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One column of individual professional ethics teachings is the World Physiotherapy’s Code of Ethics, which the practitioners of all member countries are expected to comply with. An understanding of ethical practice internationally and its challenges for physiotherapists to translate it into their daily work is needed to inform how all physiotherapists can best be equipped to be moral agents in the context of their practice and society. In this project we aimed to understand the type and frequency of ethical situations encountered by physiotherapists from all World Physiotherapy regions, and what participant factors predict the frequency of experiencing ethical issues in different contexts. We investigated all five World Physiotherapy regions. In this presentation we will focus on the results for the European region.

Intelligent Speed Assistance also referred to as Adaptation (ISA) is to be fitted to all new cars sold in Europe from 2022. The system aims to reduce road casualties by automatically limiting the maximum speed of the car to the speed limit. However, it is possible to override the ISA system by firmly pressing the accelerator or by switching the system off at the start of a journey. This study seeks to identify relationships between a driver’s level of impulsivity and their willingness to override the system. The study will also explore correlations between the ISA use and their personality (as measured in the Big Five Personality Dimensions) and their driving attitudes and behaviours.

Erhebung von Art und Häufigkeit ethischer Situationen, die PT international erleben, sowie ob Ethikkodizes (EK) und Ethische Entscheidungskonzepte (EEK) in der Grundausbildung/studium gelehrt wurden.

Additional file 2: Appendix 2. Variables (units) used in regression analysis. Table showing coding of variables (units) used in regression analyses.

Additional file 1: Appendix 1. Survey questionnaire. Text of questionnaire included in the online survey.

Sheep welfare is an emerging topic in research and food marketing, and recent studies suggest that farm labour is a key factor for both animal welfare and productivity in extensive sheep farming systems, although little research has been done into labour utilisation in these systems. This paper reports field data collection on two commercial farms and the use of a linear programming (LP) model to link labour economics and animal welfare analysis. The model maximises the number of ewes to clooked after over the lambing period, when constrained by labour availability for various key tasks and by a pre-determined level of sheep welfare. The results show a trade-off between welfare level and labour input per sheep. Dropping tasks with less significant welfare and productivity consequences is an effective way of increasing carrying capacity (from 977 ewes/shepherd to 1428), as is working longer hours (1174 ewes/shepherd) or only doing the legal minimum of welfare checking (labour reduced from 0.68 min/ewe to 0.44 min/ewe) . The field data suggest that farmers currently provide high welfare, and that, despite much time spent away from the flock (e.g. driving), they spend a large amount of time (39% of total) with their sheep.

Coconut-based intercropping (CBI) in Sri Lanka was introduced some 20 years ago to overcome the two main limitations of traditional coconut monocropping, inefficient land use and low incomes to farmers, but it has not been widely adopted. This study analyses the effect of farm-level resource constraints, and government policies on the intensity of adoption of CBI. A multiperiod linear programming (MLP) model was applied for three farmer groups - resource poor, medium endowed, well endowed - categorised using cluster analysis. Data was collected from a survey of randomly selected 113 intercroppers. Empirical results reveal that expansion of CBI is mainly constrained by seasonal labour shortages for all farmer groups, particularly the well endowed, and by the scarcity of cash in the case of resource-poor farmers. CBI policies aimed at subsidising inputs or intercrop prices are not likely to be efficient in raising adoption, but alternative policies aimed at alleviating resource constraints would be more effective. The study concluded that the low adoption of CBI is mainly attributable to the scarcity of different farm-level resources (other than land), at varying degrees among different farmer groups. Hence a targeted approach to alleviate them is suggested.

The management accounts in Farm Account Scheme (FAS) format of two Scottish farms in Organic conversion are examined and compared to Scottish average data. Farm 1 is a family run mixed farm with cereals, seed potatoes, cattle and sheep. Conversion has been phased with conversion ground in grass and set-aside, while cereals and potatoes have been grown conventionally until they could be grown organically. Cereal area was reduced so that livestock numbers and potato area could be maintained. The phased conversion plus organic aid payments has maintained the above average profitability although good prices for organic malting barley and seed potatoes have helped but these premiums may not be maintained. Farm 2 is an all grass dairy farm with two 150 cow pedigree Holstein herds on a high input high output system now 9 months into conversion. The two herds were reduced and merged on to one site to form one 200 cow herd. This released capital and labour was reduced by one man saving fixed costs, while yield per cow increased with only the grass in conversion. The challenge will be to maintain yield and profitability on organic feeds. The results to date show that with organic aid and careful planning of conversion and structural changes profitability can be maintained.

