RATIONALE: The concept of evidence-based medicine is important in providing efficient health care. The process uses research findings as the basis for clinical decision making. Evidence-based practice helps optimize current health care and enables the practitioners to be suitably accountable for the interventions they provide. Little work has been undertaken to examine how allied health professionals change their clinical practice in light of the latest evidence. The use of opinion leaders to disseminate new evidence around the management of low back (...) pain into practice has been proposed. AIMS: The aim of this study was to investigate if physiotherapists' clinical management of patients with low back pain would change following an evidence-based education package, which utilized local opinion leaders and delivered the best evidence. METHOD: Thirty musculoskeletal physiotherapists from a Community Trust in North Staffordshire were cluster randomized by location of work, to two groups. The intervention group received an evidence-based programme on the management of low back pain, including advice regarding increasing activity levels and return to normal activity and challenging patients' fears and beliefs about their pain. The control group received a standard in-service training package on the management of common knee pathologies. The physiotherapists' clinical management of patients with low back pain was measured prior to training and 6 months post training. Outcome measures were based on physiotherapists completing 'discharge summary' questionnaires, which included information relating to the use and importance of therapies for treating their low back pain patients. RESULTS: There were few significant differences in treatment options between the intervention and control groups post training. Whilst there was some indication that physiotherapists were already utilizing aspects of psychosocial management for patients with low back pain, there was little change in what physiotherapists perceived to be important to patient recovery and actual clinical practice following the intervention. CONCLUSIONS: Psychosocial factors have been identified as an important factor in the recovery of patients with low back pain. This project incorporated the latest evidence on the management of low back pain and utilized the theory of opinion leaders to disseminate this evidence into clinical practice. Whilst there were some limitations in the overall size of the study, the results help to give an insight into the challenges faced by the health care system and researchers alike to ensure quality evidence is actually utilized by practitioners for the benefits of patient care. (shrink)

Objectives—This study examined the issue of confidentiality in relation to i) undergraduate curriculum content in physiotherapy, and ii) the awareness, experiences and attitudes of clinical physiotherapists.Design—Postal survey of universities and focus group interviews with physiotherapists.Setting—Twenty-five universities in the UK and Ireland and 44 therapists in five hospitals in southern England.Results—The survey of universities indicated that legal and ethical aspects of confidentiality featured in virtually all preregistration courses that responded. However, whereas its inclusion was rated as extremely important, the degree (...) of coverage of confidentiality varied considerably between courses. Within the focus groups, 35 informants recollected coverage of confidentiality in their preregistration education, and 12 in postregistration in-service training; in neither case was this coverage in great detail. Informants identified environmental factors and working practices as barriers to preserving confidentiality. Disclosure to others also gave rise to difficulties. Informants were only aware in general terms of the relevant sections of the Chartered Society of Physiotherapy's Rules of Professional Conduct.Conclusions—Aspects of hospital-based physiotherapy practice were seen to create specific problems in relation to confidentiality. More detailed sources of education and guidance on this issue appear to be required. (shrink)

Physiotherapy raises serious bioethical questions that are far too little discussed. Concerns include the lack of a clearly defined end point, the closeness of interaction between therapist and patient, the patient’s own share of responsibility, and the common failure to refer patients for rehabilitation.Physiotherapy has evolved dramatically in recent years, to the point where it is now a major healthcare profession offering assessment, diagnosis and treatment for a wide range of conditions, from sports injuries to rehabilitation for major (...) injuries and diseases. According to the World Confederation for Physical Therapy, “Physical Therapy is providing services to people and populations to develop maintain and restore maximum movement and functional ability throughout the lifespan” .1However, almost uniquely among the healthcare professions, physiotherapy has aroused little or no philosophical interest or engagement. This is surprising, because some of the salient features of physiotherapy raise interesting and to some extent novel problems in ethics. There are, it is true, some papers on ethically related themes,2–5 but in comparison with the size of the discipline and the complexity of the problems, the profile of physiotherapy in bioethics is worryingly low.A first problem is that unlike many areas of medicine—surgery, for example, or radiography or obstetrics and gynaecology—physiotherapy has no obvious end point. In medicine, the end points of treatment are generally well defined, with only a few exceptions, such as plastic surgery or psychiatry. It is my impression that physiotherapy, with few exceptions, does not operate with the concept of end points. Although what physiotherapy aims at is clear, the point at which the aims are achieved is uncertain. For example, in many cases the patient would go on benefiting from sessions of physiotherapy, perhaps with diminishing returns but still with …. (shrink)

Despite an increasingly growth of professional guidelines, textbooks and research about ethics in health care, awareness about ethics in Danish physiotherapy private practice seen vague. This article explores how physiotherapists in Danish private practice, from an ethical perspective, perceive to practice physiotherapy. The empirical data consists of interviews with twenty-one physiotherapists. The interviews are analysed from a hermeneutic approach, inspired by Ricoeur’s textual interpretation of distanciation. The analysis follows three phases: naïve reading, structural analysis and comprehensive analysis. Four (...) main themes are constructed: Beneficence as the driving force; Disciplining the patient through the course of physiotherapy; Balancing between being a trustworthy professional and a businessperson; The dream of a code of practice. Private practice physiotherapy is embedded in a structural frame directed by both political and economical conditions that shape the conditions for practicing physiotherapy. It means that beneficence in practice is a balance between the patient, the physiotherapists themselves and the business. Beneficence towards the patient is expressed as an implicit demand. Physiotherapeutic practice is expressed as being an integration of professionalism and personality which implies that the physiotherapists also have to benefit themselves. Private practice seems to be driven by a paternalistic approach towards the patient, where disciplining the patient is a crucial element of practice, in order to optimise profit. Physiotherapists wish for a more beneficent practice in the future by aiming at bridging ‘to be’ and ‘ought to be’. (shrink)

