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Direct access to physiotherapy requires physiotherapists to recognize red flags and determine adequate management plans.Investigate Swiss physiotherapists' ability to diagnose and triage patients in a simulated direct access setting and whether their characteristics were associated with correct diagnoses and decision-making.We conducted a national online survey using a questionnaire containing 12 first-contact case scenarios. A linear mixed model estimated scores for correct diagnoses and management decisions, differences between musculoskeletal (MSK), non-critical medical (non-CrM), and critical medical (CrM) case scenarios, and the estimated effects of physiotherapists' characteristics.The linear mixed model of data from 1492 participants estimated 55.0% correct diagnoses (62.7% for non-CrM, 61.7% for MSK, and 40.5% for CrM scenarios) and 71.2% correct management decisions (78.1% for non-CrM, 73.0% for MSK, and 62.3% for CrM scenarios). For correct diagnoses, the 'academic education/continuing education' variable showed significant estimated effects for the MSK and CrM scenarios, as did 'professional experience' for the non-CrM scenarios, and the '≥ 50% musculoskeletal patients in consultations' variable for all scenario groups. For correct management decisions, 'academic education/continuing education' variable showed significant estimated effects in CrM scenarios, as did 'professional experience' in non-CrM and CrM scenarios, and the '≥ 50% musculoskeletal patients in consultations' variable in MSK scenarios.The estimated effects of physiotherapists' characteristics on correct diagnoses and management decisions showed substantial heterogeneity. Improving Swiss physiotherapists' screening abilities remains important. Further research is required to develop innovative educational concepts and improve training for screening for red flags.

International guidelines recommend the use of exercise, education and weight reduction, when appropriate, as first-line treatment for the conservative management of knee osteoarthritis (OA). These guidelines have not been applied systematically in Switzerland, resulting in an evidence-performance gap. After an analysis of available programmes, the Good Life with osteoArthritis Denmark (GLA:D) programme was determined as the most applicable exercise and education programme for its implementation in Switzerland. The implementation of GLA:D Switzerland OA was initiated to encourage the wider implementation of the clinical guideline recommendations and to improve conservative management of knee OA. The aim of this study protocol is to describe the evaluation of the implementation strategy and its impact on implementation, service and clinical outcomes; as well as to identify contributing barriers and facilitators.The Implementation Research Logic Model will be used to evaluate the strategy and analyse its impact on the implementation outcomes by means of a mixed methods approach. This protocol outlines the proposed measures, data sources and strategies for the evaluation. Predefined implementation outcomes will help to identify the implementation impact and analyse barriers and facilitators systematically. The study population will be the healthcare professionals who are involved in the conservative management of knee OA in Switzerland, that is, physiotherapists and medical doctors, and their patients.The use of the registry data containing data of patients participating in the GLA:D Switzerland OA programme does not fall within the scope of the Swiss Human Research Act (BASEC-Nr. Req-2019-00274). However, all participants involved in the evaluation will be asked to give informed written consent and all measures are taken to protect data and privacy of participants. Research findings will be submitted to journals relevant for the topic.Not applicable.

People living with axial Spondyloarthrtis (axSpA) have an increased risk of cardiovascular diseases, which can be reduced by regular physical activity (PA) and its subset of cardiorespiratory training (CRT). To fulfil their crucial role in PA promotion, physiotherapists and other health professionals need to understand the beliefs that people living with axSpA possess concerning general PA and CRT. The aim of this study is to explore these behavioural, normative and control beliefs.A qualitative descriptive design approach was chosen. Five semi-structured focus group interviews with 24 individuals living with axSpA were performed. Data was analysed using structured thematic qualitative content analysis.People with axSpA possessed multifaceted behavioural, normative and control beliefs concerning general PA and CRT. Behavioural beliefs revealed a positive attitude towards general PA, with participants mentioning numerous physical, psychological, and social benefits and only few risks. However, the conceptual difference between general PA and CRT, and the relevance of CRT, was unclear to some participants. Normative beliefs were expressed as the beliefs of significant others that influenced their motivation to comply with such beliefs, e.g. spouses, other people living with axSpA, rheumatologists. Regarding control beliefs, general PA and CRT were both mentioned as effective self-management strategies to control the disease. From experience, a high level of self-discipline, as well as technology, were shown to be useful.General PA is understood to be an important self-management strategy for people with axSpA and most participants build general PA into their daily routines. They believe that general PA beneficially impacts personal health and wellbeing. However, some participants are unaware of the difference between general PA and CRT and the important impact that this difference could have on their health. The consequences of CRT promotion for people living with axSpA should be the subject of further research.

