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There is a gap in research on how best to support exercise in moderate to severe MS. The objective of this study is to share perspectives of people living with MS and physiotherapists on their experiences in a randomized clinical trial of online physiotherapy vs. an active comparator. Semi-structured exit interviews were conducted with volunteer participants from the online and comparator arms of the trial, and focus groups were held with study physiotherapists. Transcripts were analyzed using reflexive thematic analysis. Perspectives from participants with MS yielded three themes: usability of their program, utility of their program, and motivation to participate. Visual and dexterity impairments limited the usability of the online program. Having an opportunity "to be pushed" was valued by participants in both trial arms. Motivation to exercise was variable, and participants desired periodic face-to-face contact with their physiotherapists. Perspectives from trial physiotherapists yielded similar and complementary findings concerning usability and utility. Participants with MS and physiotherapists found the online physiotherapy platform useful for supporting exercise, yet they identified some limitations. As the appeal of online platforms has increased since the pandemic, it will be important to consider the needs of people with moderate to severe MS. NCT03039400. People with moderate-to-severe MS and physiotherapists involved in a clinical trial found online physiotherapy useful for supporting exercise. Physiotherapists and participants using the online program desired improved platform accommodations for people living with MS with visual and dexterity impairments. Physiotherapists and people living with MS from both the online exercise program and comparator groups perceived a need for more face-to-face contact and opportunities to build therapeutic alliance. Perspectives from prescribing physiotherapists and people living with MS about supporting exercise online may have practice implications during and post-pandemic. [ABSTRACT FROM AUTHOR]

Fibromyalgia syndrome is a chronic musculoskeletal disorder characterised by widespread pain, sleep disturbance, headache, stiffness and fatigue. There are a number of potential detrimental factors on bone health in patients with fibromyalgia syndrome including immobility, depression, lack of sunlight and poor nutrition. In this article, the literature relating to fibromyalgia syndrome and bone health is reviewed, and evidence is provided for the potential role of physiotherapy in treating fibromyalgia and maintaining bone health. [ABSTRACT FROM AUTHOR]

Research on patient-centeredness within physiotherapy points to a need for clarification about what the concept entails in science and practice and how research positions itself within health care. Thus, the aim is to systematically map the characteristics of research on patient-centeredness in physiotherapy and critically discuss the dominant understandings within. A systematic research mapping was carried out, based on searches in leading bibliographic databases. Four categories were selected in order to characterize the research field: focus, design, theoretical approach and inherent logic. Of 5,324 studies, 101 were included in the final mapping, pointing to a limited amount of research. The papers included were published in 47 different journals. Two major research foci emerges: one testing or developing technologies (tools) to promote patient-centeredness and one exploring patients' or professionals' experiences related to physiotherapy practice. Most papers reported on empirical research and there seems to be a dearth of conceptual papers. The theoretical approaches applied were mainly psychological, pedagogical and biomedical. The papers included were divided into equal amounts of studies carried out within inherent logics of causality and complexity. The mapping suggests an incipient awareness of patient-centeredness within the research field of physiotherapy. Empirical studies dominate the field, whereas conceptual and critical papers seem in need of wider acknowledgment. The research field is divided into two mutually disconnected trends: one concerned with understanding the complexity of clinical practice and patients' experiences of treatment and illness, and another trend concerned with solving "the problem" of patient involvement. [ABSTRACT FROM AUTHOR]

To review the feasibility, acceptability, and effects of physiotherapy when delivered remotely. CINAHL, MEDLINE, EBM Reviews, and Cochrane Library databases (January 2015–February 2022) were searched and screened for papers (of any design) investigating remote physiotherapy. Data were extracted by two independent raters. Methodological quality of the identified papers was not assessed. Thematic content analysis drew out the key issues. Forty-one papers (including nine systemic reviews and six with meta-analyses) were selected involving musculoskeletal, stroke and neurological, pulmonary, and cardiac conditions. The most commonly delivered intervention was remote exercise provision, usually following assessment which was completed in-person. All studies, which assessed it, found that remote physiotherapy was comparably effective to in-person delivery at lower cost. Patient satisfaction was high, they found remote physiotherapy to be more accessible and convenient. It boosted confidence and motivation by reminding patients when and how to exercise but adherence was mixed. No adverse events were reported. Barriers related to access to the technology; technical problems and concerns about therapists' workload. Remote physiotherapy is safe, feasible, and acceptable to patients. Its effects are comparable with traditional care at lower cost. Remote physiotherapy is safe, feasible, and acceptable to patients with comparable effects to in-person care. Remote delivery increases access to physiotherapy especially for those who cannot travel to a treatment facility whether due to distance or disability. Remote physiotherapy may increase adherence to exercise by reminding patients when and how to exercise. Remote physiotherapy does not suit everyone, thus a hybrid system with both in-person and remote delivery may be most effective. [ABSTRACT FROM AUTHOR]

Purpose: Psychosocial factors are a barrier to recovery for people with musculoskeletal pain and psychosocial screening tools are consistently recommended by best practice guidelines to assist in identification. However, many physiotherapists do not use these tools. Presently, the perspectives on psychosocial screening tools of Australian physiotherapists are unknown. Exploration of these factors may create targets for increased uptake. The purpose of this paper is to qualitatively explore Australian physiotherapists' attitudes, perceptions, and behaviours towards psychosocial screening tools for musculoskeletal pain conditions. Materials and Methods: An Interpretive description qualitative study design was employed. Seventeen Australian physiotherapists were interviewed about their attitudes, perceptions, and behaviours towards psychosocial screening tools. Interviews were transcribed verbatim and analysed according to interpretive description. Results: Analysis highlighted three major themes: (1) understanding the patient through psychosocial screening, (2) confidence and competence with psychosocial factors, and (3) factors outside of my control influence screening. Conclusions: This study presents a deeper understanding of Australian physiotherapists' diverse attitudes and practices regarding psychosocial screening tools. The research highlights not only the variability in perspectives towards the relevance of psychosocial factors in patient assessments, but also the influence of external elements such as patient demographics and clinic culture on the utilization of these screening methods. IMPLICATIONS FOR REHABILITATION: Australian physiotherapists' varying attitudes and limited understanding of the impact of psychosocial factors may hinder the use of recommended psychosocial screening. Concerns about scope of practice, tool appropriateness for different patients, and clinic culture further challenge the integration of psychosocial assessments. The findings from this study indicate the need to provide more education to Australian physiotherapists on the importance and use of psychosocial risk factor screening, as part of clinical care standards and best practice guidelines in the management of patients, with musculoskeletal pain conditions. The findings from this study can support the creation of targeted training/innovations to improve the uptake of screening tools in Australian musculoskeletal clinical practice, to improve the care of patients with musculoskeletal pain conditions. [ABSTRACT FROM AUTHOR]

Purpose: The WHO emphasises that rehabilitation services must be integrated into primary healthcare as an inherent part of universal health coverage. However, there is limited research on the integration of rehabilitation services in primary healthcare in low- and middle-income countries. The purpose of this paper is to identify and describe the literature on service guidelines, models, and protocols that support the integration of rehabilitation services in primary healthcare in the BRICS countries (Brazil, Russia, India, China, and South Africa). Methods: A scoping review guided by Arksey and O'Malley's framework was conducted. Structured database and website searches identified published and unpublished records from 2010, which were subjected to eligibility criteria. Mendeley, JBI SUMARI, and Microsoft Excel were used to extract and synthesise the data. Results: The search strategy identified 542 records. Thirty-two records met the inclusion criteria. Shared care and community-based rehabilitation were the most reported practice models, and the implementation of the models, guidelines, and protocols was mostly described in mental health services. Conclusion: This review discusses BRICS countries' rehabilitation service guidelines, models, and protocols for primary healthcare integration and implementation challenges. Rehabilitation professionals should rethink, realign, and apply existing models because of the lack of primary healthcare integration directives. IMPLICATIONS FOR REHABILITATION: The integration of rehabilitation services in low-resourced and remote settings can be improved by involving community health workers and community rehabilitation workers in transdisciplinary teams. Peer support workers and community health workers can improve rehabilitation outcomes, particularly through shared care models that emphasize peer-to-peer learning, mentoring, and coaching. Self-management interventions can have a positive impact on functional outcomes. Integrated rehabilitation services in primary healthcare can be supported through community-based rehabilitation, which emphasises community involvement and engagement. [ABSTRACT FROM AUTHOR]

