A scientific study investigating what physical therapists need to improve.
I can't take care of my heart.
According to what has been researched about physical therapists who treat back pain, when a patient goes to the hospital with back pain, rehabilitation is carried out and the patient feels a thousand different ways. The current published guidelines for the treatment of low back pain (LBP) are The current published guidelines for the treatment of LBP recommend that a psychosocial management approach be used.
However, physical therapists have a biomedical education that is common to other health care professionals. Improving sedentary behavior and lifestyle habits, such as movement patterns and muscle tension, has been around for decades.
been the focus of physical therapist training for decades.
However, the need to incorporate consideration of cognitive, psychological, and social factors into the management of LBP treatment has become imperative in recent years and is a must for all healthcare professionals, not just physical therapists. The need to incorporate cognitive, psychological and social factors into the management of LBP has become a necessity in recent years, not only for physical therapists, but for all healthcare professionals.
Those who have been educated as physical therapists are more likely than other health care professionals to be able to As physical therapists, we know that educated individuals have more evidence-based pain management and beliefs than other medical professionals. And while they are educated to be aware of treatment plans that emphasize the importance of social aspects, it is unclear whether such learning adequately equips them with the necessary skills to change patient management and outcomes.
What are the studies?
Nine of the studies were conducted in Europe, two in Australia, and one in Canada.
The majority were conducted in physical therapy settings between 2004 and 2013.
A total of 182 participants were interviewed across the 12 studies.
Among the findings from these were
A simple, mechanical explanation of back pain is given.
Even though the patient may not have a clear understanding at that point.
Physical therapists are afraid that what they explain may not be understood by the patient. expressed concern about discussing with patients the impact of cognitive, psychological, and social factors on their pain presentation for fear of "going wrong.
As a result, the physiotherapist was concerned that the patient would bring up specific cognitive, psychological or social factors related to their own pain, relieving the physiotherapist of this responsibility and preferred it out of fear that it would "go wrong.
I mean, I'm doing all this, right?
If the pain still doesn't go away, it's because XX's normal behavior and thinking is no good.
Hmmm... That's a common conversation (although it shouldn't be).
However, if you think about it calmly, if you have to manage the psychological aspect as well. However, if you think about it calmly, if you have to manage the psychological aspect, the physical therapists will be neglecting their work.
No matter how much education is given, if physical aspects such as joints and muscles are considered more important than psychological aspects, they may think that they will be neglected.
And then there's this opinion.
Some of the physical therapists described how serious the lack of expertise in these areas was. Since we could not treat them, there was no point in even asking about them. Furthermore, even among the physical therapists who recognized the importance of these factors in LBP, because they were not equipped with the knowledge or skills to successfully input
considered their management to be beyond the scope of their professional role and practice. This opinion, along with the involvement of the profession, led
They explained that they could only respond in ways that would exempt them from their profession.
As a result, the responsibility of treating patients who exhibit cognitive, psychological and social factors is often transferred to other health professionals.
We can't be the ones (physical therapy professionals) who fail.
We can't be the ones who fail, and we can't be blamed for it.
The conclusions drawn in this paper are
While some physical therapists recognize the importance of these factors as important barriers to recovery, most prefer to deal with the mechanical aspects of LBP. Many physical therapists feel ill-prepared to treat these aspects of LBP.
Physical therapists can benefit from the use of screening tools to identify these factors and from training to help them discuss and manage these factors with their patients.
Aoife Synnott aMary O'Keeffe aSamantha Bunzli bWim Dankaerts cPeter O'Sullivan bKieran O'Sullivan a
Physical Therapist Prejudice
People are easily tormented by assumptions and prejudices.
This is because we sometimes need to make decisions intuitively.
However, our cognitive functions are intuitive and thoughtful. If we only function intuitively, we will become a person full of assumptions.
This is how anon is.
This is what people are like. And so on.