The gross and net margins for a representative sample of 53 Scottish potato producers classed as "Seed" (>80% of area grown for seed), "Ware" (>80% of area grown for Ware) and "Mixed" for the rest were obtained for the 1999 growing season according to the methodology of MAFF (1990,1999). The farms were arable. Yields were average but for seed growers for whom tuber number in the seed size is more important. Prices were the lowest for six years variable costs were high and gross margins are above the best for cereals. However fixed costs excluding seasonally rented land are considerable leaving negative net margins. Potato price fluctuates widely. Prices were high in 1998. Applying these prices to the 1999 data left good net margins. Average prices still left reasonable net margins. Break-even prices were £85/t for ware and £200/t for seed, which were not reached in three of the last six years. These results show the considerable investment in both fixed and variable costs and risk for this important Scottish crop.

Refereed/Peer-reviewed Introduction: Different cultures and societal structures influence the ethical experiences of physiotherapists. Objective: The study aimed to discover and describe contextual shades of ethical situations experienced by physiotherapists in their global practice. Methods: This paper reports the qualitative analysis of responses to an optional open question in an internationally distributed online survey (ESPI study) with 1,212 participants from 94 countries. All responses were coded to five categories describing the data’s relationship to the survey list of ethical situations. Data that described new ethical situations were analyzed thematically. Results: Three hundred and fifty four individual responses to the optional survey question reported400 ethical issues. Three hundred and seventy-eight of these issues were associated with the original survey questions. Twenty-two responses raised four new themes of ethical issues: lack of regulatory and/or accreditation policy and infrastructure, lack of recognition of the role and position of physiotherapists in healthcare, economic factors driving the conduct of practice, and political threats. Discussion: Local contexts and pressures of workplaces and societies in which physiotherapists practice make it almost impossible for some practitioners to comply with codes of ethics. Physiotherapists need support and preparation to respond to local affordances and the complexity, ambiguity, and sometimes messiness of ethical situations encountered in their practice. Conclusion: The findings highlight the relevance of cross-cultural research in the field of physiotherapy, and the necessity of investigating and bridging the gap between professional ethics theory and practice in diverse settings.

BackgroundLittle is known about the ethical situations which physiotherapists encounter internationally. This lack of knowledge impedes the ability of the profession to prepare and support physiotherapists in all world regions in their ethical practice. The purpose of the study was to answer the following research questions: What types of ethical issues are experienced by physiotherapists internationally? How frequently are ethical issues experienced by physiotherapists internationally? Can the frequency and type of ethical issue experienced by physiotherapists be predicted by sociodemographic, educational or vocational variables?MethodsAn observational study was conducted in English using an online survey from October 2018 to May 2019. Participants were 1212 physiotherapists and physiotherapy students located internationally which represented less than 1% of estimated number of physiotherapists worldwide at that time. The survey questionnaire contained 13 items requesting demographic detail and knowledge of ethical codes and decision-making, and 46 items asking what frequency participants experienced specific ethical issues in four categories: (A) Physiotherapist and patient interaction (19 items), (B) Physiotherapist and other health professionals including other physiotherapists (10 items), (C) Physiotherapists and the system (5 items) and (D) Professional and economic ethical situations (12 items).ResultsThe two most frequently experienced ethical issues were ‘Scarce resources and time affecting quality of physiotherapy treatment’ and ‘Physiotherapy not accessible to all people in society who need it’. These items were experienced, on average, more often than monthly. Interprofessional practice also presented frequent ethical issues for participants. Ethical issues related to the context of ‘Physiotherapists and the system’ were most frequently experienced for all world regions. Working longer years in physiotherapy and learning about ethics in basic physiotherapy education was associated with participants reporting lower frequencies of ethical issues across all contexts.ConclusionThis study provides the first global profile of ethical issues experienced by physiotherapists. Societal and cultural systems are key influences on physiotherapists’ ethical practice. Physiotherapists globally need support from their work organisations, academic institutions and professional associations, and robust ethical training, to assist them to be active moral agents in their practice.