Objectives: The aim of this study was to assess the applicability of six OARSI (Osteoarthritis Research Society International) approved exercise and education programmes for the conservative management of knee osteoarthritis to the Swiss health care system.Methods: The RE-AIM framework was used in this cross-sectional survey study to analyse the characteristics of the six exercise and education programmes. A survey was developed based on the RE-AIM dimensions, “Reach, Effectiveness, Adoption, Implementation, and Maintenance,” for rating the applicability of the programmes (on a scale of 1 = “least applicable” to 10 = “most applicable”). Programme scores of ≥7 indicated applicability to the Swiss health care system. Nine selected physiotherapy experts for knee OA management in Switzerland were invited for the rating.Results: The six programmes were rated by six of the nine invited research experts with mean scores of between 5.9 and 9.45. Four programmes scored 7 or more. These four programmes all included supervised exercise sessions and education with the goal that the participants understand the diagnosis and the management of OA. The two lower rated programmes focused on exercise counselling or weight reduction.Conclusion: The programme with the highest scores consists of exercise and education and scored higher than 7 in all RE-AIM dimensions. Therefore, this programme is most applicable to the Swiss health care system as only a few adaptations would be needed for its successful implementation.

Objective: Vigorous cardio-respiratory training (vCRT) in patients with axial Spondyloarthritis (axSpA) is effective, safe and feasible, however not yet adopted in axSpA exercise programmes. We therefore aimed to explore the barriers and facilitators for vCRT among patients, physiotherapists (PTs) and rheumatologists. Methods:Stakeholder‐specific surveys were used to examine perceptions of barriers and facilitators to vigorous CRT, with categories organized according to the recommendations proposed by Grol and Wensing. Respondents chose the 3 most important barrier and facilitator categories and rated individual items on a 4‐point scale. Frequencies and proportions were calculated, and ratings between active and inactive patients were compared. Results: Among all patients (n = 575 [response rate 34%]), the top 3 barrier categories were “low motivation” (n = 317 [59%]), “unsuccessful timing in daily routine” (n = 292 [55%]), and “hindering disease symptoms” (n = 272 [51%]). The top 3 facilitator categories were “high motivation” (n = 248 [47%]), “good organizational conditions” (n = 217 [41%]), and “facilitating disease symptoms” (n = 209 [40%]). More inactive patients than active patients chose “low motivation” as a barrier (P = 0.01). Among physiotherapists (n = 40 [response rate 48%]), the top 3 barrier categories were “heterogeneous groups” (n = 26 [70%]), “difficult organizational conditions” (n = 19 [51%]), and “low perceived motivation” (n = 19 [51%]). Among physiotherapists, the top 3 facilitator categories were “knowledge” (n = 20 [54%]), “homogeneous group composition,” and “high perceived motivation” (both n = 17 [46%]). For rheumatologists (n = 73 [response rate 17%], with 54 [74%] answering barrier items and 68 [93%] answering facilitator items), the strongest barriers included “not enough information” (n = 25 [47%]) and “anticipated or perceived disinterest of patient” (n = 27 [50%]). The strongest facilitators reported by rheumatologists included “exercise important topic even in limited consultation time” (n = 65 [96%]) and “clear evidence for effectiveness of flexibility exercises” (n = 62 [91%]). Conclusion: The identified facilitators and barriers will guide the development of stakeholder‐specific implementation strategies.

Background Children with severe congenital heart disease (CHD) are a group of children at risk for neurodevelopmental impairments. Motor development is the first domain to show a delay during the first year of life and may significantly contribute to parental concerns, stress, and difficulties in early child-parent attachment. Thus, the aim of the study was to better understand the wishes and concerns of parents of children with CHD and explore their experience of their children’s neuromotor development in the first year of life. Methods In this qualitative study, fourteen families were recruited. Their children were aged 1–3 years and had undergone open heart surgery within the first 6 months of life. Semi-structured interviews were audio-recorded and transcribed. The data was explored within an expert group, and a qualitative content analysis was conducted using VERBI MAXQDA software 2020. The study was conducted in accordance with the COREQ checklist. Results Parents of children with CHD reported several burdens and needs. Parental burdens concerned the child’s motor development, their own physical and psychological strain, and difficulties in communication with healthcare professionals. The needs, parents reported included supporting their child’s motor development, a medical coordinator, and better communication between healthcare professionals and parents. During the first phase of their children’s illness, parents underwent a dynamic transitional phase and expressed the need to rely on themselves, to trust their children’s abilities, and to regain self-determination in order to strengthen their self-confidence. Conclusions It is essential to involve parents of children with CHD at an early stage of decision-making. Parents are experts in their children and appreciate medical information provided by healthcare professionals. Interprofessional teamwork, partnering with parents, and continuous support are crucial to providing the best possible care for children and their families. Family-centred early motor intervention for CHD children might counteract the effect of parental overprotection and improve children’s motor development and thus strengthen child-parent interaction. In future work, we aim to evaluate a family-centred early motor intervention for children with CHD developed on the basis of this qualitative study. Trial registration Not applicable.