This paper applies a hybrid Heideggerian-ethnomethodological approach to physiotherapy practice. Unlike previous studies written by and for practitioners, this paper uses my personal experience receiving physical therapy as its point of departure. By combining Heidegger’s [Being and time (trans: Stambaugh J). State University of New York Press, New York 1996] notion of the ‘ontological difference’ with Garfinkel’s (Studies in ethnomethodology, Prentice-Hall, Englewood Cliffs 1967) concept of ‘accountability,’ I argue that in physical therapy practice, both client and practitioner actively shape (...) the body into a coherent object for medical intervention. I begin by introducing three key phenomenological concepts, the life-world, the ontological difference, and Heidegger’s critique of subjectivity. I then empirically substantiate these concepts by reviewing classic and recent studies in ethnomethodology. I conclude with my own experience of physical therapy, and demonstrate how both client and practitioner actively constitute the body as a medical and therapeutic object. This is cause for both disability studies and physiotherapy to reconsider some of their core concepts, ‘medicalization’ and ‘client-specific measurement,’ respectively. (shrink)

In the past, several researchers in the field of physiotherapy have asserted that physiotherapy clinicians rarely use ethical knowledge to solve ethical issues raised by their practice. Does this assertion still hold true? Do the theoretical frameworks used by researchers and clinicians allow them to analyze thoroughly the ethical issues they encounter in their everyday practice? In our quest for answers, we conducted a literature review and analyzed the ethical theoretical frameworks used by physiotherapy researchers and clinicians (...) to discuss the ethical issues raised by private physiotherapy practice. Our final analysis corpus consisted of thirty-nine texts. Our main finding is that researchers and clinicians in physiotherapy rarely use ethical knowledge to analyze the ethical issues raised in their practice and that gaps exist in the theoretical frameworks currently used to analyze these issues. Consequently, we developed, for ethical analysis, a four-part prism which we have called the Quadripartite Ethical Tool (QET). This tool can be incorporated into existing theoretical frameworks to enable professionals to integrate ethical knowledge into their ethical analyses. The innovative particularity of the QET is that it encompasses three ethical theories (utilitarism, deontologism, and virtue ethics) and axiological ontology (professional values) and also draws on both deductive and inductive approaches. It is our hope that this new tool will help researchers and clinicians integrate ethical knowledge into their analysis of ethical issues and contribute to fostering ethical analyses that are grounded in relevant philosophical and axiological foundations. (shrink)

Many physiotherapists are reluctant to treat a client with bone metastases, as treatment indications are not clearly defined. The paradigmatic case presented here, and a review of the literature, allow us to highlight some ethical and clinical issues in physiotherapy care at the end of life, particularly for patients with bone metastases. The objective of this article is not to create an ethical decision making model but rather to serve as additional guidance to existing decision models in rehabilitation. This (...) guidance is based on principlism and is specific to the oncology clients in palliative care. The proposed principles, without being exhaustive, are beneficence, non-maleficence, respect for autonomy and justice. With a review of clinical indications and precautions, the article also helps to clarify both the theoretical and the evidence-based risks. These principles provide avenues for reflection to guide the management of these patients. The physiotherapist will then be able to conduct a critical analysis, in collaboration with the interdisciplinary team, whose goal is to respect the client’s right to appropriate care at the right time and that is based on clinical need. (shrink)

This contribution focuses on a physiotherapy consultation in which the first author of the contribution is the patient and the second author is the physiotherapist. It features analysis of video excerpts in which (1) the physiotherapist instructs the patient how to do an exercise and (2) the patient turns the physiotherapist's instructions into a course of action while (3) the physiotherapist monitors, assesses, guides, and corrects the patient's instructed actions by deploying touch. The investigation draws on video-recordings and transcriptions (...) of the physiotherapist’s and the patient’s interaction during the exercise instructions, the authors’ experience of touching/being touched during these instructions, and their shared understandings as discussed during data-sessions devoted to select video-clips of exercise instructions. In a learning process, the instructor’s instructional corrections are critical: they provide learners with relevant specifications and explanations as to how instructed actions and/or remedial actions are to be accomplished. Whereas monitoring and touching the patient allows the physiotherapist to feel, assess, correct, and guide the patient’s instructed actions, being touched permits the patient to feel how the physiotherapist’s touch resonates beyond locally circumscribed body contact and adapt her movements accordingly. Our contribution thus reveals touching/being touched configurations that establish joint attention and action on extended sensoriality as forming constitutive parts of a dynamic sensorimotor process of inter- and intrabodily resonance, which is challenging to investigate. (shrink)

In the context of long waiting time to access rehabilitation services, a large majority of settings use referral prioritization to help manage waiting lists. Prioritization practices vary greatly between settings and there is little consensus on how best to prioritize referrals. This paper describes the prioritization processes for physiotherapy services in Québec and its potential implications in terms of equity in access to services. This is a secondary analysis of a survey of outpatient physiotherapy departments (n=98; proportion of (...) participation was 99%) conducted in 2015 across publicly funded hospitals in Québec. In many settings, persons with acute orthopaedic conditions were prioritized while chronic conditions were given a lower priority. There were 72 different combinations of prioritization criteria used in outpatient physiotherapy departments. Variability was also observed in the type of personnel involved in the prioritization process, the number of priority levels used to rank the referrals and the source of information used to prioritize referrals. These results highlight potential issues regarding equity in access to physiotherapy services: the prioritization of persons with acute conditions to the detriment of those with chronic conditions, the lack of consensus on a fair prioritization process and the importance to adequately assess patients’ needs for treatment. Further research and interventions on prioritization criteria and processes are needed to ensure equitable access to physiotherapy services, especially in the public sector. (shrink)

