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Evidence-based practice (EBP) refers to the integration of scientific evidence into the clinical setting. This study aimed to determine whether Latin American physiotherapists use EBP, analyze the associated factors, barriers, and facilitators, and examine the relationships between these elements in clinical practice. To conduct this cross-sectional study, the web-based questionnaire survey method was chosen. Survey was self-administered questionnaires to assess understanding of various EBP-related terms and determine their knowledge and ability to apply these concepts in clinical practice. The association between attitudes, awareness, and knowledge scores and the demographic data such as age group, years of experience, professional membership registry, and self-reported education was assessed. The questionnaire was distributed to a total of 5000 physical therapists, of which 4099 (82%) responded from seven Latin American countries (Argentina, Bolivia, Chile, Colombia, México, Perú, and Venezuela), between June 1, 2020, and May 31, 2024. Overall, the physical therapists had positive attitudes, beliefs, and interests in EBP. Their educational background, knowledge, and skills related to assessing and interpreting information were associated to the use of EBP. In addition, 53% of respondents indicated that lack of time was the main obstacle to the use of EBP. The top 3 barriers included insufficient time (53%), lack of information resources (20.8%), and lack of research tools (13.6%). Among Latin American physical therapists, individual characteristics workplace, clinical experience, educational background, and demographic characteristics, may behave as facilitators or barriers when performing an EBP. Thus, identifying methods and strategies to support physical therapists in adopting EBP in the Latin American is necessary. The academization of physiotherapy training might change this in the future., (© 2024. The Author(s).)

Aim: To investigate the influence of contextual framing on physio- and occupational therapists' clinical reasoning in sensory rooms for patients admitted to psychiatric units., Material and Method: Physiotherapists and occupational therapists from acute and intensive care units with sensory rooms were invited to participate in the study. The therapists were interviewed following sessions with patients in sensory rooms, using a semi-structured interview guide. These therapists also participated in a focus group interview. All interviews were transcribed and analysed based on the thematic analysis by Braun and Clarke., Results: Twenty individual interviews and one focus group interview were conducted with seven physio- and occupational therapists. Three themes with accompanying subthemes emerged: (i) The contextual influence: Therapists' perceptions of the use of sensory rooms, The dominance of the medical paradigm). (ii) The therapeutic alliance: The therapists' relational skills, The importance of a good therapeutic patient relation, and Physio- and occupational therapy in a psychiatric setting.: (iii) The therapeutic diagnosis, Therapeutic sensory room interventions, and Holistic approach in a limited timeframe ., Conclusion: The clinical reasoning of physio- and occupational therapists in sensory-modulating sessions for patients admitted to psychiatric units is influenced by a primarily medically dominated paradigm; legally, economically, and politically. Occupational therapists mainly focus on everyday skills and being in the present, whereas physiotherapists focused on activities with bodily anchoring and awareness.

Purpose: To explore distal radius fracture (DRF) patients' and hand therapist/occupational therapist/physiotherapists' perceptions of integrating home and family work roles (HFWR) into rehabilitation., Methods: Eighteen patients and eleven therapists completed a semi-structured telephone interview three months after DRF. Reflexive thematic analysis of the interviews and triangulation of patients' and therapists' themes was performed., Results: The patient interview yielded five themes: the experience of rehabilitation; predetermined expectations of rehabilitation; incorporating HFWR into therapy sessions; varying patient needs for addressing HFWR; and determination to return to valued activities drives behavioral choices. The therapists' interview yielded five themes: The challenges in integrating HFWR into rehabilitation; HFWR addressed when brought up by a patient; working context and referral sources influence the rehabilitation plan; rehabilitation is not explicitly tailored according to sex and gender; and utilizing HFWR as a rehabilitation strategy is perceived beneficial., Conclusions: Patients have predetermined rehabilitation expectations primarily focused on mobility and strengthening exercises. Therapists and patients agree that adapting home and family work roles is beneficial but was not a major focus for either therapists' or patients' expectations during therapy. An unfavourable environment, patient budget constraints, and limited time were identified as challenges to integrating family roles.

Purpose: There is a growing number of primary contact physiotherapists based in United Kingdom emergency departments (ED) who are expected to deliver person-centred practices. Perceptions of physiotherapists working in these high-pressure environments on person-centredness are currently unknown. A mixed methods exploration of person-centredness among ED physiotherapists targeted this knowledge gap to inform future clinical practice., Methods: Online survey and semi-structured interviews followed a convergent mixed methods design with sequential explanatory features. Data sets were analysed separately using descriptive statistics and thematic analysis, respectively, before merged analysis using joint display., Results: Twenty-six surveys and 11 in-depth interviews were completed. The three overarching themes of ED patients, ED physiotherapists, and ED environment were generated. Themes were integrated and analysed alongside quantitative survey findings. This produced three novel contributions that further our understanding of person-centred practices among ED physiotherapists., Conclusion: ED physiotherapists were mindful of an apparent, yet unspoken struggle between the competing philosophies of biomedicine and person-centredness. The results here support entering a patient's world as a person-centred approach to help navigate the line between what an ED attender wants and the clinical need of their visit.

Background: Some physiotherapists find assessing and managing clients experiencing psychological distress challenging and are uncertain regarding the boundaries of the profession's scope., Objective: To map the approaches recommended for physiotherapists in scholarly literature, with respect to the assessment and management of clients experiencing psychological distress., Methods: A systematic mapping review was conducted. CINAHL, APA PsycINFO, Embase, and Medline ALL databases were systematically searched for secondary and tertiary literature relevant to the research objective. Recommended approaches were extracted from each article and analyzed descriptively and thematically., Results: 3884 records were identified with 40 articles meeting the inclusion/exclusion criteria. Most recommendations related to identifying, assessing, and managing pain-related distress, with depression screening and referral also receiving some attention. Three approaches to detecting and assessing psychological distress were identified: 1) brief depression screen; 2) integrated suicide/nonsuicidal self-harm and depression screen; and 3) multidimensional screen and health-related distress assessment. Regarding the management of psychological distress the main approaches identified were: 1) education and reassurance; 2) cognitive-behavioral approaches; 3) mindfulness; and 4) case management., Conclusion: While assessment and management of health-related distress by physiotherapists is commonly recommended, further guidance is needed to differentiate various forms of distress.

Background and Introduction: Pain is a subjective phenomenon, that is often misunderstood and invalidated. Despite recent advances in health professional training, it remains unclear how students should be taught about the subjectivity of pain. This study explored how a novel teaching activity that integrated physiotherapy students' first-hand experiences with laboratory-induced pain could address this gap., Objective: The study aimed to explore the experiences and perceptions of physiotherapy students in relation to a workshop where physiotherapy students experienced laboratory induced pain., Methods: We used a descriptive qualitative research design. Eighteen students participated in interviews. Transcripts were analyzed using an inductive conventional content analysis., Results: We identified four overarching themes: 1) First-hand pain experiences facilitated engagement in learning; 2) Reflecting on these personal and peer pain experiences helped students make sense of pain; 3) The learning activity helped students understand the inherent subjectivity and complexity of pain; and 4) Students saw benefits for clinical practice., Conclusion: Integrating first-hand pain experiences within entry-level physiotherapy training appears to have novel value in helping students understand pain subjectivity. Future research should use robust and controlled designs to explore how this novel approach can be used to facilitate further understanding and empathy within clinical interactions with people living with pain.

Introduction/objective: The purposes of this study were to determine the presence of burnout in physical therapists and physical therapist assistants, examine differences in burnout between demographic groups, and explore circumstances that contribute to and alleviate burnout., Methods: A cross-sectional survey consisting of demographic questions, the Maslach Burnout Inventory, and open-ended questions was conducted within two health systems. Descriptive statistics and nonparametric tests were used to analyze responses to close-ended questions and to examine differences between groups. Thematic analysis was used to analyze open-ended questions., Results: In total, 202 individuals participated in the study; 146 participants responded to at least one open-ended question (72.3%). Participants, regardless of demographic characteristic, demonstrated at least some degree of burnout on each subscale. Ten major themes emerged from analysis of circumstances that contribute to and alleviate burnout: 1) workload; 2) schedule; 3) work-life balance; 4) care continuum; 5) coping/morale; 6) team dynamics and resources; 7) psychological or emotional burden; 8) compensation and recognition; 9) physical therapy as a profession; and 10) COVID-19., Conclusion: Burnout is present within physical therapists regardless of demographic group. Understanding circumstances that contribute to and alleviate burnout is an important first step to develop and research strategies to address these circumstances to positively impact the provider, patient, and the healthcare system.