A prototype assistive therapy chair (T-Chair) that induces exercise stimuli to improve trunk control and standing and walking early after stroke has been developed. The aim of this study was to assess its usability in a rehabilitation setting. Eleven physical therapists (PTs) integrated the T-Chair into the therapy programs of 15 patients post stroke. Each patient performed on average four individual therapy sessions on the T-Chair under the PTs' supervision. Usability was assessed using questionnaires, therapy diaries and focus group interviews with PTs'. Among PTs’, 64% had generally a positive view on the T-Chair. Physical therapists recognized the potential for unsupervised therapy. Generally, patients reacted positively and enjoyed training. The T-Chair has the potential to become an adequate training tool for patients with an intermediate trunk control after stroke. Further development and usability testing are required to provide a therapeutic device allowing for an intensive therapy early post stroke.

Zusammenfassung Hintergrund Die ältere Bevölkerung einer 100 000 Einwohner zählenden Schweizer Stadt wurde mittels der 3-monatigen Kampagne „60plus-lustvoll mobil“ mit 4 frei wählbaren Angeboten (Vorträge, individuelle Beratung, Gangsicherheits- und Rhythmik-Kurse) auf die Wichtigkeit von körperlicher Aktivität aufmerksam gemacht. Ziel Das Ziel der hier präsentierten Begleitforschung war die Untersuchung der die Teilnahme an der Kampagne beeinflussenden Faktoren, um für zukünftige ähnliche Kampagnen Empfehlungen zu formulieren. Methode Die Teilnehmer der verschiedenen Angebote der Kampagne wurden in einer Querschnittsstudie mit einem auf das Angebot zugeschnittenen Fragebogen befragt. Ergebnisse Die meistgenutzten Angebote waren die individuelle Beratung mit 195 Besuchern (35 % Rücklauf, n = 68) und der Vortrag mit 75 Besuchern (61 % Rücklauf, n = 46). Die häufigsten Förderfaktoren zur Teilnahme umfassten für den Vortrag „Neugierde“ (76 %), für die Beratung „Wunsch, mehr zu wissen“ (64 %), für den Gangsicherheitskurs „Gangsicherheit“ (94 %) und für den Rhythmik-60plus-Kurs „Verbesserung des Gleichgewichts und der Leistungsfähigkeit“ (71 %). Als Barriere für die Nutzung eines anderen Angebots wurde am häufigsten „kein Bedarf“ genannt. Schlussfolgerung Die Teilnehmer der Kampagne erwiesen sich als neugierig, wollten mehr Wissen erwerben und etwas für ihre Gesundheit tun. Sie bevorzugten mehrheitlich eine individuelle Beratung zur körperlichen Aktivität und nutzten die Kurse spezifisch und problemorientiert. Ihre klaren Titel unterstützten sie darin, das für sie richtige Angebot zu wählen. Auch zukünftige Kampagnen sollten spezifische und problemorientierte Angebote beinhalten.

Zusammenfassung Hintergrund In Ländern mit Direktzugang zur Physiotherapie wählen Physiotherapeuten autonom das bevorzugte Heilmittel zur Behandlung ihrer Patienten. Anders gestaltet sich die Situation in Deutschland: Hier verordnen die Ärzte das zu verwendende Heilmittel. Ziel Im Rahmen des Modellvorhabens Physiotherapie gemäß § 63 Abs. 3b SGB V wird (unter anderem) evaluiert, welche Heilmittel bei Behandlungsautonomie in welcher Frequenz und Dauer angewendet werden und welche Auswirkungen diese Wahl auf die Behandlungsergebnisse der Patienten hat. Methode Eine randomisierte kontrollierte Studie vergleicht die herkömmliche Behandlung nach ärztlicher Verordnung mit der Behandlung im neuen Versorgungsmodell hinsichtlich Wahl der Heilmittel, Behandlungsdauer und -frequenz sowie den Behandlungsergebnissen Patientenzufriedenheit (Fragebogen ZUF-8), Schmerz (visuelle Analogskala, VAS), gesundheitsbezogene Lebensqualität (Fragebogen EuroQol) und Funktion (Back Performance Scale [BPS], Roland-Morris Disability Questionnaire [RMDQ], Lower Extremity Functional Scale [LEFS]). Ergebnisse Am Modellvorhaben nahmen 630 Patienten teil, davon 296 in der Kontroll- (KG) und 334 in der Modellgruppe (MG). In der MG wendeten die Physiotherapeuten häufiger (in 33 % der Fälle) Allgemeine Krankengymnastik (AKG) und/oder Manuelle Therapie (MT) zusammen mit einem ergänzenden Heilmittel (z. B. Wärmetherapie-Fango) an (vs. 10 % in der KG; x2 = 51,525, p Schlussfolgerung Bei Behandlungsfreiheit entschieden sich Physiotherapeuten vermehrt für eine Kombination von aktiven und passiven Behandlungstechniken, ohne die Behandlungsdauer auszudehnen. Dieses Vorgehen ist mit international anerkannten Behandlungsleitlinien konform.