BackgroundEven though virtual reality is more and more considered for its power of distraction in different medical contexts, the optimal conditions for its use still have to be determined in order to design interfaces adapted to therapeutic support in oncology.ObjectiveThe objective of this study was to examine the benefits of VR using two immersion methods and comparing them with each other in a population of women with breast cancer who have undergone breast surgery, during scar massage sessions.MethodsIn a physiotherapy (...) center, each patient participated in four experimental conditions in a random order: two sessions used virtual immersion, one session proposed musical listening and the fourth one was a standard session care. The impact of the level of patient involvement in the virtual world was apprehended through the evaluation of the feeling of presence; the estimation of elapsed time of the physiotherapy sessions and particular attention was paid to the evaluation of patient emotional state.ResultsOur study showed an increase in positive emotions and a decrease in anxiety regardless which support methods were offered. Participatory VR created a feeling of more intense spatial presence.ConclusionOur results highlight the importance of the context in which VR should be offered. The presence of the practitioner and his interactions with the patient can provide a context just as favorable in reducing anxiety as the emotional regulation tools used. The use of technological tools should be favored when the practitioner is unavailable during the treatment phase or, even, in order to reduce the monotonous nature of repetitive therapeutic sessions. (shrink)

This paper describes how body regimes are effectuated in the prevailing treatment strategy of physiotherapy. The process of self‐mastering in the context of sports‐related injuries is highlighted. Through a Foucauldian perspective on body regimes the aim is to shed light on the process of individualization and self‐mastery in rehabilitation. The treatment of illness in the physiotherapy clinic does not characterize the patient as sick, and exempt the patient from daily duties and expectations. The empirical data include 17 qualitative (...) illness narratives and several years of fieldwork observing patients with anterior cruciate ligament (ACL) injuries in a physiotherapy clinic. The study demonstrates how the expectation that the patients be active and self‐mastering permeates the total process of treatment. The individual responsibility for personal well‐being is a recurrent phenomenon in public health services in general, and specifically prominent in the rehabilitation of sports injuries. (shrink)

The aim of this paper is to offer theoretical insights into the care of the self, which often initiates therapist-patient relationships in clinical practice. The reason is that when patients care about their health status, they are inclined to establish a therapeutic relationship with physical therapists. Hence, the care for self may bridge the world of the patient's private experiences and the world of the healthcare system together with its interventions, which is represented by the physical therapist In this framework, (...) care means not only the patient's choice to undergo therapy but also his/her commitment to sustaining its effects in private life. This involves educational interventions by the physiotherapist who inscribes him/herself in his/her patients’ care of the self in order to alter their habits of physical exercise, diet, personal hygiene, body posture, etc. The argument in this paper is informed by the concepts of ethics developed by Michel Foucault and Richard Shusterman. (shrink)

Conventional medical training offers little help to students to resolve the ethical dilemmas they face as healthcare professionals. Public awareness of the ethical behavior of medical practitioners has been growing. Aim of this study was to assess knowledge of, practice in and attitudes of healthcare ethics among medical, dental and physiotherapy postgraduate students. A cross-sectional analysis based on a questionnaire was performed at a hospital and dental institution of the medical college. The present study included 60 postgraduate students. The (...) questionnaire on health care ethics is a 44-point self-administered standardized questionnaire that poses ethical dilemmas in 5 vignettes with closed-ended questions to test awareness, attitude and experience in the area of healthcare ethics. In the first half of the questionnaire, knowledge and attitude were assessed using 5 case scenarios representing ethical dilemmas and the participants answered the questions using the 5 point likert scale. The second half assessed the practice of Ethics in research and clinical practice. The expected time to fill each questionnaire was about 10–15 min. 62 questionnaires were distributed. 60 completed questionnaires were returned. The response rate was 96%. The mean age of the postgraduates was 26.23 ± 2.33. Among the participants 28 were male and 32 female. 20 completed questionnaires from each, medical, dental and physiotherapy postgraduate students were collected. The multiple group comparison showed that the difference in the knowledge scores were statistically significant between dental and physiotherapy and between medical and physiotherapy but no significant difference between medical and dental. Study suggests that abstract knowledge cannot be converted into practical knowledge automatically. There is a major lack of knowledge of the ethics of health care among graduate students. The postgraduate curriculum must include a good mix of both theoretical concepts and practical application of multidisciplinary healthcare ethics ethical principles and guidelines. (shrink)

This study identified and described ethical problems encountered by physiotherapists in their practice and physiotherapists’ moral sensitivity in ethical situations. A questionnaire-based survey was constructed to identify ethical problems, and the Moral Sensitivity Questionnaire Revised version was used to measure moral sensitivity. Physiotherapists (n = 116) working in public health services responded to the questionnaire. Based on the results, most of the physiotherapists encounter ethical problems weekly. They concern mainly financial considerations, equality and justice, professionalism, unethical conduct of physiotherapists or (...) other professions and patients’ self-determination. The dimension of moral strength was emphasised in physiotherapists’ self-evaluations of their moral sensitivity. As a conclusion, ethical problems do occur not only at individual level but also at organisational and society level. Physiotherapists seem to have moral strength for speaking on behalf of the patient. Scarce resources make them feel insufficient but much could still be done to provide quality care in co-operation with other health-care professionals. (shrink)