Background: Peer assisted learning (PAL) has become increasingly popular in higher education, and a range of benefits have been reported for students. However, there is scant knowledge on PAL study groups in physiotherapy undergraduate training., Objectives: This study aimed to generate in-depth knowledge about the experiences of PAL study groups from the perspective of physiotherapy students., Methods: We conducted focus group interviews with 15 first-semester students who had attended PAL study groups, and 8 third-semester students who had been PAL leaders. The interviews were analyzed using an inductive, thematic analysis., Results: Four main themes were generated: 1) An overwhelming transition - Eased by PAL study groups; 2) The significant role model - Creating safe learning environments; 3) Building a bridge between theory and practice through scaffolding; and 4) Time to mature and filtered knowledge., Conclusion: Overall, we found that PAL study groups formed an important community of practice, and that the PAL leaders became important role models, providing academic, social, and emotional support. Students learning from students in PAL study groups seemed beneficial to bridge theory and practice. Our findings support the implementation of PAL study groups as a supplement to formal teaching and suggest that PAL aids students' transition to the university environment.

Cardiovascular diseases (CVDs) and their risk factors are a major cause of illness and death worldwide, especially in low- and middle-income countries like Cameroon. Physiotherapist-led health promotion (PLHP) has proven effective in improving health and reducing CVD risks. Understanding patient perspectives is crucial for designing effective, context-specific PLHP interventions. This study explored patients' views, experiences, perceived usefulness, acceptability, and preferred methods of PLHP, through a sequential explanatory mixed-methods approach. The quantitative data highlights a significant burden of CVD conditions and risk factors among patients seen in physiotherapy services. Qualitatively, three themes were identified and included: (1) perspectives and experiences of people at risk or with CVDs (pwCVDs) on PLHP; (2) perceived usefulness and acceptability of PLHP; (3) preferred delivery methods of PLHP. Participants reported positive feedback on PLHP and physiotherapy services. Barriers to effective PLHP included high workloads for physiotherapists, limited service access in rural areas, and prohibitive costs. Despite these challenges, participants expressed strong confidence in physiotherapists' competence, though they also called for improved regulation and ongoing professional development. PLHP components, especially physical treatment and dietary advice, were deemed highly useful and acceptable. Patients suggested various delivery methods, including peer support groups, home visits, and mass media interventions. This study highlights the need to improve the scope of practice, competence of physiotherapists, and accessibility of physiotherapy services in Cameroon for pwCVDs. It is necessary to adopt multidisciplinary approaches to achieve better outcomes for risk factors like diabetes and hypertension in context.

Questions: What are physiotherapy students' attitudes and beliefs towards providing care for lesbian, gay, bisexual, transgender, queer, intersex, asexual and other related identities (LGBTQIA+) individuals? What education have students received on LGBTQIA+ healthcare needs? What are students' preferences for receiving this content?, Design: Mixed-methods design using a purpose-built online survey., Participants: Australian undergraduate and postgraduate physiotherapy students., Methods: Participants were invited to complete an online survey. Data were collected on: personal, clinical, professional and educational exposure to LGBTQIA+ identities and topics; heteronormative attitudes and beliefs via the modified Heteronormative Attitudes and Beliefs Scale (mHABS); and perspectives about LGBTQIA+ care. Welch's t-test and analysis of variance were used to analyse differences in mHABS and subscale scores between groups based on personal, clinical, professional and educational exposure. Open text responses were analysed thematically. Quantitative and qualitative data were first analysed separately and then cross-validated for integration in the results., Results: The survey was completed by 324 eligible students. Cross-comparison of data generated four key themes pertaining to students' perspectives about working with the LGBTQIA+ community and education about LGBTQIA+ health: students with closer personal relationships to the LGBTQIA+ community demonstrated more inclusive attitudes and beliefs about LGBTQIA+ care and education; there are cis/heteronormativity and negative views towards LGBTQIA+ health; students who are ambivalent about LGBTQIA+ care hold egalitarian beliefs; and integrated education on LGTBQIA+ health delivered by members of the community is important., Conclusion: Physiotherapy students' attitudes and beliefs about the LGBTQIA+ community were diverse, with cis/heteronormativity prevalent in respondents. Students with closer relationships to the LGBTQIA+ community demonstrated more inclusive attitudes and beliefs. The lack of understanding of LGBTQIA+ needs and relevance to physiotherapy highlights the need for improved LGBTQIA+ education in physiotherapy curricula., (Copyright © 2024 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

We study the process of value co-creation in physiotherapist-patient relationships and the underlying mechanisms of this process. We present the Googling Effect Model outlining the relationship between patients' pre-encounter online information search and their commitment to compliance in physiotherapy service exchange. We tested the model on a sample of physiotherapy service patients (n = 446) in the United States. We analyzed the collected responses using the partial least squares method, using SmartPLS 4.0. Our study contributes to the existing body of knowledge in several ways. We developed and tested the Googling Effect Model. Doing so adds to the healthcare literature on value co-creation in physiotherapy. The Googling Effect Model increases the predictive value of the Service-Dominant Logic as it outlines the mechanism underlying value co-creation in healthcare, including the role and importance of pre-encounter online information search in collaborative healthcare. Moreover, the findings illustrate how the underlying mechanism through which pre-encounter online information search affects commitment to compliance differs between men and women and different ethnic groups. These findings can be used to create an environment that increases service engagement and commitment to compliance by accounting for patients' gender and ethnicity., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The LBP-related attitudes and beliefs of clinicians may impact the experience of patients by influencing clinician decision-making and by shaping the attitudes, beliefs, and actions of patients. The purpose of this study was to identify the specific LBP-related attitudes and beliefs of US-based physical therapists and determine if those beliefs correlate with clinical decision-making., Methods: An electronic survey was sent to US-based physical therapists. Attitudes and beliefs were measured using the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) and the Pain and Impairment Relationship Scale for Physiotherapists (PABS-PT). The survey also included 2 patient vignettes that collected information about clinical decision-making., Results: Complete survey responses were recorded from 420 physical therapists. Eleven of the 27 attitude and beliefs questions were answered in a more biomedically oriented way by at least 20% of respondents. Physical therapist low back pain-related attitudes and beliefs were associated with activity and management strategies for both vignettes in the expected direction. Higher scores on HC-PAIRS and PABS-BM were associated with more restrictive work and activity recommendations, lower-intensity exercise choices, biomechanical rationale for manual therapy and motor control exercises, pathoanatomical-focused education, and use of modalities., Conclusion: Some physical therapists hold biomedically oriented beliefs about the connection between pain and physical activity. Clinician beliefs were associated with activity and work recommendations, and treatment choices. Physical therapists with more biomedically oriented beliefs were more likely to limit physical activity and work, and less likely to incorporate psychologically informed interventions.