Recent marketing literature suggests that brand orientation is an alternative concept for the public health because it is believed to address the shortcomings of market orientation. Brand orientation is specifically of interest to the sector of healthcare, due to the complex nature of the sector. The purpose of the study described in this paper was to find out what the possibilities are of brand orientation for local healthcare providers. The study shows that brand orientation is relevant for physical therapy primary healthcare organizations (PTPHOs), but is not always adopted effectively. PTPHOs are strongly focused on the patient as the only stakeholder. A more powerful option would be to choose a brand positioning strategy for all relevant stakeholders. PTPHOs have to design integrated marketing activities to encourage consumers directly to use our products/services, and to encourage suppliers, distributors, and other key stakeholders to promote our products/services to consumers. In order to safeguard their role and position in the context of community care for the future, the PTPHO is challenged to become more active and more visible, and must collaborate more with other (healthcare) professionals in the community, broaden their services, and focus more on the (future) needs of the citizen. [ABSTRACT FROM AUTHOR]

Purpose: Post-stroke patients constitute a large group suffering from disabilities that require rehabilitation long after discharge. Quality indicators (QIs) that specify the minimum expected standard of quality in outpatient rehabilitation could contribute to the valuation of the effectiveness of rehabilitation on decision-makers, health professionals, patients, and relatives. This review aims to identify QIs focusing on physiotherapists' outpatient rehabilitation of stroke patients. Materials and methods: The databases Cinahl, Cochrane, Embase, PubMed, and Scopus were searched for publications, and the grey literature was also searched. Through a pragmatic appraisal and assessment with the modified AGREE II-QI instrument, relevant QIs were selected. Results: A total of 1129 papers were retrieved, and five papers presenting 91 QIs were included. Thirty-six QIs were considered relevant to physiotherapy in outpatient rehabilitation. The QIs cover structure, process, and outcome and concern basic mobility, spasticity, organisation and content of the training, patient-reported outcome measures, education of patients and relatives, and follow-up and goal setting. Conclusions: The study appraised 36 QIs relevant for outpatient rehabilitation of stroke survivors conducted by physiotherapists. A Delphi panel is required to develop the final set of QIs for physiotherapists and, subsequently, the development of a core set of multidisciplinary QIs. [ABSTRACT FROM AUTHOR]

In this paper, we draw on an example of heuristic inquiry – (Re)imagining becoming a physiotherapist: a phenomenological approach – to illustrate the role that reflexivity and representation can play in physiotherapy research outcomes and the meaning they might have for moving the profession forward. Qualitative research in physiotherapy tends to acknowledge reflexivity as a route to objectivity by making researcher biases overt, yet the debate about data representation (a researcher’s decision-making about how data are represented in a text) barely feature. This contrasts with qualitative research in other fields, including other health professions, where matters of representation (i.e., how knowledge is conveyed) are routinely debated and contested. Reflexivity, in fact, is much more than being transparent. Together with representation, reflexivity helps to position both the voices of participants and researchers within the research. The heuristic inquiry described in this paper offers new insights about learning to be a physiotherapist; it challenged assumptions about care in physiotherapy practice and it changed the first researcher’s identity and practice. These insights were generated through the synergies between reflexivity and representation, and we argue that physiotherapy research has an opportunity to be more expansive by taking a commitment to reflexivity and representation more seriously. [ABSTRACT FROM AUTHOR]

Several shifts in physiotherapy treatment of patients with rheumatoid arthritis (RA) have occurred over time. This paper aims to identify shifts in physiotherapy practice for patients with RA based on the author's work experiences from the 1980s until today at two Norwegian rheumatism hospitals, and to explore why shifts may have happened. A narrative was developed by describing events making a difference, categorizing, and ordering them with the help of narrative analysis and a sensitizing analytic lens on discourses. The storyline from the 1980s to approximately the turn of the millennium is called 'Shifts determined mainly by clinical context-driven events' which occurred in response to medical advances and physiotherapists' clinical experiences. These shifts were later justified by physiotherapists' research in the clinical context. The other storyline covers mainly the 2000s and is called 'Shifts increasingly determined by events beyond clinical physiotherapy context.' They include adjustments to further medical advances and implementation of biopsychosocial understanding of disease at the hospital, and to external research-based recommendations, health reforms, and economy. These processes have moved physiotherapy practice at the hospital from mainly providing individualized remedial and rehabilitative physiotherapy for the purpose to normalize physical function to an increasing focus on generic health measures for the purposes of health promotion and cardiovascular disease prevention. However, this shift may not fully match the complex needs presented by patients in disease remission with unrelenting fatigue and work inability and those who have multiple functional challenges and comorbidities. [ABSTRACT FROM AUTHOR]

Abstract\nPoints of interestAlthough critical disability studies has become more widely recognized within physiotherapy scholarship and education, ableism still profoundly influences and directs the physiotherapy profession. We draw from post-structural French philosopher Gilles Deleuze’s philosophy to highlight how ableism is bound up in the taken-for-granted assumptions of physiotherapy. We outline how ableism is entangled with the profession’s ontology and European notion of human. As a result, ableism is maintained by clinicians through the embodiment of the ideal species typical human, in both the domain of the mind and body. As it stands, to do physiotherapy necessitates ableism. Imagining physiotherapy otherwise, we set out to critique and unsettle the profession’s metaphysical presuppositions, creating the possibility for new generative avenues for physiotherapy. Deleuze’s ontology of difference provides the profession an alternative starting point which makes the notion of ‘normal’, and consequently ableism, unthinkable.This paper explores how physiotherapy’s foundational assumptions continue to uphold ableism.By imagining the profession as always in motion, we argue that bodies are understood as always changing.We demonstrate how French philosopher Gilles Deleuze’s philosophy might enable physiotherapy to escape its ableist history.By theorizing physiotherapy as always in motion, the possibilities of what clients and clinicians can do and become open upWe outline the utility of not assessing physiotherapeutic interventions as ‘Good’ or ‘Bad’ but by what they do and what possibilities they open up.This paper explores how physiotherapy’s foundational assumptions continue to uphold ableism.By imagining the profession as always in motion, we argue that bodies are understood as always changing.We demonstrate how French philosopher Gilles Deleuze’s philosophy might enable physiotherapy to escape its ableist history.By theorizing physiotherapy as always in motion, the possibilities of what clients and clinicians can do and become open upWe outline the utility of not assessing physiotherapeutic interventions as ‘Good’ or ‘Bad’ but by what they do and what possibilities they open up. [ABSTRACT FROM AUTHOR]

AbstractThere is a call to action for physiotherapists worldwide to contribute to the transition towards ‘sustainable health’. In this paper, we build upon the current definition of ‘sustainable health’ and also on ‘sustainable physical activity’ to introduce and theoretically substantiate the concept of sustainable human movements, and suggest a definition thereof. Sustainable human movements will be described as a threshold concept with three aligned critical concepts; (i) movement control, including forces as causes of emerging movements, (ii) movement quality, referring to how movements are performed in terms of optimisation, and (iii) physical literacy, including motivation, confidence and physical competence. A deep understanding of these concepts, combined with a collaboration and learning approach applied together with the patient, is proposed to enable a sustainable human movement approach to permeate physiotherapy theory and practice. To facilitate this, a generic and easily accessible tool has recently been developed. It combines support for structured observational movement analysis and pedagogical support for creating a mutual and extended understanding of a patient’s lived experience. This encourages the patient to become actively involved and take responsibility for promoting his/her ‘sustainable health’. The aims of this paper are to a) suggest a theoretical framework for and definition of the concept sustainable human movements, and b) introduce a clinical tool that ultimately aims at promoting sustainable movements and health. [ABSTRACT FROM AUTHOR]