Background: In the course of the last four decades, the profession of physiotherapy has progressively expanded its scope of responsibility and its focus on professional autonomy and evidence-based clinical practice. To preserve professional autonomy, it is crucial for the physiotherapy profession to meet society's expectations and demands of professional competence as well as ethical competence. Since it is becoming increasingly popular to choose a carrier in private practice in Denmark this context constitutes the frame of this study. (...) class='Hi'>Physiotherapy in private practice involves mainly a meeting between two partners: the physiotherapist and the patient. In the meeting, power asymmetry between the two partners is a condition that the physiotherapist has to handle. The aim of this study was to explore whether ethical issues rise during the first physiotherapy session discussed from the perspective of the physiotherapists in private practice. Methods: A qualitative approach was chosen and semi-structured interviews with 21 physiotherapists were carried out twice and analysed by using a phenomenological framework. Results: Four descriptive themes emerged: general reflections on ethics in physiotherapy; the importance of the first physiotherapy session; the influence of the clinical environment on the first session and; reflections and actions upon beneficence towards the patient within the first session. The results show that the first session and the clinical context in private practice are essential from an ethical perspective. Conclusions: Ethical issues do occur within the first session, the consciousness about ethical issues differs in Danish physiotherapy private practice, and reflections and acts are to a lesser extent based on awareness of ethical theories, principles and ethical guidelines. Beneficence towards the patient is a fundamental aspect of the physiotherapists' understanding of the first session. However, if the physiotherapist lacks a deeper ethical awareness, the physiotherapist may reason and/or act ethically to a varying extent: only an ethically conscious physiotherapist will know when he or she reflects and acts ethically. Further exploration of ethical issues in private practice is recommendable, and as management policy is deeply embedded within the Danish public sector there are reasons to explore public contexts of physiotherapy as well. (shrink)

Background of the study: Physiotherapists in Nigeria renewed their practicing license annually through the regulatory body and are provided with the professional code of ethics which stipulate the appropriate conduct, behaviour to guild and regulate the practice of their profession however, the level of knowledge, attitude and application of the ethical guidelines by Nigerian physiotherapists need to be investigated. Aim of Study: This study assessed the knowledge, attitude and perception of Nigerian physiotherapists in relation to the ethics of their professional (...) practice. Methodology: The cross-sectional study recruited 117 licenced Physiotherapists working in various health institutions in Nigeria. They were recruited for the study during the 2018 annual scientific conference of clinical and academic physiotherapists in Nigeria. Data on demographic, work experience, knowledge, attitude and perception of ethics of professional practise were obtained using a self-administered questionnaire. Data were summarized using a descriptive statistics of percentage and frequency distribution. Results: All the participants 117 (100%) had copies of code of ethics and oath of professional practise. 74.6% of participants had good knowledge of code of professional ethics while 25.39% had poor knowledge. Only 40.8% (48) of the respondents demonstrated good attitudes toward code of professional ethics. Similarly, only 43.4% (51) of the respondents demonstrated good attitude towards oath of professional practise. 57.0 % of the respondents have heard about ethical misconduct among colleagues while only 13.60% have been involved in ethical misconduct with respect to colleagues or patients. Greater proportion of the respondents (78.2%) considered ethics in physiotherapy as very important while 43.4% supported the introduction of physiotherapy ethics as a course to physiotherapy students in year three of their undergraduate training. Conclusion: Majority of Nigerian physiotherapists have good knowledge of professional code of ethics and oath of professional practise, however, their attitudes towards periodic updating their knowledge on code of ethics and professional oath remain poor. Clinical implication and recommendation: Ethical matter are very important to the practise of physiotherapy, however the poor attitudes of physiotherapy toward updating their knowledge on ethical matters calls for the need for the regulatory body and the professional association to organise seminars and workshops on ethics in physiotherapy and introduce pre-renewal test on ethics before annual licence renewal. (shrink)

[In Czech] This article aims to explain how Merleau-Ponty’s phenomenological account of embodiment contributes to the theory and practice of physiotherapy. The mechanistic conception of the body, to which physiotherapy usually refers, assumes a universal model of its functioning and interprets its relationship to the environment causally. In fact, however, it does not allow a satisfactory explanation of the efficiency of the therapeutic methods used in practice. In contrast, Merleau-Ponty’s concept of motor intentionality points to the fact that (...) the body “understands” the practical meaning of a situation. Bodily understanding is then manifested in particular by the ability to adequately differentiate, adapt or vary motor and postural responses to environmental challenges. This change in the conception of embodiment also has important implications for understanding the therapist-patient relationship and the intervention itself. Physiotherapists should draw more on the fact that they are themselves a body and, on this basis, guide the patient’s bodily intentionality towards a more developed understanding of the practical meaning of situations. (shrink)

This article is dealing with the professionalization intention of a physiotherapy trainer through an innovative plan called «Training group on the analysis of rehabilitation practicing». This innovative plan has been created by the management team of a physiotherapy training institute, in South of France, in response to the 2015 reforms about the studies leading to the state-registered diploma of physiotherapist. Thanks to the studies of both the genesis and goal of that plan, plus the observation of its application (...) by a trainer, this study is trying to give a few answers to the following question: How role-playing and the collective analysis the TGARP has implemented can help physiotherapy students develop their professionalization and reflexivity during their full-time education? (shrink)