Introduction Early career occupational therapists experience considerable learning. This research sought to develop a theory of how they learn once practising. Method The research employed a constructivist grounded theory methodology. Interviews were conducted with 20 participants who were either experienced ( n = 8), early career occupational therapists ( n = 10) or in supporting roles for early career occupational therapists ( n = 2). Participants were asked their views about what early career occupational therapists find troublesome and how they respond. Data were collected and analysed concurrently. Open, focused and theoretical coding were used to develop a theory. Findings The theory of learning-to-practise occupational therapy included four learning thresholds: consolidating professional reasoning; navigating into the workplace; building competence and confidence; and developing a personal theory and practise style. There were 11 strategies identified that early career occupational therapists use to cross the learning thresholds. Early career occupational therapists’ understanding and value of knowledge shifted, which culminated in them ‘realising’ their personal theory and practice style. They refined their values and beliefs and learned to be more deliberate and reflective in their thinking and actions. Conclusion Early career occupational therapists were challenged, which promoted learning. This research extends understanding of the learning needs, thinking and actions taken by early career occupational therapists to cross learning thresholds and to develop their personal theory and practice style.

The profile and reach of physiotherapy has expanded in areas of extended scope of practice, and broader engagement with population needs beyond the individual treatment encounter. These changes raise increasingly complex ethical challenges evidenced by growth in physiotherapy-based ethics studies and discussions. This paper examines how a broad cross section of Australian physiotherapists perceive, interpret, and respond to ethical challenges in their work contexts and how professional codes of conduct are used in their practice. Using an interpretive qualitative methodology, purposive sampling of 88 members of national clinical special interest groups were recruited for focus group discussions. Narrative-based and thematic data analysis identified ethical challenges as emerging from specific clinical contexts, and influenced by health organizations, funding policies, workplace relationships, and individually held perspectives. Five themes were developed to represent these findings: (1) the working environment, (2) balancing diverse needs and expectation, (3) defining ethics, (4) striving to act ethically, and (5) talking about ethics. The results portray a diverse and complex ethical landscape where therapists encounter and grapple with ethical questions emerging from the impact of funding models and policies affecting clinical work, expanding boundaries and scope of practice and changing professional roles and relationships. Codes of conduct were described as foundational ethical knowledge but not always helpful for “in the moment” ethical decision-making. Based on this research, we suggest how codes of conduct, educators, and professional associations could cultivate and nurture ethics capability in physiotherapy practitioners for these contemporary challenges. Refereed/Peer-reviewed

Introduction Information about challenges for occupational therapists is typically provided in small-scale studies from different perspectives. The purpose of this meta-synthesis was to synthesise and report about challenges in occupational therapy practice that appear to penetrate across the profession. Method Databases searched were Ovid Medline, EMBASE, AMED and CINAHL. Search terms were selected after gaining understanding of the topic: occupational therap* AND Exp burnout / OR Exp morals / OR retention OR clinical reasoning OR new graduate OR novice OR transition-to-practice. Studies were critically appraised using the criteria of credibility, transferability, confirmability and dependability. Findings, along with direct quotes, were extracted and data compared and contrasted through first, second and third order analysis. Findings Twenty-four studies were included in the meta-synthesis and three constructs were identified: ‘challenges in context’; ‘personal challenges’ and ‘social and cultural challenges’. These findings inform knowledge about constraining factors on clinical reasoning and the alignment of practice with the occupational therapy philosophy, and give insight into satisfaction with practice, ethical and professional behaviours. Conclusion These findings could inform provision of professional support, education for students and enhance agency to reform practice. More research is needed about professional socialisation, clinical reasoning and ethical issues.

usc Refereed/Peer-reviewed There is an ethical landscape associated with the understanding and management of the person with chronic pain, which spans a range of structural, policy, educational and clinical issues. This ethical landscape has normative (what one ought to do...) and non-normative (what one actually does...) terrains. Healthcare providers and patients alike encounter a moral tension between these normative and non-normative ethical terrains. This moral tension, if unrecognized and unresolved, can have damaging effects on a person's sense of 'self', sense of agency and therefore their ability to effectively participate in actions and activities required towards better health. The Ethical Reasoning Bridge is an ethical reasoning model that conceptualizes how healthcare providers can negotiate this normative and non-normative ethical landscape in terms of their decision-making in clinical practice. The use of narrative reasoning can assist healthcare providers to support patients to develop narrative capabilities (speaking, acting, telling and imputing personal responsibility for actions). If healthcare providers can learn to negotiate the normative and non-normative ethical terrains which form the landscape of chronic pain ethics, we can assist persons with chronic pain to develop narrative capabilities, and also identify 'a wider moral space' (Kleinman in What really matters: living a moral life amidst uncertainty and danger. Oxford University Press, Oxford, 2006) in which they can begin to resolve the moral dilemma they face in having to comply with the normative expectations of others at the cost of denying their own lived experience.