There are many such situations in the medical field, and they tend to be different from years of service, number of cases, and other experiences. I found a research paper that describes an example of prejudice caused by such an assumption, and would like to introduce it here.
Contents of the study
5,205 research articles were referred to for analysis. Of these, 182 physical therapists who had experience in dealing with patients with back pain were interviewed.
Conclusion
We found that there are these characteristic ideas
Only the cognitive, psychological, and social aspects of back pain were looked at.
The patient's family, work, and expectations are easily viewed as meaningless.
And when they were not satisfied, they tended to assume that ano patients would not listen to their demands. And I also wondered why patients would turn to this kind of behavior.
https://doi.org/10.1016/j.jphys.2015.02.016
There is a problem with the choice of treatment methods.
There are two types of treatment choices made by physical therapists: those who practice the methods recommended by accumulating data, and those who base their treatments on unconfirmed evidence, or on their own claims.
How much do the results of the studies presented divide the results? What are the reasons? The following is a survey of the research that has been conducted.
Research Results
In the 94 studies referred to, there were
Back pain (n = 48 studies)
Knee pain (n = 10)
Neck pain, or whiplash (n = 11)
Foot or ankle pain (n = 5)
Shoulder pain (n = 7)
Before and after knee arthroplasty (n = 6)
Other (n = 18)
The survey was designed to investigate the treatment choices of physical therapists for these.
In summary, 63% of physical therapists provided recommended treatments for musculoskeletal conditions, 43% provided non-recommended treatments, and up to 81% provided treatments based on unconfirmed evidence. Examples of recommended treatments include advice on maintaining activity and exercise therapy for knee osteoarthritis.
Examples of treatments that are not recommended include electrotherapy for neck pain and joint mobilization for acute lateral ankle sprains. In contrast to recommended therapies, the percentage of physical therapists providing treatments of unknown value seems to be on the rise.
Examples of treatments with insufficient evidence for low back pain include workplace intervention, myofascial release, cold therapy, relaxation therapy, and laser therapy. Examples of treatments with insufficient evidence for neck pain include acupuncture, massage, and postural advice.
Why this is happening
Physical therapists are required to manage a wide range of conditions, and for some conditions, science has not kept pace with practice, so innovation is needed.
As an example, there is far less research into the management of conditions such as TMJ and cuboid syndrome compared to research into low back pain.
For conditions where the evidence base is relatively weak or for complex patient conditions, it may be necessary to try treatments of unknown value. This is especially true when the response to an evidence-based treatment is weak, even when it is offered.
Therefore, innovation is needed in clinical practice.
However, obtaining evidence through research and interpreting the findings can be time consuming. For these reasons, many physical therapists believe that evidence-based practice is not important, that evidence does not improve the quality of treatment, and that it is not important for clinical decision making.
According to the results of a survey of 274 physical therapists in Canada, only 46% agreed that guidelines allow them to manage low back pain.
Only 52% agreed that physical therapists should not use electrotherapy for low back pain, and it was found that this was driven by the belief that clinical experience is more beneficial than research evidence.
The view from this survey was that some patients believe that non-evidence-based care is effective and therefore demand such care, and that blanket recommendations for non-evidence-based care are inappropriate.
Ignoring such patient demands can be a very difficult problem in a situation where you are trying to build strong communication with patients.
Another issue is where guidelines are developed.
Even physical therapists who believe that evidence can be useful in practice recognize that it can be difficult to implement guideline recommendations when existing guidelines are being developed in countries with different cultures, health care systems, and levels of resources.
Zadro JR, Ferreira G. Has physical therapists' management of musculoskeletal conditions improved over time? Braz J Phys Ther. 2020;24(5):458-462. doi:10.1016/j.bjpt.2020.04.002
Physical therapists do not engage in physical activity
Lack of physical activity, is considered a common risk factor for several non-communicable diseases (NCDs). One might imagine that increasing physical activity, even in general, would reduce the burden of disease from major NCDs and increase life expectancy. Undergraduate physiotherapy students, representing a group of young adults who are expected to have a good knowledge of physical activity, conducted a study to assess the physical activity levels of undergraduate physiotherapy students at the University of Colombo, Sri Lanka, to determine the motivations and barriers to participating in physical activity.
