The use of positive pressure devices by physiotherapists.
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The aim of this paper is to review the indications for use by physiotherapists, such as physiological rationale and the comparative efficacy of intermittent positive pressure breathing (IPPB) and continuous positive airway pressure (CPAP). A brief discussion of nasal intermittent positive airway pressure is also included. The use of IPPB for post operative prophylaxis has not been supported in the literature. In patients with low lung volumes resulting from neuromuscular disease or spinal injury, IPPB may be useful in the acute phase to improve tidal volume and cough effectiveness. The physiological benefits of CPAP to improve lung volumes are well documented in the literature. Physiotherapists use CPAP as an intermittent application in patients with low lung volumes following surgery. It is predominantly used as a second line intervention in the presence of refractory atelectasis and poor gas exchange. It may also be indicated in other patient groups with similar physiological problems. Nasal intermittent positive airway pressure combines the beneficial effects of intermittent positive pressure breathing and continuous positive airway pressure. There have been many studies evaluating its effectiveness. These have been supportive for patients with neuromuscular disease and sleep disordered breathing, but more research is needed in patients with acute respiratory failure. (+info)
Do rheumatologists recognize their patients' work-related problems?
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OBJECTIVE: The question addressed in this pilot study was 'Does the addition of an occupational health physiotherapist offering early vocational assessment influence the management of rheumatology patients (clinically and related to the workplace)?' METHOD: Sequential vocational assessments were offered to 78 subjects with rheumatological complaints of more than 1 yr duration experiencing difficulties in working. The findings from the vocational assessments were fed back to rheumatologists. Where necessary and acceptable, workplace interventions were made and the Employment Service's Access to Work scheme was utilized to address the employment problems found. RESULTS: The intervention vocational assessments trebled the number of subjects seeing a Disability Employment Adviser (17% before the study, a further 37% during it). High levels of satisfaction were reported for interventions made at work. Some important changes to the management of some patients by a few doctors were made, but information from the vocational assessments did not reach them reliably in a number of cases. CONCLUSION: An unmet need for advice and workplace aids and equipment was identified. Vocational assessment by a practitioner with clinical knowledge, ergonomic and workplace experience proved helpful to patients in this pilot study. Without vocational assessment, the hospital-based team rarely identified what were often remediable, work problems and appeared unaware of the appropriate referral route for this group of patients. Rheumatologists may need to expand their management to include consideration of work issues to ensure that their patients are referred early for appropriate ergonomic intervention when required. Further study is required to help facilitate easy identification in the clinical setting of patients with problems at work. (+info)
Conservative treatment for repetitive strain injury.
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Various conservative treatment options for repetitive strain injury are widely used, despite questionable evidence of their effectiveness. This systematic review evaluates the effectiveness of these treatment options for relieving symptoms of repetitive strain injury and improving activities of daily living. Searches in Medline and Embase, with additional reference checking resulted in 15 eligible trials for this review. Methodological quality was assessed, and data-extraction was performed. With the use of a "best-evidence synthesis", no strong evidence was found for the effectiveness of any of the treatment options. There is limited evidence that multidisciplinary rehabilitation, ergonomic intervention measures, exercises, and spinal manipulation combined with soft tissue therapy are effective in providing symptom relief or improving activities of daily living. There is conflicting evidence for the effectiveness of behavioral therapy. In conclusion, little is known about the effectiveness of conservative treatment options for repetitive strain injury. To establish strong evidence, more high-quality trials are needed. (+info)
Evaluating physical therapists' perception of empowerment using Kanter's theory of structural power in organizations.
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BACKGROUND AND PURPOSE: Little is known about physical therapists' perceptions of empowerment. In this study, Kanter's theory of structural power in organizations was used to examine physical therapists' perceptions of empowerment in a large Canadian urban teaching hospital. Kanter's theory, which has been studied extensively in the nursing profession, proposes that power in organizations is derived from access to information, support, resources, opportunity, and proportions. SUBJECTS AND METHODS: A convenience sample of physical therapists who had been working in the hospital longer than 3 months was used to determine the scores for the physical therapists' ratings of empowerment using the Conditions of Work Effectiveness Questionnaire. RESULTS: Physical therapists' scores were similar to reported staff nurses' scores for access to support, information, resources, and opportunity (mean=2.89, 2.91, 2.62, 3.25, respectively). Physical therapists' scores were higher than the majority of reported staff nurses' and nurse managers' scores for access to sources of informal and formal power structures (mean=2.81 and 3.29, respectively). There was a relationship between the empowerment score and the physical therapists' global rating of empowerment. Unlike studies of nurses, there were no relationships when demographic attributes and empowerment scores were examined. DISCUSSION AND CONCLUSION: Evidence for the validity of Kanter's theory of empowerment was found. Kanter's theory can provide physical therapists and their managers with a useful framework for examining critical organizational factors (access to information, support, opportunity, and resources) that contribute to employees' perceptions of empowerment. A baseline measure for comparing future empowerment scores of this sample is available. Further work to examine the application of Kanter's theory to other samples of physical therapists appears to be warranted. (+info)
Assessing the need for change in clinical education practices.