Background: Physical therapists must have skills in moral reasoning (the ability to analyze ethical situations in order to determine a right action). The cognitive developmental perspective initiated by Kohlberg and developed by James Rest and associates proposes that moral reasoning progresses in stages or schemas (default frameworks for determining a right course of action) with periods of transition or consolidation between schemas. The purpose of this research was to evaluate changes among physical therapy students in moral reasoning and organization of ethical knowledge following an intensive 6-week ethics course focused on transformative learning, self-knowledge/reflection, relationships between ethical and clinical knowledge, and responding to ethical disequilibrium. This paper focuses on evaluating changes in moral reasoning from the cognitive developmental perspective using the Defining Issue Test (DIT2). The DIT2 evaluates the proportion of moral reasoning that an individual uses in three schemas (personal interest, maintaining norms, post-conventional) with a focus on the shift to post-conventional reasoning. Methods: A pre-test-post-test design was used to evaluate changes in moral reasoning schema. Results: Of the 54 final year physiotherapy students invited to participate, 37 students completed all portions of the research, a usable response rate of 68.5%. The resulting sample was predominantly female (59.5%, n522) with a mean age of 24.2 years. Paired t-tests were not significant for changes in personal interest or maintaining norms, but were significant for changes in post-conventional reasoning. Discussion: Results indicate that an intensive ethics course can be successful in producing changes in post-conventional moral reasoning among physical therapy students. Refereed/Peer-reviewed

This is the second of 2 companion articles in this issue. The first article explored the clinical and ethical implications of new emphases in physical therapy codes of conduct reflecting the growing evidence regarding the importance of social determinants of health, epidemiological trends for health service delivery, and the enhanced participation of physical therapists in shaping health care reform in a number of international contexts. The first article was theoretically oriented and proposed that a re-thinking of ethical frameworks expressed in codes of ethics could both inform and underpin practical strategies for working in primary health care. A review of the ethical principle of "justice", which, arguably, remains the least consensually understood and developed principle in the ethics literature of physical therapy, was provided, and a more recent perspective-the capability approach to justice-was discussed. The current article proposes a clinical and ethical decision-making framework, the ethical reasoning bridge (ER bridge), which can be used to assist physical therapy practitioners to: (1) understand and implement the capability approach to justice at a clinical level; (2) reflect on and evaluate both the fairness and influence of beliefs, perspectives, and context affecting health and disability through a process of "wide reflective equilibrium" and assist patients to do this as well; and (3) nurture the development of moral agency, in partnership with patients, through a transformative learning process manifest in a mutual "crossing" and "re-crossing" of the ER bridge. It is proposed that the development and exercise of moral agency represent an enacted justice that is the result of a shared reasoning and learning experience on the part of both therapists and patients. Refereed/Peer-reviewed

In this paper, we present findings from literature which suggests an intrinsic relationship in patients with chronic pain between the development of rigid and limited perspectives based on the interpretation of experience and the development of decreased repertoires of movement patterns. We present a research-based clinical reasoning model for conceptualising the teaching of movement for patients with chronic pain and contend that therapists can intentionally teach movement using fundamentally different reasoning and learning processes. We propose that these different kinds of learning will assist clinicians to translate the findings of diverse and complex pain research to clinical practice and, in particular, the teaching of these patients both new perspectives and movement patterns.

Most physiotherapists would agree on the need to establish effective working relationships with their patients in order to achieve successful outcomes in therapy. Collaboration, as an entity in clinical practice, has continued to increase in importance due to a changing climate of healthcare. Traditional models of physiotherapy treatment based on the medical model and delivered in acute settings are giving way to newer models of practice, such as health promotion, that are patient or client centred and increasingly located in community settings. At the same time, the notion of patient compliance with physiotherapy advice and exercises, deriving from a medical model of practice, is being superseded by the notion of collaborative decision making (or reasoning) in physiotherapy. Recent physiotherapy literature suggests that collaborative decision making is an advanced clinical skill, while also casting doubt on just how well or consistently physiotherapists are able to set goals with their patients and nurtu...

