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Pre-professional identity (PPI) aims to provide an understanding of, and connection to, the skills and knowledge contained in a degree and the intended profession of the student. Investigation into PPI is of importance to higher-education institutions as it provides a means of understanding a student's orientation and motivation behind degree and career selection. Developing learning activities that capitalise on these motivations is proposed to increase student engagement, reduce attrition, and enhance employability. Using the growing, but relatively new profession of Exercise Science as an example, this study describes a workshop based on theoretical models relating to the concept of PPI, adult learning and self-reflective practices that can be integrated into programs to enhance students' understanding of their professional identity. One hundred and seventy-three final year Exercise Science students participated in and evaluated the workshop. The workshop was evaluated using a theoretical framework specifically designed for the evaluation of training activities. The combination of the evaluation and feedback from students were synthesised to develop a model for the application of PPI activities across a three-year undergraduate degree.

Managing boundaries between students' work and study roles is crucial for success at university. Little research has examined the strategies used to manage these roles, the factors that relate to implementing them, and the outcomes associated with their use. Boundary management theory, an identity-based perspective, explains boundary management processes; yet, few studies have examined how identity affects the enactment of boundary strategies. We investigated the extent to which identity-based concepts (i.e., student role salience and future-self) were related to different types of boundary strategies (i.e., temporal and communicative), how these related to work-study balance, and, in turn, academic satisfaction. We tested our model on a sample of 266 working university students (M[subscript Age] = 20.07 years, SD = 2.63; 74% women) and it accounted for 41% of the variance in academic satisfaction. Significant relationships were found among identity-based concepts, boundary strategies, work-study balance, and academic satisfaction, highlighting the importance of student identity and the use of temporal strategies in achieving greater work-study balance and academic satisfaction. Suggestions for how education providers can retain students who are struggling to manage work and study are discussed.

Pre-professional identity (PPI) is an understanding of the skills, qualities, conduct, culture and ideology of a students' intended profession. Understanding PPI is valuable for students and higher-education providers to provide insight into motivation for- and to promote engagement in- learning. Describing PPI is challenging, particularly for evolving health professions. This paper describes a process undertaken to understand PPI, using exercise science (ES), a new and evolving health profession, as a case study. Mixed methods were used to describe three aspects of PPI: 1) student cohort characteristics; 2) personal factors influencing PPI; and 3) perceived career direction. Final year ES students participated in an online survey and a focus group (n=305; 59% male; 75% age range of 20-24 years). Factors contributing to the development of PPI included the desire to help others; interest and experience in sports/exercise. Students had the strongest understanding of the PI domains of affiliation, money and structure and limited understanding of the role of scientist and researcher. Two outcomes were derived from the study findings to advance the theoretical understanding of PPI: 1) a 3-item framework that describes factors specific to students' PPI; and 2) a worked case study demonstrating how this framework was applied to gain a nuanced understanding of PPI in ES. Our framework can be applied to increase student and higher education providers understanding of PPI and the motivations underpinning student decision-making in higher education. [The page range (174-192) cited on the .pdf is incorrect. The correct page range is p174-200.]