This contribution aims to understand the process of renormalisation operated at the level of internship tutors by the management team in a French physiotherapy training institute, faced with the implementation of a reform of the studies. The study is based on the concepts of corporate social responsibility (CSR) and leadership and on a three-year interview survey with the management. The results highlight the issues encountered in the first year and the training dynamics implemented in the third year. The discussion (...) debates the evolution of CSR and the concomitant leadership it develops. (shrink)

In the context of long waiting time to access rehabilitation services, a large majority of settings use referral prioritization to help manage waiting lists. Prioritization practices vary greatly between settings and there is little consensus on how best to prioritize referrals. This paper describes the prioritization processes for physiotherapy services in Québec and its potential implications in terms of equity in access to services. This is a secondary analysis of a survey of outpatient physiotherapy departments conducted in 2015 (...) across publicly funded hospitals in Québec. In many settings, persons with acute orthopaedic conditions were prioritized while chronic conditions were given a lower priority. There were 72 different combinations of prioritization criteria used in outpatient physiotherapy departments. Variability was also observed in the type of personnel involved in the prioritization process, the number of priority levels used to rank the referrals and the source of information used to prioritize referrals. These results highlight potential issues regarding equity in access to physiotherapy services: the prioritization of persons with acute conditions to the detriment of those with chronic conditions, the lack of consensus on a fair prioritization process and the importance to adequately assess patients’ needs for treatment. Further research and interventions on prioritization criteria and processes are needed to ensure equitable access to physiotherapy services, especially in the public sector. (shrink)

Postdisciplinary Knowledge is the first book to articulate postdisciplinarity in philosophical, theoretical and methodological terms, helping to establish it as an important intellectual movement of the 21st century. It formulates what postdisciplinarity is, and how it can be implemented in research practice. The diverse chapters present a rich collection of highly creative thought-provoking essays and methodological insights. Written by a number of pioneering intellectuals with a range of backgrounds and research foci, these chapters cover a broad spectrum of areas demonstrating (...) alternative ways of producing knowledge. Essays are interspersed with dialogue, encouraging a comprehensive and engaging discussion on this emerging movement. Not limited to a specific field or discipline, this will be of great interest to upper level students and researchers in a wide range of subject areas, including: tourism, sociology, education, psychology, physiotherapy, fine arts, architecture and design, as well as those with a general interest in epistemology and methodology. (shrink)

Background During the first wave of the new coronavirus (COVID-19) pandemic, the sudden increase in hospitalised patients put medical facilities in southern Switzerland under severe pressure. During this time, bachelor’s degree programs in nursing, physiotherapy and occupational therapy were disrupted, and students in their second year were displaced. Students experienced the continuous reorganisation of their traineeship as healthcare facilities adapted to a climate of uncertainty. Purpose The aim of this study was to investigate the degree of moral distress and (...) the ethical issues most often encountered by physiotherapy, nursing and occupational therapy students enrolled in a traineeship during the first wave of the COVID-19 pandemic in southern Switzerland. Participants and research context The sample consisted of 102 participants, and the response rate was 81.6%. Research design Based on a pragmatic approach, a mixed-method with a convergent design was adopted. Data were collected between 30 April 2020 and 14 May 2020, via a survey administered to all occupational therapy, physiotherapy and nursing students in their fourth semester. Ethical considerations Given that no vulnerable persons were involved, the Ethics Committee of Southern Switzerland waived authorisation. However, all measures were put into place to protect participants by guaranteeing their anonymity and confidentiality. Results and discussion The data analysis showed that the main source for moral distress was ‘poor teamwork’ and that the moral issues encountered most often by students were related to the appropriateness of care and working conditions, with a clear reference to students’ own safety and that of their loved ones; the other concerns reported included the loss of learning opportunities and the perceived lack of technical knowledge and skills. Conclusions This survey offers a faithful overview of physiotherapy, nursing and occupational therapy students’ experience during the first pandemic wave. This study also identifies some key recommendations for healthcare professions’ education. (shrink)

Settler colonisation continues to cause much damage across the globe. It has particularly impacted negatively on Indigenous peoples’ health and wellbeing causing great inequity. Health professional education is a critical vehicle to assist in addressing this; however, non‐Indigenous educators often feel unprepared and lack skill in this regard. In this qualitative study, 20 non‐Indigenous nursing, physiotherapy and occupational therapy educators in Australia were interviewed about their experiences and perspectives of teaching Indigenous health. Findings from the inductive thematic analysis suggest (...) educators require skill development to: identify their discomfort in teaching cultural safety; contextualise the sources of this discomfort and; reflect on how this understanding can improve their teaching. Additionally, educators require professional training to become practitioners of cultural humility and to be facilitators and colearners (rather than experts) of the Aboriginal‐led curriculum. Of relevance to this is educator training in how to decentre non‐Indigenous needs and perspectives. Educators can also renew their teaching practices by understanding what a dominant settler paradigm is, identifying if this is problematically present in their teaching and knowing how to remedy this. Crucial to improved cultural safety teaching is institutional support, which includes Indigenous leadership, institutional commitment, relevant policies, and well‐designed professional development. (shrink)