Question(s): What are the perceptions and knowledge of physiotherapists who treat musculoskeletal disorders towards prognosis?, Design: Exploratory phenomenological study., Participants: 15 physiotherapists involved in the treatment of musculoskeletal disorders., Data Analysis: Data were collected through semi-structured interviews and analysed using inductive coding and thematic analysis., Results: Four themes were identified. First, participants perception of prognosis was influenced by how they defined prognosis. Participants often perceived that prognosis was the timeline to recovery related to function, tissue health, or pain. Second, some participants could not recall foundational knowledge about prognosis being taught during their entry-level physiotherapy program. Others recalled it being taught in relation to the tissue healing model. Third, participants described learning about prognosis through experience, professional development, or from peers. Finally, participants identified that a potential learning opportunity is to conceptualise prognosis as separate outcomes associated with function, tissue health, and pain. Each can impact upon prognosis, have a prognosis of their own, and can occur simultaneously., Conclusion: How physiotherapists perceive and understand the concept of prognosis is influenced by their foundational knowledge. It appears for physiotherapists, prognosis may be conceptualised within the biomedical model of health. Indeed, physiotherapists may perceive that prognosis is the timeline for recovery determined by the tissue model of healing. Physiotherapists also rely on experiential knowledge gained from clinical practice, professional development, and their peers to enhance learning about prognosis. The understanding of prognosis may be enhanced if physiotherapists conceptualise prognosis in terms of the multifactorial outcomes associated with function, tissue health, and pain., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Subjective pain intensity can be measured using instruments like the Faces Pain Scale-Revised (FPS-R), Verbal Rating Scale (VRS), Numerical Pain Rating Scale (NPRS), and Visual Analogue Scale (VAS). However, information on physiotherapists' and patients' knowledge and preference for these tools is scarce., Objective: We investigated the knowledge and preference of physiotherapists and participants with musculoskeletal pain (MP) regarding the pain intensity measurement scales., Methods: This cross-sectional study consisted of physiotherapists and participants with MP. Physiotherapists were recruited via social media for an online open survey, gathering sociodemographic, professional data, and their knowledge and preferences for pain intensity scales. Participants over 18 with MP, participated in interviews focusing on their familiarity and preferences for pain intensity scales. Data was analyzed descriptively, and Chi-squared test evaluated scale preferences., Results: We included 352 physiotherapists (mean experience = 10.5 years) and 94 participants with MP. Of the physiotherapists, 94.3% were familiar with pain scales, but 30.4% struggled to differentiate them. The NPRS was the most used (56.3%) and preferred scale (52.4%). Among participants with MP, unfamiliarity was noted with all scales. After instruction, 46% preferred FPS-R, with preference varying by income and education levels (p < 0.001)., Conclusion: We found a knowledge gap among physiotherapists in identifying pain intensity scales, with a preference for the NPRS among those familiar with the scales. Participants with MP had limited familiarity with these scales. After instructions, these participants preferred the FPS-R, particularly those with lower income and education levels., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background and Objective: Adoption of low back pain (LBP) guidelines in physiotherapeutic management is a well-documented problem. Thereby, an in-depth understanding of the barriers to implement an active approach for both patients and physiotherapists is needed., Design: Semi-structured interviews were conducted with physiotherapists and patients with non-specific LBP. Interviews, guided by the Theoretical Domains Framework (TDF), were analyzed using the Qualitative Analysis Guide of Leuven., Results: A total of 20 participants were interviewed, including ten physiotherapists and ten patients. Our findings reveal that patients and physiotherapists face each 23 barriers spanning 14 TDF domains. The TDF domain "social influences" revealed the most barriers, followed by "beliefs about consequences" and "environmental context" for patients and physiotherapists, respectively. Five barriers did overlap between both groups (lack of guideline awareness, incorrect exercise performance, interdisciplinary communication gaps, time constraints and challenges in patient compliance)., Conclusions: Barriers to LBP guideline recommended physiotherapeutic practices span all 14 TDF domains. Consequently, future implementation interventions need to address multiple TDF domains for effective LBP guideline implementation., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Many physiotherapists do not feel adequately equipped to address psychosocial risk factors in people with complex pain states. Hence, a biopsychosocial blended intervention (Back2Action) was developed to assist physiotherapists to manage people with persistent spinal pain and coexisting psychosocial risk factors associated with the development or maintenance of persistent pain., Objective: This study aimed to gain insight into the experiences of physiotherapists with this blended psychosocial intervention., Design: and methods: This was an interpretative qualitative study with a reflexive thematic analysis of semi-structured interviews with physiotherapists (N = 15) who delivered Back2Action. The interview started with the grand-tour question: "What was your experience in using Back2Action?" Physiotherapist were encouraged to provide examples, and follow-up questions were posed to ensure a deeper understanding could be reached., Results: Four themes were constructed: Physiotherapists became increasingly aware of (1) their own implicit expectations, biases and skills, and underlying treatment paradigms, and (2) the implicit expectations from their patients towards them. This led to (3) creating a deeper and stronger therapeutic alliance with the patient, but also (4) an understanding that implementation of a true biopsychosocial intervention - even if offered in a blended form - requires more practice, confidence and resources., Conclusions: Back2Action is considered a valuable treatment to deliver a biopsychosocial intervention in primary care. Considering the high level of knowledge, skills and competency of the participating physiotherapists, the perceived barriers may be more difficult to overcome for more junior physiotherapists., Competing Interests: Declaration of competing interest The authors declare they have no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Artificial intelligence (AI) is being introduced to rehabilitation practices, and it can optimize the patient's outcome through their ability to design personalized care strategies and interventions., Objectives: To understand the attitudes and perceptions of physical therapy professionals on the use of AI in rehabilitation in regard to treatment planning, diagnosis, outcome prediction, and advantages and disadvantages., Design and Methods: This paper followed an exploratory, qualitative research design. Semi-structured, one-to-one interviews were conducted with participants of different experience levels and specialties in physical therapy. Results were evaluated using thematic analysis., Results: Four themes were identified: (i) perceptions of AI and its applications in healthcare services, (ii) impact on the workforce (iii) considerations around implementing AI within rehabilitation and (iv) AI, and the fast-approaching future. Participants shared views on the potential impact of AI on rehabilitation practices, such as aiding the decision-making process, saving time and effort of both the therapist and patients. Participants have stressed on potential pitfalls that still need to be considered, such as patient data privacy, potential loss of patient-healthcare practitioner relationship, ethical concerns regarding overreliance on these applications and how that might hinder effective patient care., Conclusion: The findings add to the literature about physical therapists' understanding regarding the use of AI in patient care. Several concerns were raised to the adoption of AI, including concerns about patient privacy, and ethical concerns. Based on the study findings, researchers emphasize the importance of establishing guidelines when incorporating AI in rehabilitation to improve the therapist's knowledge and skills., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: In response to the COVID-19 pandemic, face-to-face consultations within healthcare settings were suspended. Remote consultations became crucial for managing musculoskeletal conditions alongside Patient Initiated Follow-ups, leading to the development of the DiAL programme at a large National Health Service Community Trust. Previous research has focused on quantitative data, little is known about staff experiences with this programme., Objectives: To explore the perceptions and opinions of physiotherapy staff using DiAL, in order to highlight the benefits and challenges of this service with identification of areas for future development., Design: Qualitative focus groups., Methods: Two virtual focus groups were conducted via Microsoft Teams, involving a purposive sample of physiotherapy staff in the musculoskeletal services known to have used DiAL. Thematic analysis was conducted., Results: Ten clinicians participated in the study, generating two main themes: Clinician Autonomy and Institutional Needs. These themes encompassed several subthemes., Conclusions: Clinicians reported higher job satisfaction and improved accessibility for patients, attributing these positive outcomes to the autonomy and flexibility provided by the platform. While the programme met National Health Service targets for Patient Initiated Follow-ups, there was a desire for ongoing improvements and a recognition that previous audits failed to capture all the benefits. DiAL serves as a treatment choice, supporting evidence on the advantages of remote consultations and contributing to the National Health Services' goal of reducing its carbon footprint. There is a collective desire for the platform to continue with future recommendations including expanding its use and exploring additional audit metrics., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Rationale: Advanced practice physiotherapy roles (Advanced Physiotherapy Practitioners [APPs] and First Contact Physiotherapists [FCPs]) are pivotal in supporting patients to manage their musculoskeletal (MSK) conditions. Having a greater understanding of how decisions are made by these practitioners will inform competency frameworks and improve the provision of patient-centred care., Aim: To evaluate the current knowledge, views and use of shared decision-making in MSK advanced physiotherapy practice in the United Kingdom., Methods: A cross-sectional survey using an online questionnaire was used to collect demographic information, knowledge, views and self-reported use of shared decision-making (SDM) of APPs and FCPs who work with adults with MSK disorders in the United Kingdom., Results: Responses from 49 participants (25 APPs and 24 FCPs) were included in the study. In total, 80% of participants had received SDM training and overall high levels of knowledge were shown. Only 12% of participants used a communication model to facilitate SDM. In total, 80% of participants reported making decisions together with the patient either always or most of the time. FCPs favoured a more patient-led approach to decision-making compared to APPs who favoured collaborative decision-making. The most commonly reported barriers to SDM included lack of time, lack of patient education resources, lack of access to patient decision aids and treatment pathway restrictions., Conclusions: The responses in this study showed that overall APPs and FCPs have good knowledge of SDM and report routine use of collaborative and patient-led decision-making approaches., (© 2024 The Author(s). Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.)

Introduction: There has been a call for healthcare to consider more explicitly the needs of the individual patient by adopting a person-centered approach to practice. Consideration needs to be given to how this is taught to pre-registration physiotherapy students., Purpose: To understand how first-year pre-registration physiotherapy students envision their philosophy of practice and how person-centered aspects of that philosophy might be implemented in a clinical setting., Methods: Semi-structured interviews were carried out with 10 first-year physiotherapy students. Data were analyzed using thematic analysis., Results: Five themes were identified: 1) understanding the person and their direction of travel; 2) contextual factors that impact on the delivery of person-centered practice; 3) awareness of personality traits; 4) doing the small things; and 5) the person-centered learning curve., Conclusion: Understanding the person and knowing what is important to them is central to the participant's philosophy of practice. They drew on specific personality traits such as listening, being patient, or using small talk to develop rapport to better understand the person they were working with. Despite the challenge of high-pressured, under resourced healthcare contexts, student physiotherapists would strive to do the small things for each person they were working with. Practice-based learning settings presented a steep learning curve and appeared to be important in developing person-centered skills which were introduced in the university setting.