This paper explores the nature of reflection that qualified physiotherapists use in their day-to-day practice. This is an area in which there is a dearth of research. With a grounded theory approach purposive sampling was used to recruit seven qualified physiotherapists for photo-elicitation interviews exploring whether they did reflect and if so, what their reflection was like. The findings were that they did reflect but that it occurred outside of working hours. Four conceptual categories were identified: Personal Concept, Personal Process, Time and Head-Space. Practitioners had their own ideas of what reflection was, own ways of reflecting and personal strategies for making the head space to reflect in. Typically, they used thinking modes of reflection, with occasional dialogical modes; written reflection was rare. Of novel significance was the use of strategies to complete reflection to their satisfaction, most frequently walking but also preparing vegetables, driving and showering, typically outside of work hours. The use of such cognitively non-demanding, routinised activities to aid reflection has not been widely explored in the literature on reflection and may suggest a need to rethink approaches to support the teaching of reflection which would have high validity for its place in the real world of practice. [ABSTRACT FROM AUTHOR]

Movement has always been central to physiotherapy practice and theory. But physiotherapists have largely focused on forms of human bodily movement governed by the neuro-mechanical body system in illness or injury. Many other forms of movement exist though, and we argue here that the exploration of these other movements might give physiotherapists new language, concepts, and tools, to guide its adaptation to forms of healthcare that are becoming increasingly complex, diverse, and inclusive. Drawing on Hannah Arendt's concept of vita activa (or "active life"), we examine how physiotherapists have traditionally captured and defined movement. Critiquing past practices for over-emphasizing what Arendt called labor, and work, we suggest that an approach governed by her concept of action, might offer physiotherapists a way to give movement greater significance. We explore what active life might mean for a revised approach to movement, and highlight examples of vita activa already emerging in physiotherapy. We close the paper by calling for a reevaluation of what movement means for the profession and its clients. [ABSTRACT FROM AUTHOR]

To summarise body awareness assessment tools and interventions relevant for stroke rehabilitation using a framework that categorises key body awareness constructs, disorders and impairments. Online electronic databases and trial registries were searched from inception until July 2021, in addition to hand searching reference lists of included studies and reviews. Study selection included any study design where the investigation involved assessing and/or intervening in body awareness following stroke. Data were extracted based on predefined criteria by two independent reviewers and mapped to the emergent framework. The final analysis included 144 papers that reported 43 assessment tools and 8 types of interventions for body awareness. Consensus was reached on a synthesised body awareness framework. This comprised specific impairments and disorders, constructs, sub-categories and main categories leading to the overarching term of body awareness. Clinical and psychometric properties of the assessment tools were not reported or poorly evaluated, and the interventions lacked robust study designs and rigorous methods. The framework produced will enable future research and clinical practice to be based on consistent concepts and definitions. Clinicians can also use this information to cautiously select assessment tools and/or interventions but are reminded of the limitations identified in this review. There is limited understanding, compounded by inconsistent terminology and definitions regarding body awareness after stroke. A synthesized framework to define key constructs and definitions of body awareness is proposed. Assessment tools and interventions reported in the literature are mapped to the proposed framework. Psychometric properties of available tools are reported. Significant work remains to refine concepts of body awareness, develop and evaluate assessment tools and interventions. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has resulted in a total of 676 million cases of infection and 6.9 million deaths. During a pandemic, healthcare workers are exposed to psychological stressors such as high risk of infection, inadequate protection, and isolation, which could have implications for their wellbeing. The purpose of this qualitative literature review carried out systematically was to examine the views of physiotherapists who worked with COVID-19 patients during the COVID-19 pandemic to identify how physiotherapy services might be better prepared for future pandemics. A systematic search was carried out across four databases (CINAHL, MEDLINE, PsycINFO, SPORTDISCUS) to identify relevant studies. Studies were assessed for quality and data extracted and analysed using thematic synthesis. A total of 631 studies were identified through the search strategy and screened against the inclusion/exclusion criteria. Six papers met the inclusion criteria. Four themes were identified from the perspective of the physiotherapy participants: lack of resources; emotional impact; coping strategies and integration; and value within the multidisciplinary team. Overall qualitative evidence around the views of physiotherapists who worked during the COVID-19 pandemic is limited. An insight into the views of participants may help healthcare organisations support physiotherapy services to be better prepared in the event of a future pandemic, specifically addressing the need to strengthen supply chains, advocating for physiotherapy as a profession in low-income counties and psychological resilience. Future research should focus on identifying the most effective support options and strategies to build psychological resilience before a crisis occurs. [ABSTRACT FROM AUTHOR]

Aims: To review systematically the literature pertaining to the physiotherapy management of patients with acetabular labral tear (ALT). Methodology: A systematic review was undertaken of the electronic databases: Medline, Embase, CINAHL, the Cochrane Library and Sports Discus. All literature pertaining to the objective of the study was included. Data was extracted and narratively analysed to answer the research question. The methodological quality of the literature was assessed using the Critical Appraisal Skills Programme (CASP) Systematic Review tools, whereas single case study papers were assessed using a specific single case study appraisal instrument. Major findings: Thirteen papers were included: two case series and 11 review/commentary papers. There was limited evidence for the use of pre-operative physiotherapy. Physiotherapy regimes for the conservative and post-operative management of patients with ALT included the prescription of proprioceptive, muscle strengthening and stretching exercises, in addition to behaviour modification. Whilst post-operative physiotherapy was considered important, it has largely been directed by the operative procedure, requiring the construction of individualized rehabilitation regimes. Principal conclusions: There remains debate regarding the appropriateness of the physiotherapy management for the non-operative management of this patient group. Greater evidence is required related to the post-operative management of patients following ALT repair. Level of evidence: Level IV - Systematic review based on studies that did not include a comparison group to assess for the effect of chance results. [ABSTRACT FROM AUTHOR]

Postural instability in Parkinson's disease (PD) is associated with several downstream consequences that ultimately lead to a greater risk of falling. Among the prominent downstream consequences is fear of falling (FOF), which is both common and problematic in PD. It can lead to a vicious cycle of FOF avoidance behavior that results in more sedentary behavior, physical deconditioning, and weakening of already impaired balance systems. This, in turn, may make the person with PD more susceptible to a future fall even with benign daily tasks. While FOF activity avoidance can be adaptive (appropriate), it can also be maladaptive (inappropriate or exaggerated). When this adaptive and maladaptive FOF avoidance behavior is contextualized to gait/balance performance, it provides a theoretical framework that can be used by clinicians to match patterns of behavior to a concordant treatment approach. In the theoretical framework proposed in this perspective, four different patterns related to FOF avoidance behavior and gait/balance performance are suggested: appropriate avoiders, appropriate non-avoiders, inappropriate avoiders, and inappropriate non-avoiders. For each of the four FOF avoidance behavior patterns, this paper also provides suggested treatment focuses, approaches and recommendations. [ABSTRACT FROM AUTHOR]

Background/PurposeMethodsKey ResultsConclusionTherapeutic relationship and social support are critical components in physiotherapy that shape patient outcomes. However, defining these constructs, discerning their similarities and differences, and measuring them pose challenges. This article aims to facilitate scientific and clinical advancement on social support and the therapeutic relationship in physiotherapy by (a) providing conceptual clarity, (b) discussing measurement tools, and (c) offering practical recommendations for the deliberate incorporation of these constructs in clinical practice.This is a perspective paper drawing on examples from existing research.Assessing the nature and strength of social support and promoting naturally occurring social support networks are practical ways for physiotherapists to foster social support in physiotherapy clinical practice. Physiotherapists can offer direct support, facilitate the development of an individual’s social skills, and promote participation in group activities. To strengthen the therapeutic relationship, it is important to maintain good communication, foster connectedness with the patient, demonstrate professional skills, and adopt a reflective practice. Physiotherapists are encouraged to establish clear roles and responsibilities, prioritize individualized patient-centered care, and involve patients in shared decision-making, ensuring congruence in goals and expectations. Willingness to dedicate time and energy within and beyond direct patient-therapist interactions can foster connections. Moreover, using the body – which is the main point of contact with patients – and physical touch can help physiotherapists to connect with patients. Finally, physiotherapists must be prepared to address and mend any conflicts which can impact the relationship’s trajectory.Social support and therapeutic relationships are complementary aspects of one’s health care, and it is crucial to purposefully account for both in physiotherapy practice to optimize person-centered care and rehabilitation outcomes. [ABSTRACT FROM AUTHOR]