Pain is a complex problem and one that confronts many physiotherapists' working in private practice on a daily basis. While physiotherapists' understanding of pain has matured a great deal in recent times, especially the role of psychosocial (PS) factors, it is unclear if and how, physiotherapists assess their patients' psychosocial status in clinical practice. The aim of this study was to explore private practice physiotherapists' assessment of patients' psychosocial status. A qualitative descriptive research design was used in this study. Participants were recruited through purposeful sampling and potential informants were invited to participate through letters or phone calls and data was collected via semi-structured interviews. Nine semi-structured interviews were conducted at the participants' workplaces. Data collection and analysis were conducted simultaneously and common concepts and themes were recognised, coded and grouped together into themes. Analysis of the data resulted in identification of various themes related to physiotherapists' assessment of patients' PS status. These themes relate to; physiotherapists capacity to conduct PS assessment, the barriers they face while conducting PS assessment and the suggestions they have provided to overcome these barriers. In general the physiotherapists' in this study demonstrated and acknowledged a poor understanding of the role of PS factors in their patients' clinical presentation. They were also unclear about the assessment of psychosocial factors. The barriers to assessment of psychosocial factors ranged from individual shortcomings to limitations in professional networks and time constraints. The most consistent barrier highlighted was participants' lack of formal education in PS theory and assessment. Refereed/Peer-reviewed

Background There has been a widespread call for an ethics in the management of patients with chronic pain which is patient centered and takes into account the lived experience of the patient. It has been argued in literature that current “duty” or principlist-based models of ethics (so-called 3rd person ethics) have not adequately addressed the needs of either patients or practitioners in this area. Method Two strands of literature within phenomenology were reviewed: the literature of interpretative phenomenological analysis and the study of the lived experience of the person with chronic pain; and the contribution of phenomenology in neo-Aristotelian virtue ethics (1st person ethics). Findings Patients experience chronic pain in existential and moral terms in addition to their biomedical issues, facing dilemmas in understanding their own self-identity and in attempting to recover a sense of moral worth and agency. Discussion We outline a patient-centered ethics to underpin contemporary collaborative, multimodal approaches in the management of chronic pain. We firstly describe an agency-oriented, neo-Aristotelian 1st person ethics and then outline a hermeneutic relationship with extant “duty-based,” 3rd person bioethics. The utility of the ethics model we propose (the ethical reasoning bridge) lies in its capacity for developing a sense of moral agency for both practitioner and patient, resonating with the current emphasis of seeking active engagement of patients in management.

The aim of this article is to explore factors that impacted learning of Afghan physiotherapists in a development project to improve the physiotherapy services in a disability programme implemented by a Swedish nongovernmental organisation in Afghanistan. Participant observation, recorded as field notes, was used to document the process, to gain a better understanding of professional development of physiotherapists in Afghanistan. Field notes were analysed and factors affecting learning were interpreted from a perspective inspired by transformative learning. Various factors were identified: a pattern approach to treatment, linear thinking, and socially oriented decision making affected how new things learned were put into practice; concrete representations and an instrumental view of knowledge characterised learning approaches; language barriers, different interpretations of meaning, and cultural codes challenged communication; and a prescriptive, encouraging approach of the expatriate physiotherapy development worker affected teaching and learning. Working with professional development across cultural borders is challenging, and the identified factors impacting learning can help expatriate physiotherapists in adapting training to the Afghan context. Exploring meaning perspectives and communicative learning could enhance understanding of these factors for both expatriate and Afghan physiotherapists and should be a focus in future development activities. Refereed/Peer-reviewed

Chronic conditions now provide the major disease and disability burden facing humanity. This development has necessitated a reorientation in the practice skills of health care professions away from hospital-based inpatient and outpatient care toward community-based management of patients with chronic conditions. Part of this reorientation toward community-based management of chronic conditions involves practitioners understanding and adoption of a concept of population health management based on appropriate theoretical models of health care. Drawing on recent studies of expertise in physiotherapy, this article proposes a clinical reasoning and decision-making framework to meet these challenges. The challenge of population and community-based management of chronic conditions also provides an opportunity for physiotherapists to further clarify a professional epistemology of practice that embraces the kinds of knowledge and clinical reasoning processes used in physiotherapy practice. Three case studies related to the management of chronic musculoskeletal pain in different populations are used to exemplify the range of epistemological perspectives that underpin community-based practice. They illustrate the link between conceptualizations of practice problems and knowledge sources that are used as a basis for clinical reasoning and decision making as practitioners are increasingly required to move between the clinic and the community. Refereed/Peer-reviewed

Invited Commentary on ‘Approaches to conflicts between treatment recommendations and patients’ decisions in Physiotherapy. A case study’, Poulis.In this case study of an elite football player, who ...