2013.
All undergraduate physiotherapy students studying at the University of Colombo, Sri Lanka were invited to participate in the study.
Phase 1 was a quantitative study to assess physical activity levels and Phase 2 was a qualitative study to identify motivations and barriers to physical activity and sport in the same cohort. Physical activity levels (Phase 1) were assessed using the interviewer administered International Physical Activity Questionnaire (long version). The qualitative study (Phase 2) was conducted with the same population using focus group discussions (n = 3) and individual in-depth interviews (n = 5).
Results.
The sample sizes for Phase 1 and Phase 2 were 113 and 87, respectively.
The mean age (±SD) of the participants was 23.4 ± 1 years and the mean total weekly MET minutes (±SD) of the study population was 1791.25 ± 3097.
According to the IPAQ category scores, a higher percentage of participants were "inactive" (48.7%), while only 15.9% were "very active". It appears that the lack of support and encouragement for sports activities received in childhood played an important role in the continuation of athletic behavior into adulthood.
The prioritization of academic activities by both parents and teachers of the participants also played a role, suggesting the importance of the environment and support from teachers, family and friends in initiating and adhering to sports and physical activity.
In conclusion, about half of the undergraduate students who are aspiring to become physiotherapists at the University of Colombo, Sri Lanka, were not physically active and the reason for not being physically active was influenced by a lack of interest in sports activities from childhood.
Ranasinghe, C., Sigera, C., Ranasinghe, P. et al. Physical inactivity among physiotherapy undergraduates: exploring the knowledge-practice gap. Sports Sci Med Rehabil 8, 39 (2016). Available at: https://doi.org/10.1186/s13102-016-0063-8
How physiotherapists can provide value-based care
Despite millions of dollars spent on research funding, studies, and guidelines, there are reports that outcomes involving musculoskeletal care continue to decline. The purpose of this study is to describe value-based care and to suggest measures for its adoption by physical therapists managing individuals with musculoskeletal-related pain disorders.
The Problem
Providing value-based care requires.
1) Considering the patient as the center
2) Guideline-based treatment planning
3) Measuring outcomes that emphasize the patient experience.
4) Providing care that includes cost effectiveness.
It is best defined as
Physical therapists are well positioned to be leaders in the application of value-based care by ensuring that they address each of the four strategies in their daily encounters with patients. The question is, are you adhering to these? That is the question.
In conclusion.
By implementing value-based care principals, physical therapists can ensure that patients with musculoskeletal-related pain disorders receive the right care at the right time by the right provider.
Cook, C.E., Denninger, T., Lewis, J. et al. Providing value-based care as a physiotherapist. Arch Physiother 11, 12 (2021). Available at: https://doi.org/10.1186/s40945-021-00107-0
Physiotherapists failing to encourage exercise.
Activities that promote physical activity (PA) in health care are important for increasing PA levels. Physiotherapists are in a good position to promote PA, but there are no studies investigating the promotion of PA by physiotherapists across Australia, so this is a survey.
Australian Physiotherapists.
An online survey of practice was conducted to determine knowledge of Australian Physical Activity and Sedentary Behaviour (PASB) guidelines and factors associated with increased frequency of promotion. Participants were asked to state the PASB guidelines, a four-component scoring system was used to measure knowledge, and multivariate logistic regression analysis was conducted to assess factors associated with frequency of promotion.
Results.
A survey of 257 Australian physiotherapists was completed and only 10% were able to accurately state the PASB guidelines, with 54% reporting promoting PA to 10 or more patients per month. Men were about three times more likely than women to promote PA to more than 10 patients per month, and those who lacked counseling skills and felt that promoting PA would not change patient behavior were much less likely to promote PA.