BackgroundPurposeResultsConclusionsIt has been two decades since the World Health Organization’s endorsement of the International Classification of Functioning, Disability and Health (ICF). It is timely to undertake a rigorous search that analyzes the discourses around the ICF’s conceptual framework within physiotherapy, the kinds of enquiry to date and the professional areas where this is happening and how.The aim of this research is to synthesize the literature related to how the physiotherapy profession (practice, research and education) thinks about and puts to use the WHO ICF.A final sample of 37 papers was agreed. Five overarching third-order interpretations were derived: (i) A way of thinking and practicing, (ii) Endorsed but not embedded, (iii) Striking a balance, (iv) Power of participation and (v) Moving forward. Together, these themes illustrate the evolving role of the ICF in physiotherapy over the previous two decades. They highlight the ICF’s potential for shaping the future of physiotherapy practice, education and research.Work is needed to connect existing literature about the ICF and related models and embed the ICF, its language and philosophy across physiotherapy education and practice. Re-representation of the model might help address misinterpretation of the ICF, but fundamentally, embedding the ICF in entry-level curriculum is likely to be the most significant driver of change in practice. [ABSTRACT FROM AUTHOR]

The therapeutic relationship between a patient and physiotherapist has been associated with improved physiotherapy outcomes. However, there is no agreed upon measure of therapeutic relationship in physiotherapy. This paper describes a validation study of a new patient-reported measure, the Physiotherapy Therapeutic Relationship Measure (P-TREM). In this multi-site validation study, participants with musculoskeletal conditions (n = 163) completed a survey containing the P-TREM, demographic questions, a Trust in Healthcare Providers scale, and a therapeutic relationship global rating for construct validation. We investigated item quality, internal structure using exploratory factor analysis (EFA), unidimensionality, internal consistency, and construct validity. We eliminated poor performing items to optimise the length of the P-TREM. The final version of the P-TREM has 30 items. EFA suggests two domains: 'Physiotherapist role' and 'Patient role', correlation between factors was 0.71. Internal consistency was excellent. We found a low-moderate correlation between P-TREM scores and Trust in Healthcare Providers and a strong correlation between P-TREM scores and the therapeutic relationship global rating, confirming our hypotheses for convergent and concurrent validity. The P-TREM can be considered for use in clinical research to understand therapeutic relationship in the care of people with longstanding musculoskeletal conditions in outpatient, in-person settings. [ABSTRACT FROM AUTHOR]

The biopsychosocial model of pain may aid the understanding pain and its clinical presentations. This paper presents a discussion of the past, present and future state of the biopsychosocial model of pain within physiotherapy. The biopsychosocial model of pain acknowledges the dynamic interdependent biological, psychological and social dimensions of peoples pain experiences and has been widely endorsed. However, the biopsychosocial model is not beyond criticism and its applicability to clinical practice has been questioned. Researchers have investigated how clinicians understand and apply the biopsychosocial model in clinical practice. Evidence suggests that physiotherapists demonstrate varying levels of confidence and proficiency in their psychosocially-oriented clinical knowledge and practice. Psychologically informed physiotherapy treatment approaches have been described and trialled and show inconsistent results and effect sizes with respect to patient-related outcomes. In addition, commentators suggest that the '-social' dimension of the model has been relatively neglected. While there is some evidence that the biopsychosocial model is evolving, and efforts are underway to develop and validate clinically-applicable tools, physiotherapy clinicians, educators and researchers have been invited to consider existing barriers and enablers to the implementation of the biopsychosocial model in clinical practice in order to improve its understanding and application within healthcare. The biopsychosocial model invites clinicians to understand and address the biological, psychological, and social dimensions of patients pain. Understanding and implementation of the biopsychosocial model of pain in physiotherapy is mixed. Improving education and training and developing and evaluating innovative biopsychosocial-oriented interventions appear to be important ways forward. The biopsychosocial model of pain is evolving in response to scientific and clinical developments. [ABSTRACT FROM AUTHOR]

Objectives: To identify the definitions used for treatment fidelity in the behaviour change literature and to explore the extent to which the assessment of fidelity has been reported according to the five domains by Bellg et al. Methods:Three databases (Scopus, Medline Ovid and CINAHL) were searched. Results were limited to studies published between 2012 and 2015. Definitions/summaries of treatment fidelity used were recorded. Methods for assessing/monitoring treatment fidelity were extracted, summarised and categorised according to the five domains. Results:Sixty-five papers were included for analysis. A definition of treatment fidelity was provided byn = 34 studies;n = 9 defined fidelity according to Bellget al.In the context of treatment fidelity,n = 9 (13.8%) reported on study design;n = 22 (33.8%) reported on an element of training of providers;n = 59 (90.7%) papers reported on delivery of treatment;n = 13 (20%) reported on receipt of treatment; andn = 10 (15.3%) reported on enactment of treatment skills. Conclusion: The definitions of treatment fidelity in the literature and the extent to which it has been reported were limited. Delivery of treatment was the most frequently reported component of treatment fidelity but other important aspects were poorly reported. The potential consequence of this is that translation of research interventions into clinical practice may not be optimised. [ABSTRACT FROM PUBLISHER]

The history of physiotherapy in Latin America has received little attention thus far in the English-speaking literature. In this paper, we draw on narratives from activists, educators, and professional leaders who have been instrumental in shaping the development of physiotherapy in Argentina, Colombia, and Ecuador. Physiotherapists in the Latin American countries faced many similar challenges, including developing physiotherapy in the shadow of medicine, overcoming conservative attitudes toward women professionals, and frequent social upheaval. The paper explores the disputed story of physiotherapy's origins in the polio epidemics, the influence of Swedish remedial gymnastics, and the educational colonialism of North American and European educators. We examine some of the effects of social unrest and trauma, military rule, and economic instability on the professions attempts to establish itself in the face of competition from other professions allied to medicine. And we consider the efforts taken to establish the profession's autonomy and its shifting relationship with the state. We employed two different methods for data collection to explore aspects of physiotherapy's history in Latin America from a political and socio-cultural context: 1) A reconstruction of memories from activist physiotherapists in Colombia, Ecuador, and Argentina, who have seen, lived, and promoted the development of physiotherapy in their own countries, gleaned from in-depth interviews; and 2) Analysis of secondary sources. Data were analyzed following the method described by Maynes, Pierce, and Laslett (2008), exploring personal narratives. Textual data were analyzed using documentary research (Prior, 2003) using thematic analysis, to inductively discover, and describe relevant themes about the two main guiding study questions. A constant comparative method as outlined by Boeije (2002) was used to form categories, establish boundaries, and discerning conceptual similarities between participants' narrative. Five physiotherapists were interviewed. One from Colombia, two from Argentina and two from Ecuador. Three main themes were identified: 'A Female Profession?', 'training and education', and 'Present Day in Argentina, Ecuador, and Colombia'. Tensions between the interests of the State, professionals, patients, cultures, urban and rural services, and practices are prevalent throughout physiotherapy in Argentina, Colombia, and Ecuador. Operating within these tensions is very much the reality for physiotherapists in Latin America today. Multiple histories emerge from the research, opening up a space for a more nuanced, polyphonic reading of physiotherapy in Colombia, Ecuador, and Argentina than has been heard to date. [ABSTRACT FROM AUTHOR]