Introduction: Individuals identifying as lesbian, gay, bisexual, transgender, queer, intersex, asexual and other related identities (LGBTQIA+) experience challenges with healthcare, including physiotherapy. To understand potential contributions to poor experiences, this study explored physiotherapists' experiences and perspectives about working with members of LGBTQIA+ communities., Methods: This study employed a qualitative research design, suitable for exploring the experiences and perspectives of individuals within the physiotherapy context. The sample consisted of physiotherapists working in Australia who participated in a larger survey study. Data were collected via semi-structured interviews which were audio-recorded and transcribed verbatim. Data analysis was conducted using a relativistic and queer theoretical framework with a reflexive thematic approach., Results: Eighteen physiotherapists with diverse sexual orientations participated in the interviews. While all participants identified as women or men, not all used binary gender pronouns. Five key themes were developed: 1) "anti-discrimination" regarding choice of language and providing safe environments; 2) "current and historical discrimination" against LGBTQIA+ individuals; 3) "taking an equality approach" when working with LGBTQIA+ patients; 4) "knowledge of LGBTQIA+ health" in a broad sense and specifically with transgender and gender-diverse people; and 5) "managing own reactions" with respect to individual biases and discomfort., Conclusion: Underpinning all themes was the overarching concept of cis/hetero/endonormativity. Assuming normativity when working with LGBTQIA+ patients, is likely to have negative effects on patients' mental health, the therapeutic relationship and quality of care. In order to improve diversity, safety, inclusion and equity of care for LGBTQIA+ individuals, it is vital that normativity within physiotherapy is challenged.

Anatomy with human dissection may help to develop respect for the human body and professionalism; however, dissection may worsen students' attitudes about body weight and adiposity. The purpose of this study was to measure weight bias among Doctor of Physical Therapy (DPT) students enrolled in gross anatomy and determine if, and how the experience of dissection impacts weight bias. Ninety-seven DPT students (70 University of Colorado [CU], 27 Moravian University [MU]) were invited to complete a survey during the first and final weeks of their anatomy course. The survey included demographic items, two measures of weight bias-the Modified Weight Bias Internalized Scale (M-WBIS) and the Attitudes Towards Obese Persons (ATOP) Scale-and open-ended questions for the students who participated in dissection (CU students) that explored attitudes about body weight and adiposity. At baseline, there were no significant differences (p > 0.202) in ATOP, M-WBIS, or BMI between the two universities. The mean scores on both the ATOP and M-WBIS indicated a moderate degree of both internalized and externalized weight bias. There were no significant changes in ATOP (p = 0.566) or M-WBIS scores (p = 0.428). BMI had a low correlation with initial M-WBIS scores (⍴ = 0.294, p = 0.038) and a high correlation with change scores in CU students (⍴ = 0.530, p = 0.011). Future studies should utilize the same measures of weight bias in other healthcare trainees to facilitate comparison and incorporate larger populations of DPT students., (© 2024 American Association for Anatomy.)

Introduction: Internationally, there is growing momentum in the physiotherapy profession to improve the cultural safety and capabilities of physiotherapists. In Australia, this is essential given the important role physiotherapists play in the delivery of healthcare to First Nations Australians. Understanding the experiences of the newest members of the profession who work with First Nations Australians is an important step in exploring the broader professions' cultural safety journey., Objective: To explore new graduate physiotherapists' experiences working in First Nations Australian health settings., Methods: The study used an interpretative phenomenological approach through semi-structured interviews to explore the experiences of seven new graduate physiotherapists, in their first 2 years of practice. All participants worked within a First Nations Australian health setting for some or all of their experience as a new graduate physiotherapist., Results: Three themes were generated: 1) enrichment through connection; 2) navigating challenges; and 3) a catalyst for self-reflection., Conclusion: New graduate physiotherapists reported positive experiences when working within a First Nations Australian health setting, underpinned by building a strong therapeutic relationship through rapport building; navigating challenges alongside their clients; and delving into critical self-reflection.

Background: Clinician bias contributes to health disparities; therefore, educational standards and professional expectations incorporate cultural humility. Vague standards and numerous pedagogical methods make implementing an effective and uniform curriculum challenging. Classroom and clinical faculty's attitudes and behaviors are pivotal; however, evidence on roles beyond instruction is lacking., Purpose: This study explored physical therapy (PT) students' perceptions of faculty's role in improving their cultural humility., Methods: This study was rooted in a phenomenological approach that incorporated elements of both descriptive and interpretive phenomenology. Thirteen first-year PT students participated in one-on-one interviews which underwent reflexive thematic analysis., Results: Reflexive thematic analysis generated two hundred-ninety codes, six categories, and one overarching theme. Dissonance emerged between students' perceptions of faculty's role and the explicit and implicit curriculum., Conclusion: Explicit messaging from classroom instruction and implicit messaging from clinical encounters and unspoken attitudes, values, and behaviors were disparate. Faculty role modeling, diversity, cultural awareness, and perceived comfort interacting with a diverse patient population improved students' self-confidence and cultural humility. Professional development including field experience with a cognitive apprenticeship approach, and standardized, discipline-specific cultural humility competencies may provide uniform and clear guidelines.

The aim of this study was to investigate and compare justice sensitivity between self-perceived beneficiaries, victims, and observers in a sample of 90 healthcare workers (nurses and physiotherapists) at the Varaždinske Toplice Special Medical Rehabilitation Hospital, Croatia. For this purpose we used a questionnaire consisting of demographic data and the Croatian version of the justice sensitivity inventory developed by Schmitt. Regardless of its limitations, our study clearly shows that healthcare professionals at Varaždinske Toplice are most sensitive to injustice from the beneficiary's perspective, that is, as persons who personally benefitted from injustice, although they may not have been instrumental to this effect. They are less sensitive to injustice perceived on the outside (observer's perspective) or to injustice suffered by themselves (victim's perspective). Another important finding is that participants of female gender, rural residence, and nurses (who are all women) are significantly more sensitive to injustice, whereas age and marital status do not seem to contribute to justice sensitivity. Future research should investigate the perception of injustice over a longer timeframe and involve all healthcare workers. It could also address different approaches to management, especially in terms of worker rewards and career advancement. Qualitative research among healthcare workers could provide a broader and clearer idea of social injustice at their workplace., (© 2024 Irena Canjuga et al., published by Sciendo.)

Background: Delegation of clinical tasks from physiotherapists to physiotherapy support workers is common yet varies considerably in musculoskeletal outpatient physiotherapy services, leading to variation in patient care. This study aimed to explore patients' preferences and estimate specific trade-offs patients are willing to make in treatment choices when treated in musculoskeletal outpatient physiotherapy services., Methods: A discrete choice experiment was conducted using an efficient design with 16 choice scenarios, divided into two blocks. Adult patients with musculoskeletal conditions recruited from a physiotherapy service completed a cross-sectional, online questionnaire. Choice data analyses were conducted using a multinomial logit model. The marginal rate of substitution for waiting time to first follow-up physiotherapy appointment and distance from the physiotherapy clinic was calculated and a probability model was built to estimate the probability of choosing between two distinct physiotherapy service options under different scenarios., Results: 382 patient questionnaires were completed; 302 participants were treated by physiotherapists and 80 by physiotherapists and support workers. There was a significant preference to be seen by a physiotherapist, have more follow-up treatments, to wait less time for the first follow-up appointment, to be seen one-to-one, to see the same clinician, to travel a shorter distance to get to the clinic and to go to clinics with ample parking. Participants treated by support workers did not have a significant preference to be seen by a physiotherapist and it was more likely that they would choose to be seen by a support worker for clinic scenarios where the characteristics of the physiotherapy service were as good or better., Conclusions: Findings highlight that patients treated by support workers are likely to choose to be treated by support workers again if the other service characteristics are as good or better compared to a service where treatment is provided only by physiotherapists. Findings have implications for the design of physiotherapy services to enhance patient experience when patients are treated by support workers. The findings will contribute to the development of "best practice" recommendations to guide physiotherapists in delegating clinical work to physiotherapy support workers for patients with musculoskeletal conditions., (© 2024. The Author(s).)