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The purposes of this perspective article are to identify areas of need within clinical education, to describe various models and tools that are proposed and utilized in clinical education, and to explore the extent to which these models and tools might meet the identified needs of clinical education. A synthesis of the literature suggests that the clinical education process in physical therapy currently is characterized by 7 primary needs and that 10 models currently exist to guide the general process or to provide specific tools and practices to enhance its effectiveness. Roles and relationships are critical components in successful clinical education. Theory suggests that clinical educators and students should engage in an intentional, structured process of changing roles during the course of the clinical education experience and that nontechnical competencies such as communication, collaboration, and reflection are crucial for effective practice and may be developed in the clinical education setting. Developing a clearer understanding of the current status of physical therapy clinical education can assist clinical educators in the use of the available models and tools or in developing a new model that addresses potentially unique needs. (+info)
Views of chartered physiotherapists on the psychological content of their practice: a preliminary study in the United Kingdom.
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BACKGROUND: Although research into the psychological aspects of sports injury is increasing and psychological interventions have been identified as important in the rehabilitation process, few studies have focused on how sports medicine practitioners deal with psychological problems. OBJECTIVE: To investigate the perceptions of English chartered physiotherapists on the psychological content of their practice. METHODS: The Physiotherapist and Sport Psychology Questionnaire (PSPQ) was adapted slightly from the Athletic Trainer and Sport Psychology Questionnaire and used in this study. A survey package comprising a PSPQ, introductory letter, and self addressed envelope was mailed to 179 chartered physiotherapists registered in the England Eastern Region Sports Medicine Directory. RESULTS: In total, 90 (50% response rate) questionnaires were returned. The sample consisted of 67 women and 23 men with a mean (SD) age of 40.1 (5.4) years and 9.2 (3.1) years of experience as chartered physiotherapists. Descriptive statistical and qualitative analysis showed that physiotherapists believed athletes were often psychologically affected by injury. The physiotherapists also reported often using psychological techniques when treating injured athletes, but few reported having access to a sport psychologist for referral. CONCLUSIONS: This research indicates that future physiotherapy education may need more emphasis on the psychological aspect of injury, and seek to increase knowledge on the potential of using psychological interventions within a physiotherapy rehabilitation programme. Furthermore, some form of referral network should be established between chartered physiotherapists and sport psychologists. (+info)
Three perspectives on physical therapist managerial work.
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BACKGROUND AND PURPOSE: The nature of managerial work in the commercial sector has not been studied since the 1970s, and little is known about the work of managers in the health care sector. In this study, the perceived importance of managerial role and skill categories among 3 groups of physical therapists were studied to better understand the work priorities of physical therapist managers. SUBJECTS: Two groups of subjects were physical therapist managers in hospitals or private practices. A third group consisted of faculty members in professional physical therapist education programs. METHODS: Respondents (n=343) rated the importance of 75 managerial activities. Responses related to 16 predetermined work categories were placed in rank order by group. A multivariate analysis of variance (MANOVA) was used to identify differences among groups. RESULTS: All groups identified communication, financial control, entrepreneur, resource allocator, and leader as the 5 most important categories and rated technical expert and figurehead as least important. The MANOVA showed differences between faculty members and private practice managers in 15 work categories, between hospital-based managers and private practice managers in 9 categories, and between faculty members and hospital-based managers in 8 categories. DISCUSSION AND CONCLUSION: Work setting appears to have an impact on level of importance placed on managerial work categories. The strongest candidates for "universal" physical therapist managerial work categories were communication, financial control, and resource allocator. (+info)
Physical therapists' perceptions of factors influencing the acquisition of motor abilities of children with cerebral palsy: implications for clinical reasoning.
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BACKGROUND AND PURPOSE: Evidence supporting factors predicting motor change for children with cerebral palsy is minimal. A consensus exercise using focus groups and survey methods was conducted to identify factors perceived to affect the acquisition of basic motor abilities among children with cerebral palsy from the time of diagnosis to 7 years of age. SUBJECTS: Fifty-seven physical therapists participated in one of 12 focus groups, and 60 physical therapists participated in a follow-up questionnaire survey via mail. METHODS: The nominal group technique was used to conduct the focus groups. RESULTS: Participants reached consensus about 12 factors in 4 constructs, which we called: (1) primary impairments (muscle tone/movement patterns, distribution of involvement, balance, and sensory impairment), (2) secondary impairments (range of motion/joint alignment, force production, health, and endurance), (3) personality characteristics (motivation), and (4) family factors (support to child, family expectations, and support to family). DISCUSSION AND CONCLUSION: The recognition of potential determinants of motor change could assist in the clinical reasoning that physical therapists use when planning interventions for children with cerebral palsy. Participants identified a set of variables, some of which are found in the literature, that can provide foundation knowledge for decision making and research on factors that bring about change in motor ability among children with cerebral palsy. (+info)