The "therapeutic relationship" in physiotherapy refers to the beneficial or healing relationship between the patient and physiotherapist. Interest in researching therapeutic relationships in physiotherapy is growing and there is a need for a measure of therapeutic relationship with a strong conceptual foundation. Body of paper:We begin with a general discussion of the state of therapeutic relationship measurement in physiotherapy research – notably, how current research is based on measures borrowed and adapted from psychotherapy. Then, we introduce Miciak's physiotherapy therapeutic relationship framework, discuss why it offers a solid foundation for measurement development, and describe the key concepts in the framework. We then discuss various approaches to measuring therapeutic relationship, illustrating how Miciak's framework could be used to inform their development. We end by discussing current challenges in measuring therapeutic relationship and how these could be addressed. [ABSTRACT FROM AUTHOR]

This paper describes a novel model of learning, designed to enhance interprofessional education (IPE) and interprofessional collaboration (IPC). Lessons learned, plans for sustainability and future directions for policy, practice, implementation, and curriculum training are also discussed. The RIPE-N model (Reflective Interprofessional Education – Network model) was developed for an interprofessional simulation environment involving five health professions – pharmacy, nursing, orthoptics, physiotherapy, and speech pathology with the potential to increase the number of health professions involved. The RIPE-N model was adapted from the original RIPE Model (Reflective Interprofessional Education Model), utilising unfolding multidisciplinary case from admission through to discharge. Key adaptations of RIPE to include a greater focus on professional practice and the opportunity for collaboration by all disciplines. Reflection is critical to the RIPE-N model to develop the reflective practitioner, hence the inclusion of collaborative reflective ('pause and reflect') stations aimed at improving collaborative clinical decision-making skills among diverse healthcare professionals. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodResultsConclusionsMuscle Energy Techniques have been reported to provide beneficial effects on range of movement in multiple musculoskeletal dysfunctions. Noting these physiological effects and clinical recommendations, the effects of METs are given importance through investigations on their input in managing COPD symptoms. The maintenance of such outcomes has though not been investigated. Therefore, the aim is to look into the short-term effects, 4-week post completion of the intervention, on pulmonary function, chest measurements, exercise tolerance and ADLs.This paper reports outcomes from a randomised controlled trial. 108 patients with COPD were recruited and assigned to 2 groups. The intervention group underwent a 4-week MET programme applied to the accessory muscles of respiration. The control group on the other hand continued with standard medical treatment. Outcome measures were assessed at baseline, at the 4th week time point on completion of the intervention, and again 4 weeks after. The outcome measures were performed in both groups which consisted of the pulmonary function tests, 6-min walk test (6MWT), chest measurements and the Manchester Respiratory Activities of Daily Living (MR-ADL) questionnaire.Significant improvements were observed after 4 weeks from cessation of MET intervention when compared to baseline for pulmonary function measures (p < 0.001), chest measurements (p < 0.001) and ADLs (p < 0.001), in subjects enrolled in the intervention group.Significant short-term effects in outcome measures following 4 weeks from completion of the MET programme were observed in the intervention group.Clinical trial registration: The study was clinically registered in ClinicalTrials.gov (NCT04773860) [ABSTRACT FROM AUTHOR]

Women need to engage in effective quadriceps resistance training programmes following anterior cruciate ligament reconstruction. Recent research has supported follicular phase-based resistance training for enhancing resistance training strength outcomes in eumenorrheic females. It is unclear whether research has investigated menstrual cycle phased resistance training programs in eumenorrheic females post-ACLR or whether there is a gap for further research in this area. This scoping review aims to describe what is known about menstrual cycle phased resistance training programmes in injured and non-injured eumenorrheic females, identify any existing gaps in knowledge, and propose future research. The research team will search five databases using predetermined search terms. Eumenorrheic female participants undergoing a menstrual cycle phased resistance training programme for at least one menstrual cycle length will be included. All studies must be in the English language and published in academic journals. The research team will evaluate relevant titles and abstracts against the eligibility criteria. Potentially relevant sources will be retrieved in full. The full text of selected studies will be assessed in detail against the inclusion criteria by two reviewers. The research team will extract data from included papers using a data charting form. The review will present all results in table format accompanied by a narrative summary. Results are not yet known. This will contribute to the understanding of methodologies and outcomes of menstrual cycle phased resistance training programmes, and indicate whether there is a role for future research in injured and non-injured populations. [ABSTRACT FROM AUTHOR]

Nowadays, fuzzy-logic systems are implemented to control machinery or processes that previously required human manipulation. The main objective of this research is to propose a controller based on fuzzy-logic that uses bio-signals for decision making. The study presents the implementation of a fuzzy-speed controller for a therapeutic machine called cycloergometer. It is used in patients who require rehabilitation therapy to improve their mobility in the lower body or to increase their relaxation or flexibility. Basic controllers have been developed where the speed is decided through a user interface, and the therapist must constantly increase or decrease the speed according to the condition of the patient. In this paper, the speed of the therapy equipment is adjusted using the heart rate of the patient. In this way, a bio-signal is used to determine whether a person is tired or relaxed. Therefore, a mechanism is obtained that is not subject to the visual criteria of the therapist. A detailed review of the literature illustrates that one of the main limitations of electroencephalography and electromyography recordings is the low signal-to-noise ratio and the fact that the signals captured at the electrodes are a mixture of sources that cannot be observed directly with noninvasive methods. Therefore, it was decided to work with electrocardiogram-based signals for better robustness of the proposed system. The controller output is a voltage signal in PWM, which is determined by the membership and error functions. The behavior of the implemented controller is validated by different experimental tests based on the increase and decrease of the simulated and real heart rate of a patient. Finally, the results obtained and the possible areas of opportunity for the proposed design are discussed. [ABSTRACT FROM AUTHOR]

Background: The aetiology of multidirectional instability (MDI) is primarily laxity of the capsule and capsular thickenings. The other factors include dysfunction of dynamic stabilisers with loss of neuromuscular co-ordination, and altered neuromuscular control of activation patterns of rotator cuff muscles and scapular stabilisers. Methods: A literature search of the following databases, MEDLINE, CINAHL, EMBASE, Cochrane, AMED and Science direct was carried out. In addition, reference lists were hand searched for relevant papers. Seven studies qualified for inclusion and their methodological quality assessed with a risk of bias tool. A systematic review was done using narrative synthesis as there was not enough homogeneity in the studies to undertake a meta-analysis. Results: The studies were of low quality with a high risk of bias but showed consistent evidence that retraining neuromuscular control, proprioception and strengthening of dynamic stabilisers can compensate for deficit in static stabiliser function. About 60–100% success rate can be achieved with long-term compliance with the exercise programme being important for maintaining the results. Conclusions: Exercise-based therapy involving strengthening, proprioception and plyometric training is appropriate in the initial management of patients with MDI. The programme should be continued for about 6 months and maintained for the long term. [ABSTRACT FROM AUTHOR]

The aim of this updated literature review was to evaluate the extent to which adults are documented as being capable of further motor recovery more than 6 months after a severe traumatic brain injury. This topic has high potential relevance for neurological physiotherapists, some of whom may be tasked with implementing physical treatment programmes for this challenging patient group. A revised search of relevant databases was carried out, using the previous review as a starting point. A further 10 papers were identified, extending the original total to 18 published studies. Of the 18 papers, 13 were single-case studies, with 5 being reports of subject groups (8–80 subjects; median, 20 subjects). Recovery was documented as occurring over periods which extended up to 180 months' post-injury, though more reports fell within the 60 months' post-injury period. Evidence supporting the hypothesis that subjects are readily capable of continuing and/or further change was not overwhelming; reasons for this are discussed. [ABSTRACT FROM AUTHOR]