Freene, N., Cools, S. & Bissett, B. Are we missing opportunities? Physiotherapy and physical activity promotion: a cross-sectional survey. BMC Sports Sci Med Rehabil 9, 19 (2017). Available at: https://doi.org/10.1186/s13102-017-0084-y
Physiotherapists not adhering to guidelines
The implementation of musculoskeletal practice guidelines (CPGs) administered by physiotherapists appears to be suboptimal. Osteoarthritis is one of the most common disorders and several studies have shown a lack of knowledge and adherence to osteoarthritis CPGs in the clinical practice of physical therapists.
However, these studies are not conclusive because they only investigate CPG knowledge and adherence in isolation or by focusing on a single treatment. Therefore, analyzing knowledge and adherence to CPGs in the same sample will allow us to better understand the gap between evidence and practice.
If this is not addressed, the care of patients with osteoarthritis may not be optimized. This study aims to assess the gap between evidence and practice among Italian physiotherapists in osteoarthritis CPGs.
The study.
An online survey, divided into two sections investigating CPG knowledge and compliance, was developed based on three high quality and recent relevant CPGs. In the first section, participants were asked to respond to 24 CPG statements on a scale of 1 (completely disagree) to 5 (completely agree), with 70% or greater agreement with a statement defined as consensus.
In the second section, participants were presented with clinical examples and could choose from a variety of interventions. Participants were categorized as "in delivery" (all recommended interventions selected), "partially delivered" (some recommended interventions missing), or "not delivered" (at least one non-recommended intervention selected), depending on the intervention selected.
As a result, 822 physical therapists (mean age (SD): 35.8 (13.3); 47% female) completed the survey between June and July 2020, and in the second section, 25% of participants were classified as "delivering," 22% as "partially delivering," and 53% as "not delivering.
In conclusion, the results showed an understanding of the treatment guidelines for the treatment of osteoarthritis, but the participants did not support the most recommended measures such as "weight loss," and they preferred to practice those with a low level of evidence, such as manual therapy performed by themselves, which means that they were not in compliance with the guidelines.
Battista, S., Salvioli, S., Millotti, S. et al. Italian physiotherapists' knowledge of and adherence to osteoarthritis clinical practice guidelines: a cross-sectional study. BMC Musculoskelet Disord 22, 380 (2021). Available at: https://doi.org/10.1186/s12891-021-04250-4
Physical therapists working in emergency departments
In a facility with an emergency department, the physical therapist may be part of that department. The presence of physical therapists seems to be acknowledged among the staff. This paper is a compilation of several references. How much of the actual work of the physical therapists belonging to the topic of the literature? The number of keywords used in the article is based on the number of citations of the physical therapist. The number of keywords in the "How many times has a physical therapist been cited?
Patient vs.
Role
Musculoskeletal management
Return and function of movements
Patient education
Referral and discharge
Non-pharmacological pain management
Cardiopulmonary management
Positive perceptions
Excellent interpersonal communication skills
For healthcare professionals
Role
Improve patient flow
Positive perceptions
Professional knowledge
Good team worker
Concerns
Role of physical therapists working in the emergency department
Limited possibilities
Time spent with patients
Explanation
The keywords above are cited from a number of references. The key words above are those that have been cited in a number of publications.
As a patient, the role of the patient is obvious.
If you are a medical professional, this is also something that makes sense.
I thought that these are hidden "needs" that are usually hard to notice.
There is nothing unusual about this, but the characteristics of the rehabilitation and emergency departments are different. Some people think that there is nothing that a physical therapist can do in a normal situation.
However, from what I have read in the literature, having a physical therapist in the emergency department can help staff become more aware of what is going on, and this is the key to what is desired. There are some things that are not included in the scope of work of other qualified professionals, and there are some things that they are not good at, because they are outside their area of expertise.
This is what I mean. In this way, you can be sure that you will be able to achieve your goals.
https://doi.org/10.1016/j.jphys.2018.08.001
