an undergraduate. The study was divided into two parts with an initial focus group conducted with six physiotherapy graduates seven months following graduation. Findings from the focus group guided the development of a questionnaire sent to graduates nine months after course completion. Results from both the focus group and questionnaire (n = 25) highlighted the benefits of online, structured, assessed reflective writing tasks. Graduates provided specific examples of their personal and professional development and perceived benefits from undertaking reflective journaling during work integrated learning. These findings may have application across a wide variety of tertiary courses of study with work integrated learning incorporated into curriculum

What are the top 10 physical activity research questions in schizophrenia?

Purpose: Research has only recently started to consider the applicability of physical activity (PA) for people with schizophrenia. Although there is increasing evidence for the benefits of physical activity, this population remains generally physically inactive and sedentary. The aim of the current study is to highlight 10 pertinent physical activity research questions in people with schizophrenia. Method: The International Organisation of Physical Therapy in Mental Health (IOPTMH) executed a consultation of its National Organisations (n=13) to identify the most salient questions relevant to guide clinical practice on physical activity in people with schizophrenia. Results: We identified the following 10 questions: (1) What are the benefits of physical activity for people with schizophrenia? (2) What are the mechanisms of the physical activity effects in people with schizophrenia? (3) What are the most prominent safety issues for physical activity prescription in people with schizophrenia? (4) What is the most optimal physical activity prescription for people with schizophrenia? (5) What are the key barriers for engaging people with schizophrenia in physical activity? (6) What are the most effective motivational interventions for physical activity adoption and maintenance in people with schizophrenia? (7) How do we translate physical activity research into clinical and community practice? (8) How can we ensure integration of physical therapists within the multidisciplinary mental health treatment team? (9) How can we prevent sedentary behaviour in people with schizophrenia? (10) What is the most appropriate physical activity assessment method in clinical practice? Conclusions: Addressing these questions is critical for developing evidence-based approaches for promoting and sustaining an active lifestyle in people with schizophrenia. Ultimately, achieving this will improve the quality of life of this population. Implications for Rehabilitation: · Investigation of behaviour change interventions for people with schizophrenia is critical · A low cost, easy to use, clinical, valid physical activity questionnaire is urgently needed

Student motivation to learn: Is self-belief the key to transition and first year performance in an undergraduate health professions program?

Background: Student motivation to learn has been undervalued to date though has been identified as an area influencing student success and retention at university. The transition into university has been highlighted as a key period affecting student outcomes as well as well-being. Early identification of those students at risk may assist the transition for many students moving into higher education. Previous research has identified the Motivation and Engagement Scale – University/College (MES-UC) as a valid instrument for measuring motivation to learn in physiotherapy students. The aim of this study was to determine the relationship between a student’s motivation to learn on entry into an undergraduate physiotherapy program and their performance through first year. The relationship of admissions scores, to motivation to learn on entry, were also considered, to determine any link between these measures. Methods: An observational longitudinal study was conducted on one cohort of undergraduate physiotherapy students commencing their studies in 2015 with a response rate of 67%. Correlations were performed between admission variables and Year 1 MES-UC scoring; and between Year 1 MES-UC scoring and subsequent academic performance across first year, taking into consideration gender and age. Results: Self-belief was identified as the key dimension of motivation influencing student success in the transition into university. Results identified the link between self-belief scores on entry and academic performance in first year, including grade point average and performance in six of nine courses. Courses where there was no significant relationship were identified as curriculum areas where students may be less motivated. There was a relationship between the admissions interview and MES-UC scoring, demonstrating a link between non-cognitive selection measures and student motivation to learn on entry into the program. Conclusion: Motivation to learn and specifically self-belief with learning, may be influential in the transition into higher education. Undertaking measures of academic motivation may be useful to determine student engagement with curriculum, through identifying any link between student self-belief and performance in specific courses. Changes to curriculum based on student motivation as well as targeting early those students with reduced self-belief may improve student success, psychosocial wellbeing and retention

Exploring the role and value of Pre-Clinical Experiences in a Physiotherapy program in the development of employability skills: a qualitative case series

First and second year undergraduate Physiotherapy students from The University of Notre Dame Australia complete 55 hours of Pre-Clinical Experience (PCE) in the first two years of the program in the lead up to formal clinical placements. Anecdotal evidence from providers has identified the preparedness of students for their formal clinical placements as a result of PCE, however no research has been conducted to date on the outcomes of these experiences as viewed by students. A case series of nine Physiotherapy students utilising focus group methods inclusive of Facebook feedback was employed to examine the experiences of Physiotherapy students and explore their thoughts on the role, outcomes and impact of PCE on their personal and professional development. Results demonstrated the value of early pre-clinical experiences in promoting ‘other’ personal skills including employability skills. Students valued the opportunity to liaise with professionals whilst also developing an appreciation of the relevance and context of prior learning undertaken at university, through the consolidation of foundational skills. This qualitative case series is a pilot study for a broader survey on the views of Physiotherapy students undertaking pre-clinical experiences during their program of study

What is the relevance of reflective practice in undergraduate e-portfolios to professional work practices?