Objective: Physiotherapists (PTs) play a crucial role in managing individuals with Frozen Shoulder (FS), frequently being the first healthcare professionals involved in the treatment of this condition., Aim: This study aimed to compare the beliefs, expectations, and perspectives of individuals with FS with the knowledge, skills, and strategies of PTs, highlighting similarities and differences., Method: This study adhered to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). From May 1st to August 1st, 2023, a two-part survey was conducted involving PTs and individuals diagnosed with FS. The survey focused on comparing key areas such as clinical assessment, patient education, treatment expectations, and the psychological aspects of the patient-clinician relationship., Results: A total of 501 PTs and 110 subjects with FS participated in the survey. Most PTs showed proficiency in FS pathoanatomical conditions and were also attentive to psychological aspects (88.4%), describing the pathology evolution in three or two stages (68.2%). They also highlighted the importance of patient education (89.6%) and recognized the potential benefits of a multiprofessional collaboration in managing FS (82.2%). Reassurance was reported as a priority by 32.3% of PTs. Subjects with FS expressed a preference for PTs who are both expert and empathetic (73.6%). Regarding their understanding of FS, 29.09% of subjects reported receiving a three-phase explanation, while 26.36% felt inadequately informed. Nearly half of the subjects (49.09%) anticipated being managed independently by a PT, with 93.64% prioritizing the improvement of their range of motion., Conclusion: This study revealed a general agreement between subjects with FS and PTs regarding aspects of the therapeutic relationship, patient education, pathology management, compliance and motivation strategies, and pain management preferences. However, significant differences emerged concerning the perception of physiotherapy effectiveness, primary treatment goals, subjects' priorities, and the importance of psychological assessment., (© 2024. The Author(s).)

Background: Ensuring a sufficient, appropriately qualified health workforce is of global concern. Understanding the attributes that employers seek is critical in recruitment, retention, and educational design. In physiotherapy, there is a dearth of evidence on desirable attributes that employers seek from early-career physiotherapists. This study directly addresses this gap. The aims of this study were to identify the characteristics of the jobs advertised for early-career physiotherapists in Australia; determine which attributes were most desired when employing an early-career physiotherapist; and identify if there were differences in the attributes required based upon workplace location., Methods: New graduate and early-career physiotherapy job advertisements were collected for six months from 1st October 2020 until 31st March 2021 from SEEK.com.au, a large online employment marketplace that operates across ten countries in the Asia Pacific and Latin America. Job advertisements needed to specify new graduate or early-career physiotherapist eligibility and be located within Australia. Data extraction were completed using QuestionPro ® . The Modified Monash Model was used to classify rurality of job location. Job advertisements were analysed descriptively and using content analysis to identify attributes., Results: The search yielded 578 job advertisements with the greatest number collected in October 2020 (25.3%). Of the advertisements, 428 (74.0%) were in metropolitan locations (Modified Monash 1), 47 (8.1%) were in regional (Modified Monash 2), 99 (17.1%) were in rural locations (Modified Monash 3-5), and 4 (0.8%) were in remote locations (Modified Monash 6-7). Most roles were in private practice (63.3%) or aged care (21.7%). The top five attributes requested by employers were client focus, communication and interpersonal skills, team player, willingness to learn, and being able to build rapport, relationships, and networks. Academic results, resilience, and empathy were the least requested attributes. Differences in requested employability attributes increased with rurality., Conclusions: This study addresses the current knowledge about attributes sought by employers for early-career physiotherapists. The most prevalent attributes requested were client focus and communication and interpersonal skills. This exploration of attributes can help to better prepare graduates for their first roles, align expectations, and increase understanding of priorities for entry level university programs, as well as identify priorities for support during transition to practice. Desired attributes should be clearly defined by employers in recruitment and retention processes., (© 2024. The Author(s).)

Objective: The demographic homogeneity of the physical therapist workforce and its educational pathway may undermine the profession's potential to improve the health of society. Building academic environments that support the development of all learners is fundamental to building a workforce to meet societal health care needs. The Benchmarking in Physical Therapy Education study uses the Physical Therapy Graduation Questionnaire to comprehensively assess learner perceptions of the physical therapist academic environment. The present report examined whether racial and ethnic minoritized (REM) physical therapist learners perceive their doctor of physical therapy education differently from their non-REM peers., Methods: Five thousand and eighty graduating doctor of physical therapy learners in 89 institutions provided demographic data and perceptions of a range of learning environment domains. Analyses included REM versus non-REM comparisons as well as comparisons among individual race and ethnicity groups., Results: Compared with their non-minoritized peers, REM respondents expressed less satisfaction with their education and lower confidence in their preparedness for entry-level practice. REM respondents observed more faculty professionalism disconnects and demonstrated less agreement that their program had fostered their overall psychological well-being. REM respondents experienced higher rates of mistreatment than their peers and reported higher rates of exhaustion and disengagement, the 2 axes of academic burnout. Black/African American and Hispanic/Latino/a/x (Hispanic, Latino, Latina, and/or Latinx) respondents incurred significantly more educational debt than Asian and White respondents. REM respondents reported greater empathy and greater interest in working in underserved communities., Conclusion: REM respondents perceived the physical therapist learning environment more negatively than their non-minoritized peers but expressed strong interest in serving people from underserved communities. These national benchmarks offer academic institutions the opportunity to self-assess their own environment and to work to improve the quality of the educational experience for all learners., Impact: In a nationwide benchmarking study, learners from minoritized race and ethnicity backgrounds reported more negative experiences and outcomes during physical therapist education than their non-minoritized peers. These same learners demonstrated high empathy and interest in serving people from underserved (under-resourced) communities. Learning environments that permit all individuals to thrive may be an essential avenue to improve the health of a rapidly diversifying society., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Doctor of physical therapy (DPT) students who experienced burnout during the COVID-19 pandemic are now entering the workforce. This study compared burnout and grit scores of DPT graduates who completed their education prior to the pandemic (Group A) with those who completed all DPT education during the pandemic (Group B)., Methods: This is a cross-sectional comparison of burnout and grit among two cohorts of graduates of an entry-level DPT program. Burnout was measured using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS); grit was measured using the 12-Item Grit Scale., Results: Burnout was significantly higher in Group B, as indicated by MBI-HSS subscales for Emotional Exhaustion, (H(1)=14.130, p<0.001) and Personal Accomplishment (H(1)=6.781, p=0.009). There were no significant differences in grit scores between the two groups (H(1)=3.286, p=0.07)., Conclusion: Pandemic-trained physical therapists in this study were no less gritty than those who graduated prior to the pandemic but were significantly more burned out., Impact: Pandemic-trained clinicians and their hiring managers/mentors should screen and support employee mental health.

Admission to physical therapist education programs (PTEPs) is commonly based on cognitive attributes such as undergraduate grade point average (uGPA), pre-requisite course GPA (pre-req GPA), and sometimes Graduate Record Examination (GRE) scores, admissions interviews or essays. The primary purpose of this exploratory study was to examine the relationships between non-cognitive attributes identified through a personality-oriented job analysis (POJA) and Doctor of Physical Therapy (DPT) student academic performance to improve admissions procedures and DPT student education and training. The present study examined correlations among 12 non-cognitive attributes identified through the POJA and existing cognitive admission criteria, specifically uGPA and pre-req GPA, with DPT grades in the first semester of the PTEP. Multiple regression using non-cognitive attributes in addition to current cognitive admissions criteria showed that uGPA was the strongest predictor of DPT grades, followed by self-reflection and anxiousness/neuroticism (negatively). While uGPA was the strongest predictor of DPT student GPA, it may be valuable to add measures of self-reflection and anxiousness/neuroticism to the admissions process to increase the likelihood of success academically. The present study adds to a still limited body of knowledge of how both cognitive and non-cognitive attributes predict graduate academic performance in a variety of health professions.