Ethics is ever-present in all aspects of human interaction and, in any physiotherapy situation there is an inherent claim to act and care for the patient in the best possible way. The physiotherapy profession is provided with rules, guidelines and codes to support and ensure ethical professional conduct. In recent decades however, physiotherapy literature has emphasized how ethical agency is immersed in clinical reasoning in each particular situation, in the doing of physiotherapy. The Danish philosopher and theologian Knud E. Løgstrup offers a bottom-up approach to ethics, which may augment the philosophical underpinning of this development in ethical thinking. Løgstrup departs from the given pre-conditions of life; a point of departure where the ethical claim emerges from sensation in the concrete situations. This paper introduces Løgstrup's situational ethics and its ontological framing, with four foci: how we can tune in to sensation and sense the ethical claim of the other; how human interdependence can be heard in what Løgstrup calls sovereign life utterances; relational responsibility and ethical norms; and the metaphorical importance of poetic understandings of the world. In four themes we reflect on how these ethical issues are at stake in physiotherapy practice with regards to: (1) uncertainty, tuned sensation and therapeutic attitude in physiotherapy; (2) sensuous, narrative and poetic meaning-making in physiotherapy; (3) physiotherapy and coming to oneself in new embodied experiences; and (4) ethical claims and codes of conduct in physiotherapy. [ABSTRACT FROM AUTHOR]

Care is central to many health professions, including physiotherapy. Different forms of care are enacted as part of being a caring professional. For example, a practitioner who provides good service to others and upholds standards while doing so is in-grained in education for professional formation. However, there are other topics and aspects of care that are not as well attended to, and that is care for the future of the profession. This too is an aspect of care, and it is an urgent objective in an era where societies and healthcare are changing at rapid rates. In this paper, I argue that Golde and Walker's (2006) idea of stewardship can help health professionals think about this often overlooked aspect of care. Stewardship adds a perspective that is centered on a deep authentic care for and responsibility towards the ongoing relevance of the profession. Stewardship keeps the question of what the profession is, and what a professional does, alive as part of its present and future practice. [ABSTRACT FROM AUTHOR]

A high proportion of people are insufficiently physically active. The reasons for this are complex and in part relate to social determinants of health, lifestyle choices, and deleterious environmental conditions like climate change, loss of green and outdoor environments and a concomitant loss of biodiversity. Physiotherapists, and other health professionals, may have a positive impact on these global issues, through the encouragement of active transport, and advocacy to reduce barriers to its uptake and optimize exposure to health-giving outdoor spaces. In this paper, we demonstrate how physiotherapists can promote active transport as a planetary health intervention, and provide insight into the benefits and challenges of this planetary health intervention, with direct implications to physiotherapy practice. [ABSTRACT FROM AUTHOR]

The history of physiotherapy can be seen as a history of boundary conflict, as the profession sought to first establish, then maintain, its distinctive professional identity. Traditional approaches to the sociology of the professions support this, seeing professionalization as an ongoing process of enclosure, encroachment, and conflict. Recent work, however, has emphasized the fluidity and collaborative nature of professionalization projects, and placed more emphasis on inter-professional negotiations and disciplinary coexistence. In this paper, we draw on this work to analyze the harmonization of the independent Mensendieck System of medical gymnastics in Norway, and the emerging state-sponsored physiotherapy system. Our contention is that over the course of the middle decades of the 20th century, advocates of the Mensendieck System and providers of orthodox, biomedically informed physiotherapy, came together and found a way to work collaboratively in a shared space without compromising their distinctive professional identities. We argue that this approach both points to ways we might revisit traditional conflict-based analyses of the history of physiotherapy, while also suggesting new ways of imagining how the profession might change in the years to come. [ABSTRACT FROM AUTHOR]

Background: Neurasthenia was one of the most commonly diagnosed disorders in the later years of the 19th century. Its most widely used treatment, known as the Rest Cure, relied heavily on physical therapies, but little is known about the practitioners who administered the treatment. In this paper, I argue that the nurse-masseuses who delivered the massage and electricity so vital to the success of the Rest Cure, used the opportunity to develop approaches to treatment that would form the backbone of the physiotherapy profession in England after 1894. Methods: Extensive primary and secondary texts were drawn from a wide range of sources and critically reviewed. Findings: This study argues that the management of neurasthenic cases in the 1880s and 90s created the conditions necessary for the development of the profession's relationship with medicine and the establishment of new practice roles for women, and that these would play an important role in shaping the physiotherapy profession in Britain after 1894. Read through the critical sociological writings of Magali Sarfatti Larson and Anne Witz, I argue that the work of the nurse-masseuses can be seen as a complex gendered negotiation between the need to be deferential to the dominant male medical profession; distinct from emerging notions of the angelic, motherly nurse; obedient, technically competent and safe. The creation of a space in the clinic room for a third practitioner who could deliver a different form of care to the doctor or the nurse, established an approach to practice that physiotherapists would later adopt almost without amendment. Discussion: I argue that this approach owes much to the work done by nurse-massueses who established and tested its principles in treating cases of neurasthenia. [ABSTRACT FROM AUTHOR]

Background: Fibromyalgia (FM) is characterized by chronic, widespread musculoskeletal pain, extensive fatigue and an array of other symptoms. Cure is not expected, and patients have to learn to live with the illness. During the last years several studies have examined how it is like to live with FM from a patient's point of view. These findings may help physiotherapists to better understand the challenges faced by patients. Objective: To describe what it is like for patients to live with FM and discuss how this may inform physiotherapy practice. Design: A systematic literature search of qualitative studies up till May 2016 was conducted, and 93 papers were read. The focus was on patients' experiences of symptoms and how they managed everyday life. Results: Incomprehensible, unpredictable symptoms of FM intrude and disturb everyday life. The body is constantly monitored by patients on a day-to-day basis according to fluctuations in pain and energy levels, and habits and routines of daily life are adapted to these shifts. With other words, the connection between body, self and daily life is ruptured. In contrast, those having recovered from FM had found out what they could tolerate during a day and had spent long time in rebuiding a life worth living. Conclusion: The present paper presents an argument that living with FM calls for a rather complex personal healing process that should be recognized and supported by physiotherapists. [ABSTRACT FROM AUTHOR]

Contemporary and future physiotherapists are, and will be, presented with challenges different to their forebears. Yet, physiotherapy tends to remain tied to historical ways of seeing the world: these are passed down to generations of physiotherapy graduates. These historical perspectives privilege particular knowledge and skills so that students gain competency for graduation. However, contemporary practice is inherently more complex than the focus on knowledge and skills would have us believe. Professional life requires students to develop the capability to deal with uncertain and diverse futures. This paper argues that physiotherapy needs to think differently about entry-level education; the focus on knowledge and competencies that has been the mainstay in physiotherapy education must now be understood in the context of an education that embraces knowing, doing, being. Two educational frameworks are offered in support of this argument – threshold concepts and ways of thinking and practicing (WTP). Taken together, these ideas can assist physiotherapy to think in fresh ways about disciplinary learning. Threshold concepts and WTP help to understand the nature of a discipline: its behaviors, culture, discourses, and methods. By interrogating the discursive aspects of the discipline, physiotherapy educators will be better placed to provide more relevant preparation for practice. [ABSTRACT FROM PUBLISHER]

Purpose: An evidence-practice gap exists between the amount of active practice recommended and the amount completed by stroke inpatients. The aim of this paper is to describe steps in the design of a participatory, theoretically tailored staff behaviour change intervention to help staff use strategies to increase active practice by stroke inpatients. Methods: A staff behaviour change intervention was developed in one rehabilitation unit in Queensland, Australia using a six-step process guided by the Behaviour Change Wheel framework. Mixed methods were used including direct observation (behavioural mapping), and focus groups to identify barriers and facilitators to implementation. Barriers and facilitators were mapped to the behaviour change techniques, and a behaviour change intervention developed in participation with rehabilitation staff. Results: Staff chose to implement ward-based practice books. Barriers included patient factors (including low motivation and severity of stroke), environmental segregation and limited skills for motivating patients. Staff belief in increasing active practice was a facilitator to implementation. The staff intervention included a training programme about motivation, environmental restructuring, audit, and feedback. Conclusions: This example of collaborative implementation research can be used and adapted by clinicians and researchers in other rehabilitation services. Rehabilitation staff can be actively involved in designing behaviour change interventions. Behaviour change interventions should target local barriers to increase activity levels and practice completed by stroke inpatients. The process of co-designing behaviour change interventions has the potential to improve the uptake of a strategy such as ward-based practice books, by more precisely identifying local barriers and possible solutions. [ABSTRACT FROM AUTHOR]

