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Introduction: Our goal was to compare behavioral- and information-based interventions aimed at increasing prescription of inspiratory muscle training (IMT) for people with chronic obstructive pulmonary disease (COPD) by interdisciplinary teams during pulmonary rehabilitation (PR). Methods: Six hospital PR programs were randomly assigned to a "behavioral- or information-based intervention." Both interventions provided evidence supporting IMT and its prescription details. However, the behavioral-based intervention focused on barriers and challenges to IMT prescription informed by a nationwide survey and the theory of planned behavior (TPB). It included hands-on practice and content, in part, was driven by learners' questions. In contrast, the information-based intervention delivered information in a typical didactic education session followed by a demonstration and question period. It was supplemented with evidence-based research articles. The primary outcome was the change in prescription rate of IMT for COPD patients by determining the difference during the 6 months preceding compared to the 6 months during the interventions. Results: Sixty-one health professionals and 488 COPD outpatients within 6 PR programs participated. No COPD patients were prescribed IMT at any of the sites during the 6-month preintervention phase. The behavioral-based intervention resulted in an IMT prescription rate of 10.2% to people with COPD, whereas the information-based intervention resulted in no IMT prescriptions. Discussion: A behavioral-based intervention that is based on TPB and addresses challenges identified by health professionals is more effective than a traditional lecture approach to increase health professionals' prescription of IMT for patients with COPD.

Explores the integrative nature of problem-based curricula and describes a systematic process for content review in a problem-based curriculum. Utilizes consultation among students, faculty, and the clinical community. Delineates the advantages of this process. (DDR)

Outlines a contemporary interpretation of ethics which reinstates morality as a core component. Describes the educational philosophy of two programs in rehabilitation science where the ethics education component is being analyzed. Contains 16 references. (DDR)

In this article the author discusses why the application of ethical reasoning within the clinical practice of physical therapy is crucial to patient care. The author cites a report within the issue that uses respective analysis of physical therapy ethics knowledge to gain insight on how to apply a model of physical therapy ethics and discusses the purpose for codes of ethics. A response by the authors is included.

The article discusses the study which examined the interprofessional education and online learning at the Institute of Interprofessional Health Sciences Education (IIHSE). The modules incorporated a problem-based learning approach using patient scenarios as a stimulus for online student learning experiences and clinical decisions. The study provided encouragement for those interested in overcoming barriers by utilizing asynchronous on-line learning activities as a component of an IPE curriculum.

Healthcare professionals often encounter moral dilemmas in clinical practice that require increased responsibility and accountability for ethical decision-making. This paper reports the results of a 6-year longitudinal study that explored changes in moral judgement of five consecutive cohorts of occupational therapy (OT) and physical therapy (PT) students over the course of their professional training. The training programme included an ethics education component. The Defining Issues Test (DIT) developed at the University of Minnesota was used to measure moral judgement. A total of 548 students participated in the study. At entry into their professional training, the DIT scores of the OT and PT students were similar but higher overall than the norms established for college level students or for graduates from professional programmes in the DIT standardization sample. At the time of graduation, results showed no significant differences in moral judgement scores between males and females, their chosen programme of study (OT or PT), year of entry, or previous education. Comparing entry scores to exit scores from both programmes for 288 students who provided data at both times, we found that moral judgement scores increased significantly in both OT and PT students over the 2-year programme of study. No differences were found in scores across gender, programme, year of entry, or previous education. Implications are discussed for including a formal ethics education component in the curricula of all health professional training programmes. Recommendations for future research are outlined. [ABSTRACT FROM AUTHOR]

The purpose of this cross-cultural study was to compare the level of moral judgement between two groups of students over the period of their professional physical therapy educational programmes as measured by the Defining Issues Test (DIT). Students from two entry-level physical therapy programmes volunteered to participate. The DIT was completed at entry and exit of their respective programmes. DIT mean scores were compared usingancova controlling for age and grade point average. Thirty-eight female, second baccalaureate degree students of diverse religious backgrounds, living in a Western culture and 13 female, first baccalaureate degree students of Islamic religious backgrounds living in an Arabic culture participated. At both entry and exit of their programmes, students from the Western group scored significantly higher on the DIT than the Arabic group (average: 51.1 and 29.9 respectively, P < 0.001). An initial score difference was anticipated given the different levels of education between the groups. Over the period of their studies, the DIT scores of the Western group increased significantly while the scores of the Arabic group remained constant. The DIT appears to not measure moral judgement uniformly across cultures. The moral dilemmas are based in Western values and offer limited insight into Arabic, Muslim moral judgement. With increasingly diverse student populations, physical therapy programmes may need to re-examine the nature of moral judgement and adapt their curricula. [ABSTRACT FROM AUTHOR]