Background Chronic pelvic pain (CPP) is a common and debilitating condition, and sufferers present to healthcare professionals with variable complex symptoms and co-morbidities. This study aimed to investigate the current beliefs and practice behaviours of healthcare professionals towards the management of CPP in Australian females. Methods We distributed an online survey to Australian healthcare professionals. Participants were questioned regarding their beliefs, the importance of various contributing factors and assessment variables, and their management preferences for two CPP vignettes. Demographic information and responses were analysed with descriptive statistics. Results Complete data were obtained and analysed from 446 respondents including gynaecologists (n =75), general practitioners (GPs) (n =184) and physiotherapists (n =187). Most of the respondents were female (88.1%), with male (11.7%) and other (0.2%) making up a smaller representation. Physiotherapists rated themselves higher in understanding mechanisms of CPP (64.7% very good to excellent) compared to gynaecologists (41.3%) and GPs (22.8%). Physiotherapists also reported higher levels of confidence in managing patients with CPP (57.8% quite or extremely confident) compared to 41.3% of gynaecologists and 22.3% of GPs who reported being quite or extremely confident. All three professions rated patient's beliefs (89.8%), nervous system sensitisation (85.7%), stress/anxiety/depression (91.9%), fear avoidance (83.3%), history of sexual/emotional/physical abuse (94.1%) and pelvic floor muscle function (85.0%) as very/extremely important factors in the development of chronic pelvic pain. Most gynaecologists (71.0%) and GPs (70.2%) always referred for pelvic ultrasound during assessment. Physiotherapists assessed goal setting (88.8%) and screened for patients' beliefs (80.9%) more often than gynaecologists (30.4% and 39.1% respectively) and GPs (46.5% and 29.0% respectively). Conclusions All three groups of healthcare professionals demonstrated a good understanding of pain mechanisms and incorporated a biopsychosocial and multidisciplinary approach to management of females with chronic pelvic pain. However, both gynaecologists and GPs were less confident in their understanding of and management of CPP, and less likely to consider patient beliefs and goals. The findings of this online survey may assist in the provision of more targeted education to further improve management of this condition.

Background: Physiotherapists' attitudes and beliefs play a crucial role in the management and treatment outcomes of non-specific neck pain (NSNP)., Objective: To investigate the attitudes and beliefs of physiotherapists in Jordan towards NSNP, and to identify factors influencing these attitudes and beliefs., Methods: A Cross-sectional survey of registered physiotherapists working in Jordan was conducted. A structured questionnaire was used to assess the attitudes and beliefs of physiotherapists towards NSNP. Descriptive and inferential statistics were used., Results: A total of 301 PTs completed the survey, 155 females (51.56%). Most respondents held bachelor's degrees, with an average of 9.5 ± 6.6 experience years. The total score for PABS-PT (Z = 11.4, p < 0.001) and its BM (Z = +11.9, p < 0.001) and PS (Z = 3.6, p < 0. 001) subscales were significantly positive. The score of the biomedical subscale was more significantly positive than psychosocial subscale. The treatment orientation was positively correlated with education level, and negatively with age and experience. The most reported treatments were manual therapy followed by general exercises and electrical modalities. No significant relationship was observed between treatment orientation and treatment selection., Conclusion: This study created the initial profile for pain attitudes and beliefs in Jordan. Physiotherapists hold positive attitudes and beliefs towards the NSNP treatment orientations with a superiority of the BM approach. Engaging educational sectors and stakeholders in the current situation of PTs' attitudes and beliefs is important., (© 2024 John Wiley & Sons Ltd.)

Background: Little is known about delivering telehealth from a healthcare provider's perspective., Purpose: To investigate physiotherapists' (PTs) experiences in delivering live online exercise and education for people with knee osteoarthritis (OA)., Methods: This was a qualitative individual interview study with a thematic analysis approach. The interviewees were six PTs delivering 8 weeks of supervised online exercise and education for people with knee OA in secondary public care in Denmark., Results: The three main themes were (1) From hands to words-on the transition from on-site to on-line physiotherapy, (2) Online selection-on the perceived barriers to managing a telehealth service and (3) Therapeutic relation under pressure-on the contextual difficulties in building relationships and alliances in online classes., Conclusion: The PTs in this study seemed to gradually come to terms with delivering first-line OA care online, appreciating advantages and new possibilities. PTs' initial apprehension towards this new form of physiotherapy service may be rooted in the traditional conception of physiotherapy as a predominantly manual profession but also in a lack of formal training in physiotherapy telehealth services. This study underlines the growing need for better and more formalised training in physiotherapy telehealth services to meet growing demands., (© 2024 The Author(s). Musculoskeletal Care published by John Wiley & Sons Ltd.)

Objectives: Understanding key stakeholders' perceptions around the value of baseline testing, as well as barriers or facilitators experienced as part of the process, may assist with the decision-making process of whether to implement baseline testing in community sport. This study explored coaches', players' and physiotherapists' perceptions of the perceived value, barriers and facilitators of baseline testing as part of New Zealand Rugby's (NZR) community concussion initiative., Design: The study employed a pragmatic, qualitative descriptive design., Methods: Semi-structured interviews were used to explore participants' perceptions. In total, 73 individual interviews were conducted. The sample consisted of 36 players, 13 coaches and 24 physiotherapists involved in NZR's concussion management pathway. Interviews were audio-recorded and transcribed verbatim. Data were analysed using thematic analysis., Results: In terms of perceived value, baseline testing was reported to play a role in i) facilitating a positive concussion culture; ii) positive perceptions of rugby and player safety and iii) enhancing concussion management as part of the pathway. Barriers and facilitators of the baseline testing process included i) stakeholder buy-in as critical driver of the process and ii) contextual and operational factors. Although contextual and operational challenges exist, these participants, as key stakeholders in the process, perceived the value of baseline testing to be more important than the barriers experienced., Conclusions: The value of baseline testing extends beyond concussion assessment and management, by enhancing community concussion awareness, attitudes and player safety. The findings of this study may assist in the decision-making process around inclusion of pre-season baseline testing in community rugby., Competing Interests: Declaration of interest statement At the time of the study, DS was employed by New Zealand Rugby., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Purpose: Person-centred care is widely accepted as being central to high quality care, but little is known about how physiotherapists implement person centred rehabilitation in Intensive Care. This study explores the self-reported experiences and interpretations of physiotherapists delivering person-centred rehabilitation in this setting., Methods: A qualitative study using Interpretative Phenomenological Analysis explored the lived experiences of physiotherapists and students who have worked in Intensive Care. Three focus groups, with four participants in each, were conducted. Data were fully transcribed, analysed and managed using NVivo software., Results: Participants shared similar interpretations about the principles of person-centred care. Operationalising person-centred rehabilitation during early recovery was not easily achievable. As the person's clinical condition improved, participants moved away from routine physiotherapy and their practice became more person-centred through the development of a partnership. Participants connected as humans to understand the person and respond to their needs within a culture that valued person-centred care., Conclusions: Physiotherapists aspire to develop a partnership with their patients by connecting on a human level with them and addressing their biopsychosocial needs. Physiotherapists with experience of developing patient partnerships influence the culture of the Intensive Care team and are role-models to facilitate collaborative person-centred activity in others.

Background: Advanced practice physiotherapy (APP) models of care are promising to alleviate pressure in emergency departments (EDs) where physiotherapists' new roles include being a first-contact practitioner and leading the overall care and management of patients with minor musculoskeletal disorders (MSKDs) to alleviate ED physicians' caseload., Purpose: To explore patients' acceptability, experience, satisfaction, and perception of a new APP-led model of care in the ED., Methods: Patients presenting to the ED with a minor MSKD and who agreed to participate in a multicenter, pan-Canadian randomized controlled trial assessing the efficacy and costs of an APP model of care were invited to participate in this qualitative study. Semi-structured interviews were performed to identify themes related to their experiences with this model. Verbatim transcripts were coded and analysed using an inductive thematic analysis., Results: 11 patients participated and three themes were identified: 1- They were satisfied with the care received within the model; 2- They found APPs to have the appropriate skill set to manage MSKDs and to assume medical-delegated tasks; 3- Timely access to care was a key factor in the acceptability of this model and participants believed physiotherapists were appropriate first-contact practitioners. One participant proposed that the APP model of care should also offer follow-up care., Conclusion: Participants had a positive experience of care in this new model. These results support the implementation of APP models of care in EDs as the participants appear receptive to new roles for APPs., (© 2024 The Author(s). Musculoskeletal Care published by John Wiley & Sons Ltd.)