Background: International Guidelines recommend self-management, exercise and weight management if appropriate as first line conservative treatment for patients with knee osteoarthritis (OA). The objective of this study was to survey the conservative non-pharmacological management of patients with knee OA in Switzerland and to explore perceived barriers and facilitators for the application of guideline recommendations. Methods: Based on the results of semi-structured interviews with selected general practitioners (GPs), rheumatologists and orthopaedic surgeons, a survey was performed across their scientific societies. Questions addressed diagnostic measures, treatment options, reasons for referral to exercise as well as barriers and facilitators. Results: In total, 234 members responded. They indicated that usually patients presented due to pain (n=222, 98.2%) and functional limitations of the knee (n=151, 66.8%). Additionally to clinical assessment X-ray (n=214, 95.5%) and MRI (n=70, 31.3%) were used as diagnostic measures. The referral to exercise, was driven by the patients’ expectation/high level of suffering (n=73, 37.1%), as well as by their own clinical experience (n=49, 24.9%). They estimated to refer 54% of their patients to exercise. Further, the specialists rated as the most important barriers for the referral to exercise ‘disinterest of patient’ (n=88, 46.3%) and ‘physically active patient’ (n=59, 31.1%). As most important facilitators, they rated ‘priority to mention exercise during short time of consultation’ (n=170, 89.4%) and ‘insufficiently physically active patient’ (n=165, 86.9%). Conclusion: A substantial evidence-performance gap in the management of patients with knee OA seems to be present. To successfully support systematic referral to exercise as first line intervention, it may be important to not simply suggest exercise in general, but a specific best-practice exercise and education programme for knee OA.

Research directly related to physiotherapy treatment is of highest priority. It should focus on diagnostic groups related to chronicity in anticipation of demographic changes. Multidisciplinary networks for research and practice, alongside sound coordination of research projects, should increase the impact of physiotherapy research. An accurate dissemination of research priorities, defined and supported by multiple stakeholder groups, might strengthen their impact on research and practice.

Background Since 2002, the professional education for Swiss physiotherapists has been upgraded to a tertiary educational level. With this change, the need for research related to professional practice has become more salient. The elaboration of research priorities is seen as a possible way to determine the profession's needs, to help coordinate research collaborations and to address expectations regarding physiotherapy. There is still limited evidence about stakeholders' views with regard to physiotherapy research. The objective of this study was to investigate key stakeholders' opinions about research in physiotherapy in Switzerland. Methods Focus groups with patients, health professionals, researchers and representatives of public health organizations were conducted, and semi-structured interviews were conducted with politicians, health insurers and medical doctors from three linguistic regions in Switzerland. An interview guide was elaborated. Data were transcribed and analysed using inductive content analysis (Atlas-ti 6®). Results Eighteen focus groups and 23 interviews/written commentaries included 134 participants with various research experiences and from different settings. Fourteen categories were defined reflecting three themes: identity, interdisciplinarity and visibility. Stakeholders had positive views about the profession and perceived physiotherapists' important role now and in the future. Yet, they also felt that physiotherapy was not sufficiently recognized in society and not visible enough. A stronger professional identity would be key to enhancing interdisciplinary work. Conclusions Results of this qualitative study provide insights into key aspects for moving the physiotherapy profession forward. Identity is at the heart of physiotherapy, not necessarily in terms of research priorities but in the definition of domains of competence and future positioning. Identity is also tightly connected to Interdisciplinarity as this might threaten the existence of the profession. Stakeholders outside the profession insist on the importance of visibility. The results of this study can help stakeholders reflect on the future of physiotherapy and elaborate research priorities. © 2013 The Authors. Physiotherapy Research International published by John Wiley & Sons Ltd.