IntroductionAt present, in the UK, live lobe donation of the lung is generally considered in the context of patients with cystic fibrosis which is a life-threatening, inherited disease.1 However, if this technique is successfully developed it may be applicable to other patients with end stage lung disease. Cystic fibrosis is a disease where the major morbidity and mortality is due to pulmonary infection and respiratory failure.2 In l938 70% of patients born with CF died within one year of birth, but (...) now the average survival has improved to 32 years.1 The improved survival has been due to improved medical care, but also, and in very large measure, to the devotion of the families who have carried out time-consuming daily treatments such as chest physiotherapy, nebuliser treatment, high calorie diets etc. To these patients and their families lung transplantation brought new hope.3 The first successful transplant for CF was performed in the UK in 1985 and we now have patients alive and well more than ten years after transplantation. However, sadly, nearly 50% of patients with CF die on the transplant waiting list because of a shortage of donor organs from brain stem dead donors. This is a tragedy for the individual patient, the families and those who care for them. Is there a way forward?Can the number of organs available for transplantation be increased?Education of the public so that a relative of a brain dead individual will give permission for the organs to be used has been carried out for many years but only with a small increase in the number of available organs. “Required request” where doctors would be required, by law, to ask relatives of brain dead patients to consider transplantation and “assume consent” where consent to donation is assumed unless there is evidence to the contrary, do not have the …. (shrink)

Background: The new human coronavirus that leads to COVID-19 has spread rapidly around the world and has a high degree of lethality. In more severe cases, patients remain hospitalized for several days under treatment of the health team. Thus, it is important to develop and use technologies with the aim to strengthen conventional therapy by encouraging movement, physical activity, and improving cardiorespiratory fitness for patients. In this sense, therapies for exposure to virtual reality are promising and have been shown to (...) be an adequate and equivalent alternative to conventional exercise programs.Aim: This is a study protocol with the aim of comparing the conventional physical therapy intervention with the use of a non-immersive VR software during COVID-19 hospitalization.Methods: Fifty patients hospitalized with confirmed diagnosis of COVID-19 will be divided in two groups under physiotherapy treatment using conventional or VR intervention: Group A: participants with COVID-19 will start the first day of the protocol with VR tasks in the morning and then in the second period, in the afternoon, will perform the conventional exercises and Group B: participants with COVID-19 will start the first day with conventional exercises in the morning and in the second period, in the afternoon, will perform activity with VR. All participants will be evaluated with different motor and physiologic scales before and after the treatment to measure improvements.Conclusion: Considering the importance of benefits from physical activity during hospitalization, VR software shows promise as a potential mechanism for improving physical activity. The results of this study may provide new insights into hospital rehabilitation.Trial Registration:ClinicalTrials.gov, identifier: NCT04537858. Registered on 01 September 2020. (shrink)

Despite recurring efforts, a gap exists across a variety of contexts between the protection of patients' safety in theory and in practice. This timely Research Handbook highlights these critical issues and suggests both legal and policy changes are necessary to better protect patients' safety. Multidisciplinary in nature, this Research Handbook features contributions from eminent academics, policy makers and medical practitioners from the Global North and South, discussing the essential facets concerning patient safety and the law. It highlights how the role (...) of legislation and case law has the potential to influence, both positively and negatively, medical practice and the quality of care. Chapters explore patient safety and the global health agenda; physiotherapy; 'non-therapeutic' clinical research with children; patient safety awareness in healthcare education; and the increasing use of robotics and artificial intelligence in healthcare. Outlining a wide range of international perspectives on patient safety and the law, this Research Handbook will appeal to academics and researchers specialising in health and medical law, human rights and healthcare regulation. It will also serve as a valuable resource for legal and medical practitioners alike, as well as clinicians and professionals working in healthcare governance. (shrink)

Background: Physical exercises can affect executive function both acutely and chronically, with different mechanisms for each moment. Currently, only a few reviews have elaborated on the premise that different types of exercises have different mechanisms for improving executive function. Therefore, the primary purpose of our systematic review was to analyze the effects of acute and chronic exercises on executive function in children and adolescents.Objective: We identified acute and chronic exercise studies and randomized controlled trials of executive function in children and (...) adolescents that reported overall effect, heterogeneity, and publication bias of acute and chronic exercises on executive function.Methods: We searched for RCTs of exercise interventions in children and adolescents from databases including PubMed, Web of Science, Scopus, The Cochrane Library, CNKI, and Wanfang, from January 1 2009 to December 31 2019. We performed methodological quality evaluations on the included literature using the Physiotherapy Evidence Database Scale and graded evidence with a meta-analysis using Stata 12.0 software.Results: In total, 36 RCTs were included ; the overall results of the meta-analysis indicated that acute exercises significantly improved working memory = −0.72; 95% confidence interval −0.89 to −0.56; p < 0.001), inhibitory control, and cognitive flexibility, whereas chronic exercises significantly improved working memory, inhibitory control, and cognitive flexibility.Conclusion: Acute and chronic exercises can effectively improve the executive function of children and adolescents. The effects on inhibitory control and cognitive flexibility are considered as small effect sizes, while the effects on working memory are considered as moderate effect size. Limited by the quantity and quality of the included studies, the above conclusions need to be verified with more high-quality studies. (shrink)

This paper addresses the ontological status of the body in the context of bodily practices in body-oriented disciplines, such as sport training, dance, and physiotherapy. Following Descartes’, Huss...

