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Background The demand for physiotherapy clinical placements is rising which requires innovative approaches and an understanding of clinical placement models. Objective To determine physiotherapy student contribution to direct patient care activity during a collaborative clinical placement model. Secondary aims determined the impact of clinical area and clinical educator to student (CE:student) ratio and if a group of students could reach equivalent direct patient care activity of a junior or senior physiotherapist. Method Physiotherapy student, and junior and senior physiotherapist occasions of service (OOS) were collected from five Queensland Public Health Sector hospital information management systems from four physiotherapy clinical areas (i.e. cardiorespiratory, musculoskeletal, neurorehabilitation, and orthopedics). Number of days of clinical activity was recorded to provide average OOS/day. Results Across a 5-week clinical placement a group of physiotherapy students in a collaborative clinical placement model provided on average 10.6 OOS/day (95%CI 10.1-11.2). In three (75%) clinical areas, a group of students participating in higher CE:student ratios produced more OOS/day. Clinical area and CE:student ratio predicted 39% of the variance in student average OOS/day. On average a group of students reached the equivalent direct patient care activity of a junior and senior physiotherapist by week two of a 5-week clinical placement. Conclusion Physiotherapy students in a collaborative clinical placement model met or exceeded the direct patient care activity of a physiotherapist, irrespective of clinical area and CE:student ratio.

Background: Clinical placements offer students an opportunity to provide direct patient care and are essential to develop safe and effective practitioners. It is unknown what changes in direct patient care activities are required as students transition to graduate physiotherapists. Objective: To determine the change in direct patient care activity from physiotherapy student to new graduate. Methods: Five hospitals provided clinical activity data from 412 physiotherapy students and 50 new graduate physiotherapists working in four physiotherapy clinical areas. Main Outcome Measures: Percentage of day spent in direct patient care, average occasions of service (OOS) per day and average length of one OOS (LOOS) for physiotherapy students and new graduates. Results: Students spent less time during their day providing direct patient care (24%, 95% confidence interval (CI) 19 to 29), performed fewer OOS (4.4, 95%CI 4.0 to 4.8) and had longer LOOS (18 min, 95%CI 13 to 23) compared to new graduates. This was consistent across all clinical areas. Conclusions: Physiotherapy student caseload is half that of a new graduate physiotherapist, with students taking longer to complete an OOS. Given this disparity in workload, active stakeholder engagement is essential to implement strategies that support and optimize the transition from student to graduate.

Question(s)What is the impact of including an allied health assistant (AHA) role on physiotherapy service delivery in terms of service provision, scope of practice and skill mix changes in an acute respiratory service?DesignA pragmatic pre-post design study examined physiotherapy services across two three-month periods: current service delivery [P1] and current service delivery plus AHA [P2].Outcome measuresClinical and non-clinical activity contributing to physiotherapy services delivery quantified as number, type and duration (per day) of all staff activity, and categorised for skill level (AHA, junior, senior).ResultsOverall physiotherapy service delivery increased in P2 compared to P1 (n=4730 vs n=3048). Physiotherapists undertook fewer respiratory (p < 0.001) and exercise treatments (p < 0.001) but increased patient reviews for inpatients (p < 0.001) and at multidisciplinary clinics in P2 (56% vs 76%, p < 0.01). The AHA accounted for 20% of all service provision. AHA activity comprised mainly non-direct clinical care including oversight of respiratory equipment use (e.g. supply, set-up, cleaning, loan audits) and other patient related administrative tasks associated with delegation handovers, supervision and clinical documentation (72%) and delegated supervision of established respiratory (5%) and exercise treatments (10%) and delegated exercise tests (3%). The AHA completed most of the exercise tests (n = 25). AHA non-direct clinical tasks included departmental management activities such as statistics and ongoing training (11%). No adverse events were reported.ConclusionInclusion of an AHA in an acute respiratory care service changed physiotherapy service provision. The AHA completed delegated routine clinical and non-clinical tasks. Physiotherapists increased clinic activity and annual reviews. Including an AHA role offers safe and sustainable options for enhancing physiotherapy service provision in acute respiratory care services.