Aged care is becoming an increasingly significant feature of health care, but it is not an area physiotherapists have traditionally favored. Aging populations of increasingly chronically ill people represent the most important community of need in health care however, and so physiotherapists risk being marginalized if they do not adapt their practices to meet this growing need. Aged care may therefore represent a testing ground for a new physiotherapy, and the lessons learned in reforming physiotherapy for older adults may extend to all aspects of practice. In this paper, I explore how our current approach to aged care came about, and make the case for change. Having critiqued biomedicine, I also argue that the newer holistic models of health care are equally inadequate, because they attempt to dissolve important philosophical differences between physical, experiential, and social paradigms into an amorphous whole. I argue that these 'embodied' models of health make a holistic approach to aged care impossible and, instead, suggest new materialism and object-oriented ontologies as alternative physiotherapy paradigms. [ABSTRACT FROM AUTHOR]

Our purpose was, through an extensive and systematic review of the literature, to verify the effectiveness of physical exercises in the treatment of adolescent idiopathic scoliosis. We performed a search of different databases ( Medline , Cochrane Library , Embase , Cinhal ), and a hand-search of the non-indexed pertinent literature, and found 11 papers: none of the studies was randomized, six were prospective, seven were controlled, and two compared their results to historical controls; one paper had both a prospective design and a concurrent control group. The methodological quality of the retrieved studies was reviewed and found to be very poor. With one exception, the published studies demonstrated the efficacy of physical exercises in reducing both the rate of progression or the magnitude of the Cobb angle at the end of treatment. However, being of poor quality, the literature failed to provide solid evidence for or against the efficacy of physical exercises in the treatment of adolescent idiopathic scoliosis. Nevertheless, considering that exercises could also be proposed on the basis that benefits rather than to avoid progression have been shown in the literature, and that the results contained in published studies here reviewed suggest an effect on the primary goal of preventing progression, there is a basis for discussion of this option with patients and their families, which in turn allows decisions to be made according to their preferences. [ABSTRACT FROM AUTHOR]

This paper reports the findings from an evaluation of a pilot interprofessional training ward project for pre-qualification medical, nursing, occupational therapy and physiotherapy students. This initiative required sustained collaboration from staff based in two National Health Service (NHS) trusts and four schools in three universities. The ward was based on a model of interprofessional education developed in Sweden, but adapted in the light of this experience and also to meet the needs and aspirations of the training ward stakeholders in London. The training ward was evaluated using a multi-method design. Data were collected from all participants involved in this pilot: students, facilitators and patients. The findings from the evaluation are presented and discussed. This paper pays particular attention to the collaborative experiences of the students, staff and institutions involved in this initiative. In addition, 1-year follow-up data collected from the students who had, by then, qualified as clinical practitioners are reported. The paper presents conclusions from the evaluation, and comments on the training ward's strengths, limitations and future development. [ABSTRACT FROM AUTHOR]

Some individuals with hemiplegia show a postural disorder called pusher behavior. Various underlying theoretical mechanisms have been proposed, thus leading to various treatment approaches. The aim of this scoping review is to identify and analyze the available evidence on the treatment approaches for pusher behavior. Two independent reviewers conducted a literature search for original studies reporting on treatments for pusher behavior. Studies were searched in PubMed, Scopus, Web of Science, CINAHL and PEDro from their inception to December 2020. Treatment approaches were grouped in homogeneous areas based on the supposed underlying mechanism. To assess the reporting of the interventions, the Template for Intervention Description and Replication (TIDieR) was used. Thirty-one papers describing 45 interventions were included in the review. Most of the studies were case reports (i.e. including 1 person) (n = 16), followed by randomized controlled trials (n = 5), single subject design trials (n = 5), non-randomized controlled trials (n = 3), and case series (i.e. including more than 1 person) (n = 2). Treatment approaches were grouped into five categories: visual feedback, somatosensory cues, visual-somatosensory integration, brain stimulation, and other nonspecific treatments. The median number of TIDIeR items reported was 7 (range 4 to 10). Pusher behavior is still little-known. Five main categories of treatment approaches based on the alleged etiological underlying mechanisms have been identified. Most of studies are case reports; controlled trials should be further conducted. Intervention reporting should be improved to allow treatment replication in larger trials. [ABSTRACT FROM AUTHOR]

Having spent their first century anchored to a biomedical model of practice, physiotherapists have been increasingly interested in exploring new models and concepts that will better equip them for serving the health-care needs of 21st century clients/patients. Connectivity offers one such model. With an extensive philosophical background in phenomenology, symbolic interactionism, structuralism, and postmodern research, connectivity resists the prevailing western biomedical view that health professionals should aim to increase people’s independence and autonomy, preferring instead to identify and amplify opportunities for collaboration and co-dependence. Connectivity critiques the normalization that underpins modern health care, arguing that our constant search for deviance is building stigma and discrimination into our everyday practice. It offers provocative opportunities for physiotherapists to rethink some of the fundamental tenets of their profession and better align physiotherapy with 21st century societal expectations. In this paper, we provide a background to the place connectivity may play in future health care, and most especially future physiotherapy practice. The paper examines some of the philosophical antecedents that have made connectivity an increasingly interesting and challenging concept in health care today. [ABSTRACT FROM PUBLISHER]

Purpose: The aim of this review was to assess the effectiveness of multidisciplinary, activity-based interventions on adults with chronic musculoskeletal or widespread pain who identify as ethnoculturally diverse (ECD) compared to adults belonging to the predominant culture of the host country. Methods: Online databases Medline, CINAHL, AMED, Psych Info and PubMed were searched from the earliest date available until April 2023. The quality of the included studies were assessed against the Risk of Bias in Non Randomized Studies of Interventions (ROBINS-I). Postintervention data were analyzed using meta-analyses and the certainty of evidence determined using the Grading of Recommendation, Assessment, Development and Evaluation approach (GRADE). Results: Nine cohort studies with 3467 participants living in America and north-western European countries were included. ECD adults had higher pain intensity (SMD 1.36, 95%CI 0.29 to 2.35, p = 0.03), higher levels of depression (SMD 0.96, 95%CI 0.40 to 1.52, p < 0.01) and a nonsignificant difference in pain-related disability (SMD −1.45, 95%CI −3.28 to 0.39, p = 0.12) following multidisciplinary pain intervention compared to adults of the predominant culture. Conclusion: Adults from ECD backgrounds in Western nations have poorer outcomes after multidisciplinary, activity-based chronic pain interventions compared to adults from predominant cultural groups in these countries suggesting program adaptations may be required. IMPLICATIONS FOR REHABILITATION: Adults from ethnoculturally diverse backgrounds in Western nations have poorer outcomes after chronic pain interventions suggesting different approaches to management are needed. Programs can be adapted to reflect culture-specific beliefs, metaphors, language and concepts in their content to better address pain and improve outcomes among ethnoculturally diverse communities. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the implementation of a self-management program, My Therapy, designed to increase inpatient rehabilitation therapy dosage via independent practice. Materials and methods: A process evaluation of My Therapy for adult patients admitted for rehabilitation for any condition supervised by physiotherapists and occupational therapists across eight rehabilitation wards compared usual care. Outcomes included reach, dosage, fidelity and adaptation. Results: The mean (SD) age of the process evaluation sample (n = 123) was 73 (11) years with a mean (SD) length of stay of 14.0 (6.6) days. The My Therapy program reached 68% of participants (n = 632/928), and resulted in an average increase in therapy dosage of 26 (95% CI 12 to 40) minutes/day of independent practice. All My Therapy audited programs (n = 28) included body function/structure impairment-based exercises, and half (n = 13/28) included activity/participation-based exercises. On average, participants completed programs 1.8 (SD 1.2) times/day, which were prescribed in accordance with the My Therapy criteria, demonstrating fidelity. There were no between-group differences in daily steps or standing time, however, My Therapy participants spent more time sitting (p ≤ 0.05). Implementation adaptations were minimal. Conclusion: A self-management rehabilitation program was implemented with fidelity for two in three rehabilitation patients, resulting in increased therapy dosage with minimal adaptations. IMPLICATIONS FOR REHABILITATION: The My Therapy self-management program was implemented with good reach (68% of participants received My Therapy) across four public and private inpatient rehabilitation services. Under My Therapy conditions, the dosage of inpatient rehabilitation therapy participation increased by an average of 26 minutes per day, which will help close the evidence-practice gap between the current rehabilitation dosage of about 1-hour per day, and the recommended rehabilitation dosage of 3-hours per day. My Therapy programs most frequently included impairment-based exercises that were completed in sitting, and did not increase time spent standing and walking. Consideration should be given to prescribing My Therapy (content and dosage) at an optimal level to promote patient functional independence, while maintaining safety. [ABSTRACT FROM AUTHOR]