Following the introduction of do-not-resuscitate orders in the 1970s, there was widespread misinterpretation of the term among healthcare professionals. In this brief report, we present findings from a survey of healthcare professionals. Our aim was to examine current understanding of the term do-not-attempt-resuscitate, decision-making surrounding DNAR and awareness of current guidelines. The survey was distributed to doctors and nurses in a university teaching hospital and affiliated primary care physicians in Dublin via email and by hard copy at educational meetings from (...) July to December 2014. A total of 519 completed the survey. The response rate in the hospital doctors group was 35.5%, 19.8% in the nurses group but 68.8% in the specialist nurses group and 40% in the primary care physician group.Alarmingly, our results demonstrate that 26.8% of staff nurses and 30% of primary care physicians surveyed believed that a patient with a DNAR order could not receive any/at least one of a list of simple treatments including antibiotics, physiotherapy, intravenous fluids, pain relief, oxygen, nasogastric feeding or airway suctioning, which were higher percentages compared to the other hospital doctors and experienced nurses groups with statistically significant differences. Furthermore, a higher percentage of staff nurses and primary care physicians believed that a patient with a DNAR order could not be referred to hospital from home/a nursing home, when compared with other healthcare groups. Our findings highlight continued misunderstanding and over-interpretation of DNAR orders. Further collaboration and information is required for meaningful Advance Care Plans. (shrink)

There are currently no instruments available to measure ethical sensitivity in the therapeutic sciences. This study therefore aimed to develop and implement a measure of ethical sensitivity that would be applicable to four therapeutic professions, namely audiology, occupational therapy, physiotherapy, and speech-language pathology. The study followed a two-phase, sequential exploratory mixed-methods design. Phase One, the qualitative development phase, employed six stages and focused on developing an instrument based on a systematic review: an analysis of professional ethical codes, focus group (...) discussions, in-depth interviews, a review of public complaints websites, and an expert panel review. The development phase culminated in the Measuring Instrument for Ethical Sensitivity in the Therapeutic Sciences (MIEST), a pen-and-paper measure for studying ethical sensitivity in the therapeutic sciences.Phase Two, the quantitative stage, focused on implementing the MIEST in two different stages. A total of 100 participants completed the instrument. MIEST scores were found to be comparable for all four professions, which confirmed the multidisciplinary usability of the instrument. Participants tended to base decisions on the ethical principle of beneficence. The MIEST is effective to assess and describe the ethical sensitivity of professionals in the four specified therapeutic sciences. The constructed vignettes also make the MIEST appropriate for use in problem-based learning programs. (shrink)

The arts provide openings for symbolic expression by engaging the sensory experience in the body they become a source of insight through embodied cognition and emotion, enabling meaning-making, and acting as a catalyst for change. This synthesis of sensation and enactive, embodied expression through movement and the arts is capitalized on in The BodyMind Approach®. It is integral to this biopsychosocial, innovative, unique intervention for people suffering medically unexplained symptoms applied in primary healthcare. The relevance of embodiment and arts practices (...) in TBMA are discussed in relation to the views of participants in the pursuit of self-management. If widely employed TBMA could have an enormous impact, reach, and significance for patients and global health services. This original pre-clinical trial of qualitative research reports on the perceptions of participant patients with generic MUS, a world-wide issue usually treated by either psychological therapy or physiotherapy. TBMA is not a therapy but a health education program founded upon the concept of an integration of psychological elements with physiological, bodily, and sensory experiences. Thematic analysis of qualitative data sets from open-ended questions in semi-structured interviews and a written questionnaire post intervention is presented. Five aspects which appear to be key to learning self-management were derived from analyzing the data: body with mind connections; importance of facilitation; potential benefits; preparedness for change; self-acceptance/compassion. This article advances the discourse on the nature of self-management for MUS through changing the mind-set and the relationship participants have with their bodily symptom/s through employing embodied methods and arts practices, challenging current, and solely verbal, psychological conceptual frameworks. Rigor lies in the method of data analysis using cross verification of credibility between reported findings and scrutiny by stakeholders. We conclude that facilitated TBMA groups employing embodied methods and arts practices can act as a method for developing the self-management of MUS and improving wellbeing. (shrink)

This paper addresses the ontological status of the body in the context of bodily practices in body-oriented disciplines, such as sport training, dance, and physiotherapy. Following Descartes’, Huss...