Abstract Background Systematic reviews provide clinical practice recommendations that are based on evaluation of primary evidence. When systematic reviews with the same aims have different conclusions, it is difficult to ascertain which review reported the most credible and robust findings. Methods This study examined five systematic reviews that have investigated the effectiveness of Pilates exercise in people with chronic low back pain. A four-stage process was used to interpret findings of the reviews. This process included comparison of research questions, included primary studies, and the level and quality of evidence of systematic reviews. Two independent reviewers assessed the level of evidence and the methodological quality of systematic reviews, using the National Health and Medical Research Council hierarchy of evidence, and the Revised Assessment of Multiple Systematic Reviews respectively. Any disagreements were resolved by a third researcher. Results A high level of consensus was achieved between the reviewers. Conflicting findings were reported by the five systematic reviews regarding the effectiveness of Pilates in reducing pain and disability in people with chronic low back pain. Authors of the systematic reviews included primary studies that did not match their questions in relation to treatment or population characteristics. A total of ten primary studies were identified across five systematic reviews. Only two of the primary studies were included in all of the reviews due to different inclusion criteria relating to publication date and status, definition of Pilates, and methodological quality. The level of evidence of reviews was low due to the methodological design of the primary studies. The methodological quality of reviews varied. Those which conducted a meta-analysis obtained higher scores. Conclusion There is inconclusive evidence that Pilates is effective in reducing pain and disability in people with chronic low back pain. This is due to the small number and poor methodological quality of primary studies. The Revised Assessment of Multiple Systematic Reviews provides a useful method of appraising the methodological quality of systematic reviews. Individual item scores, however, should be examined in addition to total scores, so that significant methodological flaws of systematic reviews are not missed, and results are interpreted appropriately. (348 words)

Abstract Background Achilles tendinopathy (AT) is a common condition, causing considerable morbidity in athletes and non-athletes alike. Conservative or physical therapies are accepted as first-line management of AT; however, despite a growing volume of research, there remains a lack of high quality studies evaluating their efficacy. Previous systematic reviews provide preliminary evidence for non-surgical interventions for AT, but lack key quality components as outlined in the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Statement. The aim of this study was to conduct a systematic review and meta-analysis (where possible) of the evidence for physical therapies for AT management. Methods A comprehensive strategy was used to search 11 electronic databases from inception to September 2011. Search terms included Achilles, tendinopathy, pain, physical therapies, electrotherapy and exercise (English language full-text publications, human studies). Reference lists of eligible papers were hand-searched. Randomised controlled trials (RCTs) were included if they evaluated at least one non-pharmacological, non-surgical intervention for AT using at least one outcome of pain and/or function. Two independent reviewers screened 2852 search results, identifying 23 suitable studies, and assessed methodological quality and risk of bias using a modified PEDro scale. Effect size calculation and meta-analyses were based on fixed and random effects models respectively. Results Methodological quality ranged from 2 to 12 (/14). Four studies were excluded due to high risk of bias, leaving 19 studies, the majority of which evaluated midportion AT. Effect sizes from individual RCTs support the use of eccentric exercise. Meta-analyses identified significant effects favouring the addition of laser therapy to eccentric exercise at 12 weeks (pain VAS: standardised mean difference −0.59, 95% confidence interval −1.11 to −0.07), as well as no differences in effect between eccentric exercise and shock wave therapy at 16 weeks (VISA-A:–0.55,–2.21 to 1.11). Pooled data did not support the addition of night splints to eccentric exercise at 12 weeks (VISA-A:–0.35,–1.44 to 0.74). Limited evidence from an individual RCT suggests microcurrent therapy to be an effective intervention. Conclusions Practitioners can consider eccentric exercise as an initial intervention for AT, with the addition of laser therapy as appropriate. Shock wave therapy may represent an effective alternative. High-quality RCTs following CONSORT guidelines are required to further evaluate the efficacy of physical therapies and determine optimal clinical pathways for AT.

Abstract Background Cultural competence, the ability to work in cross-cultural situations, has been acknowledged as a core skill for physiotherapists and other health professionals. Literature in this area has focused on the rationale for physiotherapists to provide culturally-competent care and the effectiveness of various educational strategies to facilitate the acquisition of knowledge about cultural competence by physiotherapists and physiotherapy students. However, there is a paucity of research on how students with different cultural needs, who are attending one university class, can be accommodated within a framework of learning core physiotherapy skills to achieve professional standards. Results This paper reports on steps which were taken to resolve the specific needs of a culturally-diverse body of first year physiotherapy students, and the impact this had on teaching in a new physiotherapy program located in Greater Western Sydney, Australia. Physiotherapy legislative, accreditation and registration requirements were considered in addition to anti-discrimination legislation and the four ethical principles of decision making. Conclusions Reflection on this issue and the steps taken to resolve it has resulted in the development of a generic framework which focuses on providing quality and equitable physiotherapy education opportunities to all students. This framework is generalizable to other health professions worldwide.