BACKGROUND A growing body of literature documents associations of maternal psychosocial stress during pregnancy with fetal, infant and child behaviour and development. However, findings across studies are often inconsistent, which may in part be due to differences in stress definitions and assessments. METHODS We systematically reviewed methods applied to assess maternal psychosocial stress during pregnancy in studies looking at associations with biobehavioural outcomes in the offspring. A systematic literature search was performed on Web of Science and PubMed for the time period between January 1999 and October 2009. Psychometric instruments assessing maternal psychosocial stress during pregnancy were identified and described if data on psychometric properties were available. RESULTS We identified 115 publications that assessed psychosocial stress during pregnancy with validated methods. These publications applied overall 43 different instruments assessing constructs falling under seven categories, ordered according to their frequency of use: anxiety, depression, daily hassles, aspects of psychological symptomatology (not reduced to anxiety or depression), life events, specific socio-environmental stressors and stress related to pregnancy and parenting. If available, we provide information on validity and reliability of the instruments for samples of pregnant women. CONCLUSIONS Within the 'prenatal stress' research, a broad range of instruments is applied to assess psychosocial stress during pregnancy. Prenatal stress research should take into consideration that the variety of methods in use might hamper the comparability of stress research results. In each category of stress constructs, one instrument with good psychometric properties in pregnant women is highlighted as the best currently available measure.

Contexte : L'introduction de la reforme de Bologne en 2006 a amene le deplacement du systeme de formation des physiotherapeutes suisses du niveau professionnel au niveau academique. Cela a ouvert une discussion concernant l'acces direct a la physiotherapie. Objectif : L'objectif de cette enquete menee au moyen d'un questionnaire etait de connaitre la position des physiotherapeutes de Suisse par rapport a l'acces direct et de savoir s'ils s'estimaient en mesure de fournir cet acces direct. Methode : Apres la validation linguistique et culturelle du questionnaire, celui-ci a ete envoye aux membres de l'Association suisse de physiotherapie en mai 2010. Le taux de retour s'est eleve a 27 %. Resultats : La majorite (86 %) des physiotherapeutes interroges est favorable a l'introduction de l'acces direct en Suisse et 84 % s'estiment en mesure de pouvoir l'offrir. Soixante pour cent des repondants estiment cependant que des qualifications complementaires sont necessaires. Une connaissance approfondie de la pathologie (drapeaux rouges 90 %, diagnostic differentiel 75 % et participation a des formations continues 65 %) ont ete le plus souvent cites. Conclusion : Les physiotherapeutes de Suisse manifestent une attitude positive envers l'introduction de l'acces direct. Ces resultats sont comparables a ceux d'une enquete menee en Allemagne. Il est necessaire de prevoir des etapes complementaires pour introduire l'acces direct en Suisse, par exemple mener un projet-pilote comportant des objectifs realistes. Niveau de preuve : non adapte

Hintergrund: Mit der Einfuhrung der Bologna-Reform im Jahr 2006 wurde das Ausbildungssystem der Physiotherapeuten in der Schweiz auf akademisches Niveau angehoben. Dies hat zu einer Diskussion hinsichtlich des Direktzugangs zur Physiotherapie gefuhrt. Ziel: Ziel dieser Fragebogenuntersuchung war es, die Einstellung von Physiotherapeuten in der Schweiz zum Direktzugang zu erfahren und ob sie sich einen Direktzugang zutrauen. Methode: Nach einer kulturellen und sprachlichen Validierung der Befragungsinstrumente wurde der Fragebogen im Mai 2010 an die Mitglieder des Schweizer Physiotherapie Verbandes verschickt. Die Rucklaufquote betrug 27 %. Ergebnisse: Die Mehrheit (86 %) der befragten Physiotherapeuten befurwortet die Einfuhrung des Direktzugangs in der Schweiz, und 84 % trauen sich den Direktzugang auch zu. Laut 60 % der Befragten sind dafur jedoch zusatzliche Qualifikationen unabdingbar. Umfassendes Wissen uber Pathologie (Red Flags; 90 %), Differenzialdiagnostik (75 %) und die Teilnahme an Weiterbildungen (65 %) werden am wichtigsten erachtet. Schlussfolgerungen: Physiotherapeuten in der Schweiz zeigen eine positive Einstellung gegenuber dem Direktzugang. Damit liegen vergleichbare Ergebnisse mit Deutschland vor. Weitere Schritte sind notwendig, um den Direktzugang in der Schweiz voranzubringen, wie z. B. die Durchfuhrung von Pilotprojekten mit realistischen Zielen.

Postpartum depression (PPD) affects up to 19% of all women after parturition. The non-apeptide oxytocin (OXT) is involved in adjustment to pregnancy, maternal behavior, and bonding. Our aim was to examine the possible association between plasma OXT during pregnancy and the development of PPD symptoms. A total of 74 healthy, pregnant women were included in this prospective study. During the third trimester of pregnancy and within 2 weeks after parturition, PPD symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Blood samples for plasma OXT assessment were collected in the third trimester. Following the literature, participants with postpartum EPDS scores of 10 or more were regarded as being at risk for PPD development (rPPD group). In a logistic regression analysis, plasma OXT was included as a potential predictor for being at risk for PPD. Results were controlled for prepartal EPDS score, sociodemographic and birth-outcome variables. Plasma OXT concentration in mid-pregnancy significantly predicted PPD symptoms at 2 weeks postpartum. Compared with the no-risk-for-PPD group, the rPPD group was characterized by lower plasma OXT concentrations. To our knowledge, this is the first study to show an association between prepartal plasma OXT concentration and postpartal symptoms of PPD in humans. Assuming a causal relationship, enhancing OXT release during pregnancy could serve as a potential target in prepartum PPD prevention, and help to minimize adverse effects of PPD on the mother-child relationship.