Summary: The purpose was to update an original systematic review to determine the effect of inspiratory muscle training (IMT) on inspiratory muscle strength and endurance, exercise capacity, dyspnea and quality of life for adults with chronic obstructive pulmonary disease (COPD). The original MEDLINE and CINAHL search to August 2003 was updated to January 2007 and EMBASE was searched from inception to January 2007. Randomized controlled trials, published in English, with adults with stable COPD, comparing IMT to sham IMT or no intervention, low versus high intensity IMT, and different modes of IMT were included. Nineteen of 274 articles in the original search met the inclusion criteria. The updated search revealed 17 additional articles; 6 met the inclusion criteria, all of which compared targeted, threshold or normocapneic hyperventilation IMT to sham IMT. An update of the sub-group analysis comparing IMT versus sham IMT was performed with 10 studies from original review and 6 from the update. Sixteen meta-analyses are reported. Results demonstrated significant improvements in inspiratory muscle strength (PImax, PImax % predicted, peak inspiratory flow rate), inspiratory muscle endurance (RMET, inspiratory threshold loading, MVV), exercise capacity (Vemax, Borg Score for Respiratory Effort, 6MWT), Transitional Dyspnea Index (focal score, functional impairment, magnitude of task, magnitude of effort), and the Chronic Respiratory Disease Questionnaire (quality of life). Results suggest that targeted, threshold or normocapneic hyperventilation IMT significantly increases inspiratory muscle strength and endurance, improves outcomes of exercise capacity and one measure of quality of life, and decreases dyspnea for adults with stable COPD. [Copyright &y& Elsevier]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: The purpose of this study was to conduct a systematic review to determine the effect of inspiratory muscle training (IMT) on inspiratory muscle strength and endurance, exercise capacity, dyspnea and quality of life for adults with chronic obstructive pulmonary disease (COPD). A systematic review of the literature was conducted according the Cochrane Collaboration protocol using Medline and CINAHL. Nineteen of 274 extracted articles met the inclusion criteria and addressed comparisons of interest which included: IMT versus sham; IMT versus no intervention; low- versus high-intensity IMT; and two different modes of IMT. Thirteen meta-analyses were reported. Results indicate that targeted resistive or threshold IMT was associated with significant improvements in some outcomes of inspiratory muscle strength (PImax (cm H2O)) and endurance (Inspiratory Threshold Loading (kPa)), exercise capacity (Borg Scale for Respiratory Effort (modified Borg scale), Work Rate maximum (Watts)), and dyspnea (Transition Dyspnea Index), whereas IMT without a target or not using threshold training did not show improvement in these variables. There was no conclusive evidence regarding quality of life measures. IMT is effective for adults with COPD when using threshold or targeted devices that control or provide a target for training intensity. [Copyright &y& Elsevier]

The identification and consideration of relevant ethical issues in clinical decision-making, and the education of health care professionals (HCPs) in these skills are key factors in providing quality health care. This qualitative study explores the way in which physical therapists (PTs) integrate ethical issues into clinical practice decisions and identifies ethical themes used by PTs. A purposive sample of eight PTs was asked to describe a recent ethically-based clinical decision. Transcribed interviews were coded and themes identified related to the following categories: 1) the integration of ethical issues in the clinical decision-making process, 2) patient welfare, 3) professional ethos of the PT, and 4) health care economics and business practices. Participants readily described clinical situations involving ethical issues but rarely identified specific conflicting ethical issues in their description. Ethical dilemmas were more frequently resolved when there were fewer emotional sequelae associated with the dilemma, and the PT had a clear understanding of professional ethos, valued patient autonomy, and explored a variety of alternative actions before implementing one. HCP students need to develop a clear professional ethos and an increased understanding of the economic factors that will present ethical issues in practice. [ABSTRACT FROM AUTHOR]