Objectives: The prevalence of self-harm and the potential link with suicidal ideation highlights the need to prepare future physiotherapists to deal with the potentially catastrophic outcomes to which a lack of understanding in this area can lead. The aim of this research was to investigate if final year physiotherapy students felt prepared to assess risk of suicide or self-harm following patient disclosure, or showing signs of intention to harm themselves., Design: An interpretive phenomenological methodology (IPA) was implemented to aid in the understanding and interpretation of participants' own experiences. In conjunction with the overarching design, semi-structured interviews, via two focus groups, were used to explore participants' views., Setting: Focus groups were conducted via an online platform., Participants: Purposive sampling was employed as a sampling method to recruit final year physiotherapy students. The final sample consisted of ten participants., Results: Four main themes were identified: Experiences of disclosure; Encountering mental health; Lack of mental health education, and Lack of knowledge regarding policy and procedure., Conclusions: The findings highlight a deficit with regards to the preparedness of final year students in dealing with disclosure to self-harm. A lack of both formal education regarding mental illness and of practice experience in the field of mental health contribute to this. Therefore, a more rigorous and directed approach to education regarding mental illness is essential. Furthermore, involvement in mental health practice placements would allow for a greater level of experiential learning and understanding of the issues faced by those living with mental illness., Contribution of the Paper: Contribution to the evidence: Contribution to knowledge., (Copyright © 2024 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.)

Background and Purpose: Physical therapist (PT) education professionals agree on promoting holistic admissions practices to increase student body diversity but lack consensus about what factors in an application should be part of this process. This systematic literature review aimed to understand the value of noncognitive variables in PT education admissions., Methods: The initial literature search identified 1,592 articles in databases and relevant journals. Of the 39 studies meeting the inclusion criteria, 29 reported on noncognitive variables., Results: Commonly used noncognitive variables (interviews, written essays, letters of recommendation, and clinical experiences) were insignificant or inconsistently associated with performance in the PT program or on the National Physical Therapy Examination. Sociodemographic variables appeared to negatively affect the academic qualifications of applicants who were older, identified with underrepresented racial/ethnic groups, and reported English as a second language. Finally, 5 studies identified personal attributes, such as emotional intelligence and grit, as having a significant relationship with successful student outcomes., Discussion and Conclusion: Cognitive variables should serve as only one of several factors considered in admissions to achieve a more diverse class of students. Physical therapist education programs may use this evidence to reevaluate their admissions practices to include a balanced consideration of cognitive and noncognitive variables., Competing Interests: The author reports no conflicts of interest., (Copyright © 2024 Academy of Physical Therapy Education, APTA.)

Aim: To explore the experiences of UK-based private physiotherapists when running and progressing a physiotherapy business., Design: A hermeneutic phenomenological approach., Participants: Six UK-based private physiotherapy practice owners were recruited via purposive and snowball sampling., Methods: In-depth, semi-structured video interviews (2 per participant), audio-recorded and transcribed. Field notes, respondent validation and a reflexive diary were used. Data underwent line-by-line analysis, identifying codes and themes. Constant comparison of data, codes and themes occurred throughout. Peer review was utilised, small sections of data and all emerging codes were independently reviewed., Results: Three interconnecting themes. Working for myself: participants highlighted the freedom, flexibility and independence of business ownership, whilst acknowledging the additional pressures/challenges associated with this. Evolution of a practice: business growth was slow, requiring income supplementation initially. Successful growth often utilised luck and unexpected opportunities. Working with others: participants faced decisions regarding solo or joint ownership, when/what additional staff were required, whether staff should be employed or self-employed, and how to appropriately manage/support staff., Conclusions: Private practice ownership brings an array of benefits and challenges. Areas for future research include exploring the stresses of private roles and business ownership, the evolution of private physiotherapy practices, small-scale business partnerships, and employment vs self-employment. CONTRIBUTION OF THE PAPER., Competing Interests: Conflict of Interest The authors report there are no competing interests., (Copyright © 2024 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.)

Aim: To investigate the extent and impact of litigation on the UK physiotherapy profession., Design: An online cross-sectional questionnaire survey design was used. The survey was open to all qualified physiotherapists who have practiced in the UK, from any speciality, of any grade and from any setting including NHS, non-NHS, and private practice., Results: 688 respondents completed the survey (96% CI). All UK nations were represented. 73% were female, 44% were qualified >20 Years. Most worked in the NHS (74%) and worked in a neuromusculoskeletal setting (62%). 10% of respondents had been involved in litigation. 128 claims were reported with some respondents being involved in more than 1 case. Litigation was a highly stressful experience for those who experienced it and was a source of concern for many others. The personal impact was stress (76%) and worry and anxiety (67%). The most common professional impact was defensive practice (68%). Most respondents incorrectly identified who should provide their legal support. 46% were not satisfied with the support received. Most (77%) reported that litigation training should be included in pre-registration, as well as postgraduate (68%) programs., Conclusion: This is the first UK survey that has investigated the experiences of litigation on the UK physiotherapy profession. Ten percent of physiotherapists in our survey had been involved in litigation. Litigation impacted physiotherapists' physical and mental wellbeing and their clinical practice. Improved support, both emotional and legal is required. Clinical negligence training should be included in pre-registration and postgraduate programs. CONTRIBUTION OF THE PAPER., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Despite Australia's multiculturalism, physiotherapists from minority ethnic groups, including Muslim women, may experience social exclusion in physiotherapy training based on research in other countries., Objective: Explore Muslim women's experiences of physiotherapy education in Australia and how these experiences could be improved (if needed)., Methods: Qualitative research approach. Data were produced through semi-structured interviews and analyzed with reflexive thematic analysis., Results: Eleven participants were interviewed. Four main themes were produced: 1) omnipresent concerns about disrobing, physical proximity and touch in mixed-gender settings; 2) physiotherapy seen as a culturally inappropriate profession for Muslim women; 3) prevalence of an "Aussie" student environment; and 4) lack of systemic inclusivity. Suggestions to improve inclusivity, involved: systemically embedding measures such as alternatives for disrobing and proximity between genders; and promoting diverse social activities., Conclusion: Results suggest Australian physiotherapy education lacks systemic cultural sensitivity for Muslim women. To reduce the burden for change being placed on Muslim women students, culturally responsive institutional protocols and staff training could be established.

Introduction: In May 2022, the American Council of Academic Physical Therapy announced a "nationwide shortage of faculty" in entry-level Doctor of Physical Therapy (DPT) programs across the country. As the number of physical therapist education programs continue to grow, concerns with faculty shortages increase., Review of Literature: Research on reasons faculty stay in entry-level DPT programs is limited. With a nation-wide shortage of faculty and the continued growth of DPT programs across the country, more investigation into faculty retention is warranted., Subjects: Two hundred forty-four participants responded to the quantitative survey. Ten program directors (PD) and 10 faculty members (FM) completed a qualitative interview through Zoom., Methods: This mixed-methods design included a quantitative survey across 264 accredited DPT programs followed by 20 qualitative online interviews. Multiple regression was completed for the data analysis, and a phenomenological approach was used to explore perceptions of job satisfaction and organizational commitment on intent to stay., Results: Two hundred thirty-six subjects (mean age = 50.04 ± 9.54 years; males = 63, females = 173; PD = 55, FM = 180) were included in the analysis. The multiple regression model significantly predicted intent to stay for all participants, F(9,211) = 12.43, P < .001; adj R2 = .32. Commitment to the organization was the greatest predictor of intent to stay, β = 0.61, t(0.622) = 5.05, P < .01. Three themes with 6 subthemes emerged from the qualitative analysis, the impact of leadership, making a commitment, and the Covid crisis., Conclusion and Discussion: Encouraging leadership to focus on structural factors such as striving to establish FMs as part of the departmental team, allowing autonomy and flexibility in the teaching role, building transparency and openness with communication, and focusing on realistic and equitable workloads could potentially increase intent to stay for faculty in entry-level DPT programs., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Academy of Physical Therapy Education, APTA.)

Background: Work-related burnout is a significant concern amongst healthcare professionals, including physiotherapists. It can negatively impact on both staff well-being and the quality of care delivered to patients., Objectives: To estimate the prevalence of burnout among physiotherapists., Data Sources: PubMed, CINAHL, Web of Science, Embase, Scopus and PsycINFO, from inception to February 1st, 2022., Study Selection or Eligibility Criteria: Studies reporting burnout prevalence among physiotherapists., Data Extraction and Data Synthesis: Prevalence of burnout. Sub-analyses were performed grouping studies based on countries where surveys were conducted, classified as developed or developing countries. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale., Results: 32 studies were included in the systematic review and 31 in the meta-analysis, enrolling a total of 5984 physiotherapists from 17 countries. Pooled prevalence (95% confidence interval) of burnout was 8% (4-15). Prevalence figures for Maslach Burnout Inventory dimensions were: (i) emotional exhaustion, 27% (21-34) (ii) depersonalization, 23% (15-32) (iii) low personal accomplishment, 25% (15-40). Both overall and single components prevalence was higher, although not significantly, in studies from developing than in developed countries., Limitations: Tools used to assess burnout and cut-off scores chosen to identify the burnout prevalence differed across studies., Conclusion and Implications of Key Findings: Prevalence of burnout reported by physiotherapists appears high worldwide, in particular in developing countries, and compares with that reported by nurses and physicians. Substantial heterogeneity in the prevalence of burnout, in its definition and assessment methods across studies, and limited quality of most studies precludes drawing definitive conclusions., Systematic Review Registration Number: PROSPERO CRD42022307876 CONTRIBUTION OF THE PAPER., (Copyright © 2024 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.)