Abstract Background The current investigation examined the inter- and intra-tester reliability of knee joint angle measurements using a flexible Penny and Giles Biometric® electrogoniometer. The clinical utility of electrogoniometry was also addressed. Methods The first study examined the inter- and intra-tester reliability of measurements of knee joint angles in supine, sitting and standing in 35 healthy adults. The second study evaluated inter-tester and intra-tester reliability of knee joint angle measurements in standing and after walking 10 metres in 20 healthy adults, using an enhanced measurement protocol with a more detailed electrogoniometer attachment procedure. Both inter-tester reliability studies involved two testers. Results In the first study, inter-tester reliability (ICC[2,10]) ranged from 0.58–0.71 in supine, 0.68–0.79 in sitting and 0.57–0.80 in standing. The standard error of measurement between testers was less than 3.55° and the limits of agreement ranged from -12.51° to 12.21°. Reliability coefficients for intra-tester reliability (ICC[3,10]) ranged from 0.75–0.76 in supine, 0.86–0.87 in sitting and 0.87–0.88 in standing. The standard error of measurement for repeated measures by the same tester was less than 1.7° and the limits of agreement ranged from -8.13° to 7.90°. The second study showed that using a more detailed electrogoniometer attachment protocol reduced the error of measurement between testers to 0.5°. Conclusion Using a standardised protocol, reliable measures of knee joint angles can be gained in standing, supine and sitting by using a flexible goniometer.

Abstract Background The Active Movement Scale is a frequently used outcome measure for children with obstetric brachial plexus palsy (OBPP). Clinicians observe upper limb movements while the child is playing and quantify them on an 8 point scale. This scale has acceptable reliability however it is not known whether it accurately depicts the movements observed. In this study, therapist-rated Active Movement Scale grades were compared with objectively-quantified range of elbow flexion and extension and shoulder abduction and flexion in children with OBPP. These movements were chosen as they primarily assess the C5, C6 and C7 nerve roots, the most frequently involved in OBPP. Objective quantification of elbow and shoulder movements was undertaken by two-dimensional motion analysis, using the v-scope. Methods Young children diagnosed with OBPP were recruited from the Royal Children's Hospital (Melbourne, Australia) Brachial Plexus registry. They participated in one measurement session where an experienced paediatric physiotherapist facilitated maximal elbow flexion and extension, shoulder abduction and extension through play, and quantified them on the Active Movement Scale. Two-dimensional motion analysis captured the same movements in degrees, which were then converted into Active Movement Score grades using normative reference data. The agreement between the objectively-quantified and therapist-rated grades was determined using percentage agreement and Kappa statistics. Results Thirty children with OBPP participated in the study. All were able to perform elbow and shoulder movements against gravity. Active Movement Score grades ranged from 5 to 7. Two-dimensional motion analysis revealed that full range of movement at the elbow and shoulder was rarely achieved. There was moderate percentage agreement between the objectively-quantified and therapist-rated methods of movement assessment however the therapist frequently over-estimated the range of movement, particularly at the elbow. When adjusted for chance, agreement was equal to chance. Conclusion Visual estimates of elbow and shoulder movement in children with OBPP may not provide true estimates of motion. Future work is required to develop accurate, clinically-acceptable methods of quantifying upper limb active movements. Since few children attained full range of motion, elbow and shoulder movement should be monitored and maintained over time to reduce disability later in life.