Background Increasing age, numbers, and complexity of care are potentially impacting physiotherapy service delivery for adults with cystic fibrosis (CF). Purpose This study aimed to describe physiotherapy service provision, scope of practice, and skill mix in a large tertiary adult CF center, and determine if services were meeting clinical practice recommendations. Methods A prospective cross-sectional study examined inpatient and outpatient physiotherapy care across a three-month period in a tertiary adult CF center. Physiotherapy services were described by number and skill level of physiotherapists, total hours of activity, and number, type, and duration of each physiotherapy activity. Results Twenty-two physiotherapists provided care. Respiratory (n = 1058, 38%), and exercise treatments (n = 338, 12%) were the most frequent. Exercise testing (n = 20, 1%), and detailed treatment reviews (n = 79, 3%) occurred infrequently. Time for research was limited. Junior physiotherapists undertook more exercise treatments per day (p < .01), with senior physiotherapists attending outpatient clinics (p < .01). Conclusion A large number of physiotherapists were involved in the delivery of services. Recommended respiratory and exercise treatments were frequently provided; however, other recommended activities occurred infrequently. The impact of increasing age, numbers of patients, and complexity of care may be contributing to demand exceeding supply for physiotherapy services. Future studies are required to determine innovative approaches to address the gaps in clinical practice recommendations.

Background: The transition from physiotherapy student to new graduate poses many challenges. In other health disciplines concerns have been raised about new graduate preparedness for practice.Objective: To explore the perspectives of new graduate and experienced physiotherapists on the transition from student to new graduate.Methods: Semi-structured interviews were conducted with 15 focus groups; nine new graduate groups and six experienced physiotherapist groups. Interviews were transcribed in preparation for thematic analysis whereby researchers examined transcripts independently and identified codes. Codes were compared and themes developed, discussed, and refined. Themes were reviewed by all authors.Results: Four themes emerged surrounding the transition from physiotherapy student to new graduate: 1) preparedness for practice; 2) protected practice; 3) independent and affirmation of practice; and 4) performance expectations. Both groups identified increased caseload volume and complexity were challenging, and that students were typically protected from realistic workloads. New graduates at times felt unprepared for their new roles and highlighted that coping with change in independence and managing expectations of themselves was difficult. Strategies identified that may assist the transition from student to new graduate included organizational, clinical placement experiences and building self-efficacy.Conclusions: Challenges are experienced during the transition from physiotherapy student to new graduate. To enhance this transition a multifactorial approach is required that includes all key stakeholders and strategically targets challenges associated with the student transition to new graduate.

Objective Pulmonary rehabilitation is recommended for people with chronic lung disease however access remains limited in rural and remote settings. The aim of this project was to explore the perspectives of rural and remote health care professionals regarding the establishment and delivery of pulmonary rehabilitation. Setting Rural (NSW) and remote (NT) Australian healthcare settings. Participants Health care professionals (n = 25) who attended a training program focussing on the delivery of pulmonary rehabilitation. Main outcome measure(s) Surveys with open written questions were completed by participants following the training program. Key informants also participated in face-to-face interviews. Thematic analysis was undertaken of data collected on participant opinions, attitudes and concerns regarding the establishment and delivery of pulmonary rehabilitation in their individual situation. Results Participating health care professionals (predominantly nurses and physiotherapists) identified a number of issues relating to establishing and delivering pulmonary rehabilitation; including staffing, time and case load constraints, patient and community attitudes, lack of professional knowledge and confidence and inability to ensure sustainability. The practicalities of delivering pulmonary rehabilitation, particularly exercise prescription and training, were also important concerns raised. Conclusions Lack of health care professional staffing, knowledge and confidence were reported to be factors impacting the establishment and delivery of pulmonary rehabilitation. This study has facilitated a greater understanding of the issues surrounding the establishment and delivery of pulmonary rehabilitation in rural and remote settings. Further research is required to investigate the contribution of health professional training and associated factors to improving the availability and delivery of pulmonary rehabilitation in rural and remote settings.