Erworben im Rahmen der Schweizer Nationallizenzen (http://www.nationallizenzen.ch), The aim of this study was to investigate whether maternal adversities and cortisol levels during pregnancy predict cord blood DNA methylation of the oxytocin receptor (OXTR). We collected cord blood of 39 babies born to mothers participating in a cross-sectional study (N = 100) conducted in Basel, Switzerland (2007-10). Mothers completed the Inventory of Life Events (second trimester: T2), the Edinburgh Postnatal Depression Scale (EPDS, third trimester: T3), the Trier Inventory of Chronic Stress (TICS-K, 1-3 weeks postpartum) and provided saliva samples (T2, T3) for maternal cortisol profiles, as computed by the area under the curve with respect to ground (AUCg) or increase (AUCi) for the cortisol awakening response (CAR) and for diurnal cortisol profiles (DAY). OXTR DNA methylation was quantified using Sequenom EpiTYPER. The number of stressful life events (P = 0.032), EPDS score (P = 0.007) and cortisol AUCgs at T2 (CAR: P = 0.020; DAY: P = 0.024) were negatively associated with OXTR DNA methylation. Our findings suggest that distinct prenatal adversities predict decreased DNA methylation in a gene that is relevant for childbirth, maternal behavior and wellbeing of mother and offspring. If a reduced OXTR methylation increases OXTR expression, our findings could suggest an epigenetic adaptation to an adverse early environment.

Research priorities, defined by multiple stakeholders, can proximally facilitate the coordination of research projects and national and international cooperation and distally further improve the quality of physiotherapy practice. The aim of this study was therefore to establish physiotherapy research priorities in Switzerland considering multiple stakeholders' opinions.A mixed methods design was chosen. For a qualitative identification of physiotherapy research topics, 18 focus group discussions and 23 semi-structured interviews/written commentaries were conducted. For the quantitative analysis, 420 participants prioritized research topics using a two-round Delphi questionnaire survey. The following stakeholder groups were surveyed in the German-speaking, French-speaking and Italian-speaking regions of Switzerland: physiotherapy researchers, practitioners and educators, representatives of patient organizations, public health organizations, health insurers, physicians, nurses, occupational therapists and other health professionals, as well as physical educators.The top five overall physiotherapy research priorities identified were as follows: physiotherapy treatment, physiotherapy assessment and diagnosis, prevention, physiotherapist-patient interaction and physiotherapy professional education at the bachelor level. With regard to diagnostic groups, the highest priorities were placed on musculoskeletal disorders, neurology, orthopaedics, geriatrics and ergonomics/occupational health. Consensus was moderate to high, and only few differences between stakeholder groups were revealed.Research directly related to physiotherapy treatment is of highest priority. It should focus on diagnostic groups related to chronicity in anticipation of demographic changes. Multidisciplinary networks for research and practice, alongside sound coordination of research projects, should increase the impact of physiotherapy research. An accurate dissemination of research priorities, defined and supported by multiple stakeholder groups, might strengthen their impact on research and practice. Copyright © 2015 John WileySons, Ltd.

A growing body of literature documents associations of maternal psychosocial stress during pregnancy with fetal, infant and child behaviour and development. However, findings across studies are often inconsistent, which may in part be due to differences in stress definitions and assessments.We systematically reviewed methods applied to assess maternal psychosocial stress during pregnancy in studies looking at associations with biobehavioural outcomes in the offspring. A systematic literature search was performed on Web of Science and PubMed for the time period between January 1999 and October 2009. Psychometric instruments assessing maternal psychosocial stress during pregnancy were identified and described if data on psychometric properties were available.We identified 115 publications that assessed psychosocial stress during pregnancy with validated methods. These publications applied overall 43 different instruments assessing constructs falling under seven categories, ordered according to their frequency of use: anxiety, depression, daily hassles, aspects of psychological symptomatology (not reduced to anxiety or depression), life events, specific socio-environmental stressors and stress related to pregnancy and parenting. If available, we provide information on validity and reliability of the instruments for samples of pregnant women.Within the 'prenatal stress' research, a broad range of instruments is applied to assess psychosocial stress during pregnancy. Prenatal stress research should take into consideration that the variety of methods in use might hamper the comparability of stress research results. In each category of stress constructs, one instrument with good psychometric properties in pregnant women is highlighted as the best currently available measure.