Abstract Background Consumers of research (researchers, administrators, educators and clinicians) frequently use standard critical appraisal tools to evaluate the quality of published research reports. However, there is no consensus regarding the most appropriate critical appraisal tool for allied health research. We summarized the content, intent, construction and psychometric properties of published, currently available critical appraisal tools to identify common elements and their relevance to allied health research. Methods A systematic review was undertaken of 121 published critical appraisal tools sourced from 108 papers located on electronic databases and the Internet. The tools were classified according to the study design for which they were intended. Their items were then classified into one of 12 criteria based on their intent. Commonly occurring items were identified. The empirical basis for construction of the tool, the method by which overall quality of the study was established, the psychometric properties of the critical appraisal tools and whether guidelines were provided for their use were also recorded. Results Eighty-seven percent of critical appraisal tools were specific to a research design, with most tools having been developed for experimental studies. There was considerable variability in items contained in the critical appraisal tools. Twelve percent of available tools were developed using specified empirical research. Forty-nine percent of the critical appraisal tools summarized the quality appraisal into a numeric summary score. Few critical appraisal tools had documented evidence of validity of their items, or reliability of use. Guidelines regarding administration of the tools were provided in 43% of cases. Conclusions There was considerable variability in intent, components, construction and psychometric properties of published critical appraisal tools for research reports. There is no "gold standard' critical appraisal tool for any study design, nor is there any widely accepted generic tool that can be applied equally well across study types. No tool was specific to allied health research requirements. Thus interpretation of critical appraisal of research reports currently needs to be considered in light of the properties and intent of the critical appraisal tool chosen for the task.

Abstract Background Spinal pain in young people is a significant source of morbidity in industrialised countries. The carriage of posterior loads by young people has been linked with spinal pain, and the amount of postural change produced by load carriage has been used as a measure of the potential to cause tissue damage. The purpose of this review was to identify, appraise and collate the research evidence regarding load-carriage related postural changes in young people. Methods A systematic literature review sought published literature on the postural effects of load carriage in young people. Sixteen databases were searched, which covered the domains of allied health, childcare, engineering, health, health-research, health-science, medicine and medical sciences. Two independent reviewers graded the papers according to Lloyd-Smith's hierarchy of evidence scale. Papers graded between 1a (meta-analysis of randomised controlled trials) and 2b (well-designed quasi-experimental study) were eligible for inclusion in this review. These papers were quality appraised using a modified Crombie tool. The results informed the collation of research evidence from the papers sourced. Results Seven papers were identified for inclusion in this review. Methodological differences limited our ability to collate evidence. Conclusions Evidence based recommendations for load carriage in young people could not be made based on the results of this systematic review, therefore constraining the use of published literature to inform good load carriage practice for young people.

Relatively little is known about how working students manage their dual roles of work and study. To extend this research, we examined the direct and indirect relationships between boundary flexibility-ability (the appraised capacity to modify a boundary of one role to accommodate better the demands of another role) and boundary flexibility-willingness (the preparedness to do so) in both the work and study domains and outcomes of student burnout and study engagement in a sample of 851 working students (76% female; mean age 20.69 years). We tested the indirect paths via work-study conflict and facilitation. Both work and study flexibility-ability and flexibility-willingness, independently and in concert, were related to student burnout (46% variance explained) and study engagement (28% variance explained) as expected, and results supported work-study conflict and facilitation as underlying mechanisms in these relationships, with the indirect path via work-study conflict being more important than that via work-study facilitation. Thus, there are benefits for students when work and study boundaries are flexible and when students are willing to make use of this flexibility.

We examined how mature-aged, non-traditional students (studying part-time, working full-time) managed their multiple roles by testing a serial, indirect effects model, in which student role congruence (i.e., extent to which students structure role boundaries to meet their own and others' preferences) was related to study engagement, and where work-study conflict/facilitation and exhaustion, in sequence, were underlying mechanisms that explained this relationship. We also untangled congruence between different role boundaries (i.e., work, study, family, leisure) to assess which were more important to facilitate engagement. We found, (N = 211; M = 37 years; 65% women), study engagement was predicted by study (direct and indirect) and leisure congruence (indirect), but not work and family congruence, with these relationships explained by reduced conflict (not facilitation) and, in turn, less exhaustion. The study suggests that how students manage their multiple role boundaries is important as this potentially affects their study engagement.