Reflective practice is a graduate attribute that is typically difficult to assess and measure. Universities are increasingly turning to digital technology as a medium to support reflective skills. This is particularly relevant to undergraduate courses that incorporate professional field placements where students are off campus, including health professional courses. The aim of this study was to determine the relevance of reflective practice in undergraduate e-portfolios to current work practices of new graduate physiotherapists. Graduates (n=6) took part in a focus group which guided the development of a questionnaire sent to all 2010 physiotherapy graduates, addressing the use of e-portfolios and their impact on transition into the workforce. 42% (n=25) of graduates completed the questionnaire. The use of a structured framework for reflections, within the online medium, assisted to promote reflective practice. Graduates felt that they were more automatic in their reflections and resultant work practices, as a result of utilising assessed undergraduate e-portfolios. The future challenge for educators is to balance context, assessment and delivery of reflective practice tasks. E-portfolios are one medium that may assist with the development of reflective practice skills beyond graduation

Assessing WIL

This publication currently In Press (12 August 2014

Are there associations between physical activity, fatigue, sleep quality and pain in people with mental illness? A pilot study

Good mental health is imperative to well-being. Symptoms of fatigue, chronic pain and poor sleep are common in people with mental illness and contribute to substantial loss of functioning. Physical exercise interventions have shown to decrease these symptoms in a range of populations; however, their possible association with physical activity related to day-to-day functioning have not been explored in people hospitalized with severe mental illness. Inpatients (n = 4) of a metropolitan mental health facility were fitted with an Actiwatch, which collected physical activity and sleep measures for an anticipated 14-day data collection period. During this time, morning and evening pain and fatigue scores were collected on an 11-point numerical rating scale. Significant associations were found between morning pain and morning fatigue scores (β = −0.44, P = 0.023), morning pain and physical activity (β = 12.34, P = 0.042), and physical activity and evening pain scores (β = 0.20, P = 0.017). Fatigue tended towards interfering more with quality of life than did pain, but this was not significant (P = 0.07). This study provided preliminary data suggesting associations between pain and fatigue, and intensity of pain and physical activity levels. This information can be used to generate hypotheses for future clinical trials

Are there associations among physical activity, fatigue, sleep quality and pain in people with mental illness? A pilot study

Accessible summary Many people with mental health disorders experience fatigue, pain and poor sleep. In other patient groups, physical exercise has been shown to have positive effects on these symptoms. It is unknown whether day-to-day physical activity (not necessarily exercise) affects sleep quality or severity of pain or fatigue in those with mental illness. This study observed physical activity, sleep quality, pain and fatigue in four people hospitalized with severe mental illness. Significant associations were found between pain and fatigue severity in the morning, but not in the evening. A significant association was found between physical activity and morning and evening pain severity. No association was found between activity and fatigue. This is a preliminary study that may guide future investigations of the effect of physical activity and exercise on symptoms commonly experienced in people with mental illness. Abstract Good mental health is imperative to well-being. Symptoms of fatigue, chronic pain and poor sleep are common in people with mental illness and contribute to substantial loss of functioning. Physical exercise interventions have shown to decrease these symptoms in a range of populations; however, their possible association with physical activity related to day-to-day functioning have not been explored in people hospitalized with severe mental illness. Inpatients (n = 4) of a metropolitan mental health facility were fitted with an Actiwatch, which collected physical activity and sleep measures for an anticipated 14-day data collection period. During this time, morning and evening pain and fatigue scores were collected on an 11-point numerical rating scale. Significant associations were found between morning pain and morning fatigue scores (β = −0.44, P = 0.023), morning pain and physical activity (β = 12.34, P = 0.042), and physical activity and evening pain scores (β = 0.20, P = 0.017). Fatigue tended towards interfering more with quality of life than did pain, but this was not significant (P = 0.07). This study provided preliminary data suggesting associations between pain and fatigue, and intensity of pain and physical activity levels. This information can be used to generate hypotheses for future clinical trials