Background: The current workforce does not meet the demand for physiotherapy services in Australia. Future demand is predicted to expand driven primarily by the aging population. Previous research describes significant attrition and short career intentions of junior physiotherapists., Objective: This study explored factors associated with physiotherapy graduates' early career intentions and satisfaction., Method: Four cohorts of student physiotherapists completed two online surveys designed specifically for this study assessing their immediate and future career intentions and satisfaction. Surveys were completed after undergraduate training (Student Survey) and 2 years later (Practitioner Survey). Question formats included single or multiple select, Likert scale, and free-text responses. Responses were analyzed via descriptive statistics and content and relational analysis., Results: Despite most early career practitioners (83%) reporting career satisfaction, 27% intended to pursue long-term physiotherapy careers (>20 years) and 15% intended to work for 5 years or less. Fewer (11%) reported a longer career intention and 26% a shorter career intention compared to their student survey. Extrinsic occupational factors, such as support, were mentioned as influential in increasing intended future career length since course completion., Conclusion: This study found some evidence of factors contributing to shorter career intentions of early career physiotherapists. Specific support of early career physiotherapists may encourage longer career intentions and help build future workforce capacity.

Background: Low back pain (LBP) poses a significant global health burden where a biopsychosocial model of care has been recommended. Physiotherapists (PTs) play a crucial role in LBP management; however, their attitudes and beliefs towards LBP were not reviewed in detail., Objective: This systematic review aims to summarise the attitudes and beliefs of PTs towards LBP and the factors influencing them., Methods: The review protocol and methods adhere to the PRISMA-P and Meta Analyses and Systematic Reviews for Observational Studies in Epidemiology (MOOSE) guidelines. A comprehensive search of PubMed, Scopus, CINAHL, Web of Science, PEDro and Ovid databases will be conducted to search for cross-sectional studies evaluating PTs' attitudes and beliefs towards LBP. Two reviewers will independently screen the articles, conduct data extraction and assess methodological quality using the Joanna Briggs Institute's critical appraisal tool for prevalence studies. Data synthesis will involve a narrative synthesis of study characteristics, attitudes, beliefs, and methodological quality. If feasible, a meta-analysis will be performed to quantify the pooled effects., Conclusion: Despite the emphasis on biopsychosocial approaches for managing LBP, the adoption of such approaches in physiotherapy practice is still suboptimal, with attitudes and beliefs of PTs being considered an important factor influencing treatment practices. Our review will summarise the literature on attitudes and beliefs of PTs towards LBP. Such knowledge would inform the need for development of additional interventions addressing the attitudes and beliefs that would eventually enhance the update of the biopsychosocial model of care in physiotherapy management of LBP., (© 2024 John Wiley & Sons Ltd.)

Background: Functional electrical stimulation (FES) is an evidence-based intervention that is rarely used by Canadian physical therapists (PTs) and occupational therapists (OTs). A common barrier to FES implementation is a lack of knowledge and training. FES learning resources that meet therapists' learning needs and preferences may address this barrier., Objective: To explore OTs' and PTs' perspectives on the utility of FES e-learning resources, including whether the resources met their learning needs and preferences., Methods: Through this qualitative descriptive study, feedback on FES e-learning resources was solicited from 5 PTs and 18 OTs who work clinically, but do not use FES. Participants reviewed ≥3 prerecorded lectures on FES topics and then completed a semi-structured interview. Participants were asked about the lectures' content, delivery, ease of use and comprehensibility, and were asked to suggest modifications to facilitate self-directed learning about FES. Interviews were analyzed using conventional content analysis., Results: Three themes were identified. (1) Feedback on FES e-learning: the content and delivery of the prerecorded lectures facilitated participants' learning, although opportunities to improve content and delivery were identified. (2) Factors influencing FES learning needs and preferences: Participants identified internal (i.e., baseline knowledge, learning style) and external (i.e., learning with colleagues, practice setting) factors that affected learning. Themes 1 and 2 impacted (3) the effects of FES e-learning: Participants described the outcomes of their FES e-learning, including increases in FES knowledge, confidence, and use in clinical practice., Conclusion: Therapists' perceived the FES e-learning resources to be useful and to address their learning needs and preferences., (© 2024 The Authors. Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)

Background: Social media offer opportunities for informal learning and are increasingly adopted by health professionals as learning tools. However, little is known of how new graduate physiotherapists engage with social media for learning., Purpose: This study aimed to explore new graduate physiotherapists' perceptions and use of social media as learning tools during their transition into professional practice., Methods: This study used a qualitative general inductive approach. New graduate physiotherapists ( n  = 16) were recruited through purposive snowball sampling and participated in semi-structured interviews. Data were subjected to a general inductive analytical method., Results: Four themes were generated: 1) social media as tools for learning; 2) navigating and engaging with social media as a learner; 3) thinking critically about social media; and 4) relevance to practice., Conclusion: New graduate physiotherapists use social media as adjunct learning tools which can be positioned within several frameworks, including the Situated Learning Theory. However, new graduates voice uncertainties regarding information credibility, the importance of critical thinking skills in navigating information, and concerns regarding blurred work-life boundaries. Recommendations are made for research to further understand social media as emerging learning tools, especially for new graduates who are experiencing insufficient workplace support.

Background: JEMS ® (Joanne Elphinston Movement Systems) described as a systematic, holistic approach to analyze and create sound foundations for movement, is increasing in popularity among physiotherapists. The aim of this study was to investigate and capture the experiences and narratives of physiotherapists (PTs) using JEMS ® for rehabilitation with patients in primary healthcare., Materials and Methods: In this qualitative description study, we invited 13 PTs to focus group discussions (FGD). Four groups were conducted, three FGD at different locations in Region Västra Götaland, Sweden, and one FGD using Skype. The groups met on one occasion. The FGD method has a qualitative semi-structured research design based on a social constructivist tradition of research. Data were analyzed using the Kreuger method, considering the content of the discussion in a collective understanding of the subject and the interaction taking place among participants., Results: Three themes were identified: how the PTs describe their practical and emotional experiences, and how JEMS ® has changed their clinical work. Most clearly emerged subjects considering the interaction and communication with the patient, about finding a structure in clinical practice and about the development the informants experience in their role as a physiotherapist and as an individual., Conclusions: The FGD was chosen to capture the variety and width of experiences of the PTs using JEMS ® . The opportunity for learning and reflecting in the FGDs was appreciated by the PTs. The interaction between the patient and the PT was described as fundamental in establishing foundations for movement. Opportunities to meet and treat patients regardless of functional limitations elaborated and were in that way applicable in primary healthcare where patients seek a physiotherapist for a variety of reasons.

Objective: To explain how Dutch novice physical therapists experience their transition from student to physical therapist in private practice., Methods: A qualitative, phenomenological study was performed in The Netherlands to collect personal experiences from novice physical therapists who graduated <1 year ago. Data were collected with semi-structured interviews and analyzed using interpretative phenomenological analysis., Results: The transition experience from student to novice physical therapist is a personal, complex, and context-dependent phenomenon. Sixteen novice physical therapists (of whom 10 were still working in private practice) said their transition was liberating, stressful, insecure, unexpected, chaotic, and challenging. The variety in experiences occurred from the fact that the impact of an experience varies from one individual to the other, depending on their previous (life) experiences, uncertainty tolerance, coping, and personal and professional environment. Four overarching themes emerged: (1) 'Suddenly, I was on my own', (2) 'I was unprepared for the hassle and demands of clinical practice', (3) 'I couldn't make the impact I expected', and (4) 'I had to find a new me'., Conclusions: A novice physical therapist's transition is a context-related phenomenon, unique for each individual and determined by individual experiences and coping strategies. Novice physical therapists described a feeling of 'faking': they had to pretend to know what they were doing [while treating a patient] while in reality, they felt like they did not. For some novice physical therapists, a primary reason to leave the profession.