Hintergrund: Der Direktzugang zur Physiotherapie birgt die Chance, antizipierte Engpasse im Gesundheitswesen zu verhindern. Schweizer Physiotherapeuten befurworten mehrheitlich dessen Einfuhrung. Ziel: Die vorliegende Studie analysierte die Entscheidungen von Physiotherapeuten beim Erstkontakt mit Patienten. Methode: An die 7874 Mitglieder des Schweizer Physiotherapieverbands wurde ein zuvor validierter Fragebogen mit 12 klinischen Fallbeispielen geschickt. Die Teilnehmer entschieden fur jedes Fallbeispiel, ob eine physiotherapeutische Behandlung indiziert und/oder eine Uberweisung in medizinische Behandlung notwendig war. Ergebnisse: An der Studie nahmen 2137 Mitglieder teil. Durchschnittlich 76 % der Physiotherapeuten wahlten die richtige Vorgehensweise in Fallen, in denen eine physiotherapeutische Intervention indiziert und eine Uberweisung in arztliche Behandlung nicht notwendig war. In medizinischen, aber nicht kritischen Fallen uberwiesen durchschnittlich 81 % der Befragten korrekt in medizinische Behandlung. In kritischen medizinischen Fallen uberwiesen 67 % korrekt und ohne gleichzeitige Aufnahme einer Physiotherapie. Schlussfolgerungen: Die Mehrheit der befragten Schweizer Physiotherapeuten entschied in den meisten Fallbeispielen korrekt uber das weitere Vorgehen, obwohl die Uberweisungsfunktion in der heutigen Praxis nicht gefordert wird. In Bezug auf kritische medizinische Bedingungen sollen kunftige Studien die Vertiefung der Kompetenzen in den Bereichen Pathologie und Differenzialdiagnostik prufen.

Background Physical inactivity contributes substantially to the increased risk for cardiovascular diseases in patients with ankylosing spondylitis (AS) (1). There is evidence that cardiovascular training (CVT) is effective, feasible and safe for AS patients (2). Therefore, CVT should be implemented in AS exercise classes. The attitudes of the target groups guide this implementation process (3). Objectives To explore the perceived facilitators and barriers of performing and providing CVT among AS patients and physiotherapists (PTs) respectively. Methods Three focus groups with AS patients (n=18) and four focused interviews with PTs (n=4) provided facilitators and barriers that were grouped in “categories”. The importance of these categories was ranked in subsequent online surveys among 1710 active members of the Swiss AS patient organisation (SVMB) and 84 PTs leading the SVMB exercise groups on a 4-point scale (from “not facilitating/hindering at all” to “very facilitating/hindering”). Results Patients. Focus groups: Identified categories were: coping; disease-related symptoms; knowledge; motivation; outcome expectations; structural/environmental conditions; social support, and timing in daily routine. Survey: 704 patients responded (41.2%), 43% were women, 35.8% attended exercise groups; mean age was 51.9 (SD ±12.8) years. The three top ranked categories were both, facilitators and barriers: “high/low motivation” (facilitator for 47.1%, barrier for 59.5% of patients), “successful/unsuccessful timing in daily routine” (35.2% and 55%) and “disease-related symptoms” (39.5% and 51.4%). PTs. Focused interviews : Identified categories were: group composition; knowledge; motivation; outcome expectations; structural/environmental conditions; support from SVMB, and timing in exercise group. Survey: 47 PTs responded (56%), 82.2% were women, mean age was 43.76 (SD ±11.84) years, mean experience with AS groups was 10.11 (SD ±7.96) years, 20.5% reported including CVT “always” in their exercise set. Two top ranked categories were both, facilitators and barriers: 9group composition9 (facilitator “age homogeneity” for 58.3%, barrier “heterogeneous health/fitness status of participants” for 70.3%) and “high/low motivation” (45.9% and 51.4%). “Knowledge” (about design of CVT) was an important facilitator (54.1%). Another important barrier was “difficult structural/environmental conditions” (unsuitable facilities, missing equipment and outdoor possibilities) (51.4%). For over 90% of the patients and PTs “outcome expectations” was a facilitator. Conclusions The facilitators and barriers perceived by AS patients and PTs are crucial when implementing CVT in AS-interventions. Facilitators suggest promising approaches, barriers anticipate challenges and request targeted solutions. References Kang J et al. Comorbidity profiles among patients with anylosing spondylitis: a nationwide population-based study. Annals of the rheumatic diseases. 2010;34(3):1165-8 Niedermann K et al. Cardiovascular training improves fitness in patients with ankylosing spondylitis. Arthritis Care Res (Hoboken). 2013 Jul 8. doi: 10.1002/acr.22062 Grol R, Wensing M, Eccles M. Improving patient care. The implementation of change in clinical practice. 2005. Elsevier Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.4408