Purpose: To develop a questionnaire for adolescent idiopathic scoliosis (AIS) patients undergoing physiotherapeutic scoliosis-specific exercises (PSSE) and to evaluate its content validity, structural validity, and reliability. Methodology: Seven PSSE treatment experts checked the content validity of the Patient's Perception of Scoliosis-Specific Physiotherapy Questionnaire (Physio-IS). For each Physio-IS item, the content validity indexes must be ≥ 90%. Regarding structural validity and reliability 52 adolescents (ages 10–17) with AIS completed the questionnaire. Structural validity was assessed through exploratory factor analysis. Reliability was verified through internal consistency. Results: Physio-IS content was validated in three evaluation rounds, obtaining 100% expert agreement. About structural validity we identified four domains (cumulative explained variance = 68.2%): (1) specific knowledge (seven questions on understanding their scoliosis condition); (2) social repercussion (five questions about social relationship implications); (3) pain (two questions about scoliosis-associated pain); and (4) associated concern (apprehension/expectations regarding the future). The Physio-IS demonstrated very good internal consistency (Cronbach's alpha = 0.76–0.92). Conclusion: The Physio-IS is a valid and reliable tool for assessing AIS patients undergoing PSSE and helping physiotherapists identify aspects requiring more attention, thus facilitating intervention strategies, as knowing the patient's perception of their condition or treatment is fundamental to AIS treatment success. IMPLICATIONS FOR REHABILIATION: Physio-IS is an innovative tool in the treatment of Adolescent idiopathic scoliosis (AIS). Physio-IS is a valid and reliable tool for the assessment of adolescents with AIS undergoing phyisiotherapeutic scoliosis-specific exercises (PSSE). The specific questionnaire can contribute to physiotherapeutic treatment decisions, allowing the physical therapist to see the patient as a whole. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the acceptability of two co-designed mobile applications Mit Sygehus [a knowledge-based solution] and Genoptræn.dk [a self-training solution] to support a cross-sectoral, person-centred and empowering stroke rehabilitation. Setting: The applications were implemented and tested throughout two stroke rehabilitation trajectories in Southern Denmark, comprising two acute, two sub-acute and two municipal stroke rehabilitation settings. Methods, participants and analysis: A process evaluation focusing on acceptability was conducted. Individual and dyadic interviews were performed with ten stroke survivors (three women and seven men, aged 50-84) with moderate stroke and seven significant others (five women and two men, aged 50-78) post-rehabilitation. A constructivist Grounded Theory analysis was used to explore what, why, when, and how the apps worked or did not work throughout the stroke rehabilitation trajectory and if adaptions were needed. Results: Participants found that Mit Sygehus provided adequate and sufficient knowledge and was easy to use, however, acceptability of Mit Sygehus declined throughout the rehabilitation process. Also, knowledge on 'return-to-work' and 're-gaining driver's license/permission to drive' needed to be developed. The content in Genoptræn.dk was perceived as acceptable, through content being person-centred, motivating and meaningful. Genoptræn.dk furthermore, supported the transfer between rehabilitation settings, provided a sense of progress throughout the rehabilitation process, facilitated positive habits regarding self-training, and relieved the burden on significant others. Genoptræn.dk was perceived most acceptable in the sub-acute rehabilitation setting and declined when rehabilitation continued in the municipal setting. Conclusion: Stroke survivors and their significant others found Mit Sygehus and Genoptræn.dk acceptable to support cross-sectoral, person-centred and empowering stroke rehabilitation, however acceptability declined throughout the rehabilitation process. Further investigations are required to determine how cognitive rehabilitation can play a greater role in app-supported stroke rehabilitation and how the need for more long-term follow-up can be supported. [ABSTRACT FROM AUTHOR]

Telerehabilitation is proposed as a promising avenue to enhance service accessibility for Indigenous communities, yet its application for Indigenous children remains relatively unexplored. This scoping review followed the PRISMA-ScR framework to explore current knowledge on the use of telerehabilitation for Indigenous children. Ten scholarly databases, seven grey literature databases, reference searches, and expert consultations were utilised to identify relevant studies. Included articles discussed the use of telerehabilitation provided by rehabilitation professionals (e.g. occupational therapist (OT), physical therapist (PT), speech and language pathologist (SLP) to Indigenous children and/or caregivers. Seven studies were included. Telerehabilitation was explored in different ways, the most common being real-time videoconferencing by SLPs. While some studies explicitly acknowledged cultural responsiveness within both the research process and the intervention, most were not designed for Indigenous children and their caregivers; rather, these participants were included with non-Indigenous participants. Successful implementation and sustainability of telerehabilitation services requires addressing technological limitations, understanding, and respecting diverse worldviews, and co-developing services to meet the unique needs of Indigenous families. Telerehabilitation has been rarely used with Indigenous children and when it was, little attention was given to cultural considerations. These findings emphasise that future telerehabilitation interventions should be truly community-led to ensure cultural relevance. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to compare the effects of home exercise alone and telerehabilitation combined with home exercise in individuals with transtibial amputation. Materials and methods: The telerehabilitation group (n = 24) received telerehabilitation combined with home exercise, while the control group (n = 24) received home exercise alone. Outcomes included the timed up-and-go (TUG) test and the 30-second chair-stand test (30CST), the Activities-specific Balance Confidence (ABC) Scale, the Trinity Amputation and Prosthesis Experience Scales (TAPES), the Amputee Body Image Scale (ABIS), and the Nottingham Health Profile (NHP). The analysis used a 2 × 2 mixed repeated measures ANOVA. Results: The group-by-time interactions were significant for TUG (p = 0.002, F[1;41] = 10.74) and 30CST (p = 0.001, F[1;41] = 11.48). The mean difference (6th week-baseline) was −0.49 for TUG and 0.95 for 30CST in the telerehabilitation group and −0.14 for TUG and 0.13 for 30CST in the control group. There were statistically meaningful group-by-time interactions on the ABC (p = 0.0004, F[1;41] = 14.47), the TAPES-activity restriction (p = 0.0001, F[1;41] = 28.96), TAPES-prosthesis satisfaction (p = 0.004, F[1;41] = 9.19), and the NHP (p = 0.0002, F[1;41] = 16.07) favoring the telerehabilitation group. Conclusions: Telerehabilitation combined with home exercise can offer greater benefits in improving gait, muscle strength, balance confidence, activity restriction, prosthesis satisfaction, and quality of life compared to home exercise alone for individuals with transtibial amputation. Implications for rehabilitation: Exercise helps individuals with lower limb amputation overcome their physical limitations and enables them to use their prostheses effectively. Physiotherapy and rehabilitation after amputation are not at the desired level, and individuals with lower limb amputation encounter various difficulties in accessing physiotherapy. Telerehabilitation has great potential to facilitate access to physiotherapy for individuals with amputation and reduce resource utilization. In a relatively small sample of amputees, this study shows that telerehabilitation-based exercise improves physical health and quality of life. [ABSTRACT FROM AUTHOR]