The purpose of this systematic review was to determine the effect of inspiratory muscle training (IMT) (alone or combined with exercise and/or pulmonary rehabilitation) compared to other rehabilitation interventions such as: exercise, education, other breathing techniques or exercise and/or pulmonary rehabilitation among adults with chronic obstructive pulmonary disease (COPD). A systematic review of the literature on IMT and COPD was conducted according to the Cochrane Collaboration protocol. Inclusion criteria for the review included randomized controlled trials, published in English, comparing IMT or combined IMT and exercise/pulmonary rehabilitation with other rehabilitation interventions such as general exercise, education, other breathing techniques or exercise/pulmonary rehabilitation among adults with COPD. 274 articles were retrieved, and 16 met the inclusion criteria. Seven meta-analyses were performed that compared targeted or threshold IMT to exercise (n = 3) or to education (n = 4). Results showed significant improvements in inspiratory muscle strength and endurance, and in the dyspnea scale on a quality of life measure, for participants in the IMT versus education group. In other instances where meta-analyses could not be performed, a qualitative review was performed. IMT results in improved inspiratory muscle strength and endurance compared to education. Further trials are required to investigate the effect of IMT (or combined IMT) compared to other rehabilitation inventions for outcomes such as dyspnea, exercise tolerance, and quality of life. [ABSTRACT FROM AUTHOR]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: This article summarizes the rationale, supporting evidence, and techniques used in training the inspiratory muscles in chronic obstructive pulmonary disease (COPD). Summary of Key Points: COPD is a progressive debilitating lung disease, often caused by smoking, that increases the work of breathing. Inspiratory muscle training (IMT) can alleviate dyspnea and improve exercise tolerance for people with this condition. Before devising a training program, the strength of the respiratory muscles needs to be evaluated by measuring maximal inspiratory pressure (PImax) and expiratory mouth pressure. In addition, inspiratory muscle endurance should be assessed by determining the maximal sustainable inspiratory mouth pressure for a specific endurance time or the maximal inspiratory threshold load that can be achieved during an incremental loading test. Evidence supports the beneficial effects of IMT when training is adequate in duration and frequency (30 minutes daily, 4 to 6 days per week), in mode (threshold or targeted resistive trainer), and in intensity (40 to 70% PImax). Supervision and monitoring are required during training to ensure that target training intensities are achieved, to evaluate patient tolerance, and to prevent CO2 retention, excessive fatigue, or exertion-induced inspiratory muscle injury. Conclusions: IMT may provide added benefit to pulmonary rehabilitation for individuals with COPD. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the ethical issues encountered by physical therapy students during a clinical placement. Fifty-six students in the third unit (semester) of an undergraduate physical therapy program wrote weekly entries in a journal during a 6-week clinical placement. For each entry, students were to describe an event, its value and their reaction to it, and to discuss new learning that occurred and how they would respond in the future. At the end of the clinical placement, three faculty members evaluated the journals qualitatively to determine the extent to which ethical issues were a component of student learning. Ethical issues were mentioned by 53 of the 56 students. Three major themes were identified: respect for the uniqueness of individuals (37 students), professionalism--responsibility and behavior as a member of the profession (25 students), and professional collegiality - interaction with and respect for health professionals (25 students). Minor themes included: allocation of resources; advocacy for client, society and/or health policy; and informed consent. Students frequently reported ethical issues in the clinical setting. These issues were predominantly related to the students' relationships with clients and co-workers and the exploration of their roles as emerging physical therapists. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effects of a 12-week home walking program on cardiovascular parameters, fatigue perception, and walking distance in persons with multiple sclerosis (MS)., Methods: Twelve ambulatory persons with MS, not currently participating in exercise were randomly assigned to control (C) or experimental groups (EX). Pretest data collection included resting HR, BP, fatigue perception (Fatigue Severity Scale), and 6-minute walk test. EX received a home walking program (30 min, 3 x week, x 12 weeks), using a modification of Karvonen's formula to calculate HR range. A HR monitor was used to adjust walking speed. The C group refrained from any regular exercise. Posttest data were collected at week 12 and analyzed using the Mann-Whitney U Test., Results: No statistically significant differences were noted between groups in any measured parameters; however, walking distance and Physiologic Cost Index did improve in the exercise group., Conclusion: No adverse events or increase in fatigue levels related to the exercise intervention were reported in this study. This home walking program may not be of sufficient intensity to elicit significant cardiovascular changes. Abnormal cardiac responses have been documented in this population, which may have affected the results. Clinicians may need to use alternate measures to assess fitness in this population.

Purpose: To determine the effect of inspiratory muscle training (IMT) (alone or combined with exercise and/or pulmonary rehabilitation) and compare with other rehabilitation interventions among adults with chronic obstructive pulmonary disease (COPD)., Methods: We conducted a systematic review, using Cochrane Collaboration protocol. We included randomized controlled trials, published in English, comparing IMT or combined IMT and exercise/pulmonary rehabilitation with other rehabilitation interventions among adults with COPD. Abstracts were reviewed independently by 2 investigators to determine study eligibility up to December 2005. Data were abstracted and methodological quality of included studies was assessed., Results: A total of 156 additional articles were retrieved. Two new studies met the inclusion criteria and were included with 16 studies in the original review. Results highlight updated subgroup analyses comparing (1) IMT versus exercise and (2) combined IMT and exercise versus exercise alone. Fourteen meta-analyses were performed for outcomes of inspiratory muscle strength, exercise tolerance, and quality of life. Results showed significant improvements in maximum inspiratory pressure and maximum exercise tidal volume favoring combined IMT and exercise compared with exercise alone., Conclusions: Performing a combination of IMT plus exercise may lead to significant improvements in inspiratory muscle strength and one outcome of exercise tolerance for individuals with COPD.