Background The feasibility of effective fall prevention programmes (FPPs) for use in daily clinical practice needs to be assessed in the specific healthcare settings. The aim of this study was to explore the perceived benefits and barriers of an evidence-based, home-based pilot FPP among the involved seniors, general practitioners (GPs), home care nurses (HCNs) and physiotherapists (PTs), in order to develop tailored implementation strategies. Methods The study was a mixed method study using an ‘exploratory sequential design’. In the initial qualitative sequence, semi-structured interviews were performed with four participants from each group and analysed using a deductive content analysis. In the successive quantitative sequence, target group specific postal surveys were conducted with all participants. The triangulation of both steps allowed merging the in-depth experiences from the interviews with the general findings from the survey. Results In this evaluation study participated 17 seniors (mean age 79.7 (SD +/-6.2) years). 40 GPs, 12 HCNs and four PTs. All were satisfied with the organization and processes of the FPP. The main benefit, perceived by each target group, was the usefulness of the FPP in detecting risk of falling at the senior’s home. A low number of recruiting GPs and HCNs, divergent opinions of the health professionals towards the aim of the FPP as well as no perceived need for changes by the seniors were the most important barriers to the participation of (more) seniors. Conclusions Multidisciplinary home-based fall prevention is a useful approach to detect the risk of falling in seniors. The barriers identified need to be resolved through tailored strategies to facilitate the successful nationwide implementation of this pilot FPP. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1719-5) contains supplementary material, which is available to authorized users.

Objective Hypothalamic-pituitary-adrenal (HPA) activation during pregnancy is linked to dysfunctional behavioral outcomes in the offspring. According to Belsky's differential susceptibility hypothesis, individuals vary regarding their developmental plasticity. Translating the differential susceptibility hypothesis to the field of fetal programming, we hypothesize that infants' temperament, as the constitutionally based reactivity to stimulation, moderates prenatal environmental effects on postnatal emotion regulation. Methods Maternal HPA axis activity and stress-reactivity during pregnancy was estimated, by measuring cortisol concentrations in saliva, collected at 0, 30, 45 and 60 min after awakening and in blood, collected during a laboratory stress test (Trier Social Stress Test), respectively. Newborns reactivity to stimulation was evaluated between postnatal day 10 and 14 using the Neonatal Intensive Care Unit Network Neurobehavioral Scale. Infant's self-quieting-activities, as an indicator of emotion regulation, were evaluated at the age of six months during the still face paradigm. Results Maternal cortisol reactivity to stress during pregnancy was associated with infant's emotion regulation at the age of six months. Whereas cortisol levels after awakening in mid and late pregnancy were not associated with emotion regulation. Furthermore, regression analyses revealed that in interaction with neonatal reactivity, both, prenatal maternal HPA activity as well as prenatal maternal HPA reactivity to stress predicted emotion regulation. Conclusion The findings indicate that newborns' reactivity to stimulation is moderating the association between prenatal exposure to maternal glucocorticoids and emotion regulation in infancy. Data suggests that temperamental characteristics of the newborn are a relevant differential susceptibility factor with regard to prenatal effects on emotion regulation.

Background: A growing body of literature documents associations of maternal psychosocial stress during pregnancy with fetal, infant and child behaviour and development. However, findings across studies are often inconsistent, which may in part be due to differences in stress definitions and assessments. Methods: We systematically reviewed methods applied to assess maternal psychosocial stress during pregnancy in studies looking at associations with biobehavioural outcomes in the offspring. A systematic literature search was performed on Web of Science and PubMed for the time period between January 1999 and October 2009. Psychometric instruments assessing maternal psychosocial stress during pregnancy were identified and described if data on psychometric properties were available. Results: We identified 115 publications that assessed psychosocial stress during pregnancy with validated methods. These publications applied overall 43 different instruments assessing constructs falling under seven categories, ordered according to their frequency of use: anxiety, depression, daily hassles, aspects of psychological symptomatology (not reduced to anxiety or depression), life events, specific socio‐environmental stressors and stress related to pregnancy and parenting. If available, we provide information on validity and reliability of the instruments for samples of pregnant women. Conclusions: Within the ‘prenatal stress’ research, a broad range of instruments is applied to assess psychosocial stress during pregnancy. Prenatal stress research should take into consideration that the variety of methods in use might hamper the comparability of stress research results. In each category of stress constructs, one instrument with good psychometric properties in pregnant women is highlighted as the best currently available measure.