BackgroundLittle is known about the ethical situations which physiotherapists encounter internationally. This lack of knowledge impedes the ability of the profession to prepare and support physiotherapists in all world regions in their ethical practice. The purpose of the study was to answer the following research questions: What types of ethical issues are experienced by physiotherapists internationally? How frequently are ethical issues experienced by physiotherapists internationally? Can the frequency and type of ethical issue experienced by physiotherapists be predicted by sociodemographic, educational (...) or vocational variables?MethodsAn observational study was conducted in English using an online survey from October 2018 to May 2019. Participants were 1212 physiotherapists and physiotherapy students located internationally which represented less than 1% of estimated number of physiotherapists worldwide at that time. The survey questionnaire contained 13 items requesting demographic detail and knowledge of ethical codes and decision-making, and 46 items asking what frequency participants experienced specific ethical issues in four categories: Physiotherapist and patient interaction, Physiotherapist and other health professionals including other physiotherapists, Physiotherapists and the system and Professional and economic ethical situations.ResultsThe two most frequently experienced ethical issues were ‘Scarce resources and time affecting quality of physiotherapy treatment’ and ‘Physiotherapy not accessible to all people in society who need it’. These items were experienced, on average, more often than monthly. Interprofessional practice also presented frequent ethical issues for participants. Ethical issues related to the context of ‘Physiotherapists and the system’ were most frequently experienced for all world regions. Working longer years in physiotherapy and learning about ethics in basic physiotherapy education was associated with participants reporting lower frequencies of ethical issues across all contexts.ConclusionThis study provides the first global profile of ethical issues experienced by physiotherapists. Societal and cultural systems are key influences on physiotherapists’ ethical practice. Physiotherapists globally need support from their work organisations, academic institutions and professional associations, and robust ethical training, to assist them to be active moral agents in their practice. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Note on Being Ability–different, Atypically–bodied... Criptastic?Emily HutcheonIn being prompted to write about my experiences with disability [alternatively written: (dis)ability, dis/ability, “disability,” disAbility], I am confronted with more questions than I have answers. Am I to reflect on that small window of time, one so small that I don’t actually remember it, when I did not know that I was different? My mom [End Page 196] has recounted vivid (...) moments where I seem to come to this realization—for example, at the age of three, when I see my twin sister and friends scrambling on a playground and I process that I am unable to join them. Realization of my differentness (my different body, my different way of moving, my different abilities) continued into my youth and adulthood (Can’t skate—check. Can’t ride a two–wheeled bike—check. Usually walk behind others, destined to be the last in a group—check. Was the smart kid in class, aka smartass–in–training—check).Eventually, I realized that my differentness was not contained to my body or my abilities. Were my mind, my self, and my relationships different as well? I seemed to empathize when others didn’t or couldn’t. I saw that certain things were just wrong, and was confused when others didn’t share my concern. I seemed to see, feel, and experience things that others did not. For instance, I had two invasive operations before the age of eleven, a handful of minor procedures and countless physiotherapy sessions. Some memories of these times are horrific. Some I cherish, including the genuine care of the health care staff. Some are hilarious, like being doped–up before invasive surgery at the age of ten and calling my favorite surgeon “So cute!!” But always, there was physical pain, pain, pain. At times, I was completely dependent on others to help me to the bathroom, the shower, to move around, and to recover. I received such tender and exquisite care from my mom during these times. The dependency, which I had no choice but to experience, the dependency that is feared by almost everyone I know (“If I am ever a burden to my family, shoot me”) is something that my mom and I constantly joke about (“Em, I will take care of you now, only if you change my diapers when I’m old, kay?”). I have come to learn that this dependency, along with those other shades of vulnerability, are an inevitable consequence of being human, and to deny this is to relinquish our capacity to connect with others.I had, and continue to have, relationships with strangers, friends and family, which are, in my best estimation, atypical. I am the recipient of staring, laughing, pointing, sympathy, disgust, empathy, tender care, curiosity, hostility, resentment, and ambivalence. While in the gym, complete strangers approach me to say, with all the kindness, enthusiasm, and obliviousness in the world: “Glad to see you out and about. Good for you!” For some, I am to be protected; for others, I am to be tiptoed around; and for others, I am to be congratulated for “overcoming my circumstance” and for being oh–so–valuable to society because of my smarts and productivity.It is a rare few who accept what Cerebral Palsy and epilepsy offer to my life and to their own, with all of their accompanying complexities, possibilities, and contradictions.It is ironic that the excellent health care and services I have received, which have probably changed my life for the better, are only made possible because of the “disability” label, which I have come to heartily dislike. I have always felt ill–at–ease with this word and concept. In my mind, it just does not describe me or others around me. Perhaps more accurately, the definitions and associations that stubbornly accompany the term (e.g., the disabled person as asexual, passive and in need of protection, the disabled person as the conquering hero) would never accurately describe me. Undoubtedly, the term is negative in its connotations. And, of course, the concept of disability relies on certain notions of “normal.” By most accounts in... (shrink)

Ethik ist in Gesundheitsberufen allgegenwärtig, auch wenn das den Betroffenen nicht immer bewusst ist. Doch das Bewusstsein hierfür hat in den letzten Jahren deutlich zugenommen. Dies zeigt sich nicht nur auf politischer Ebene, sondern auch daran, dass in vielen grösseren Gesundheitsinstitutionen Ethikstrukturen geschaffen worden sind.Zudem wird der Ethik in der Ausbildung zu Gesundheitsberufen zunehmend mehr Gewicht eingeräumt. Im Folgenden gehen wir von unseren Erfahrungen als Dozierende für Ethik im Bachelorstudiengang Physiotherapie der Zürcher Hochschule für angewandte Wissenschaften (ZHAW) in Winterthur aus. (...) Wir argumentieren für die für uns zentrale Schlussfolgerung, dass die Ethikausbildung in der Ausbildung zu Gesundheitsberufen viel interdisziplinärer gestaltet sein sollte, als sie das heute meistens ist. Denn Ethik ist, wie die Kommunikationskompetenz oder das Grundwissen zur Forschung, eine transdisziplinäre und interprofessionelle Kompetenz. Das gilt nicht nur für deren Vermittlung, sondern insbesondere für die medizinische Berufspraxis. (shrink)

BackgroundPatients have the right to equal, respectful treatment. Nowadays, one third of patient complaints concern health care staff’s behavior towards patients. Ethically safe care requires ethical competence, which has been addressed as a core competence in physiotherapy. It has been defined in terms of character strength, ethical awareness, moral judgment skills in decision-making, and willingness to do good. The purpose of this study was to analyze the ethical competence of practicing physiotherapists.MethodA self-evaluation instrument (Physiotherapist’s Ethical Competence Evaluation Tool) based (...) on an analysis of a concept “ethical competence” was constructed in 2016 and physiotherapists (n = 839), working in public health services or private practice responded to the questionnaire.ResultsBased on the results, most of the physiotherapists evaluated themselves highly ethically competent in all areas of ethical competence, subscales being Strength, Awareness, Skills and Will. Willingness to do good was evaluated as highest, while character strength, including the strength to support ethical processes and speak on behalf of the patient, was evaluated the lowest. Physiotherapists most commonly consult a colleague when encountering an ethical problem. Other methods for problem solving are not very familiar, neither are the international or national ethical codes of conduct.ConclusionsThis was the first attempt to assess all aspects of ethical competence empirically in a clinical environment in physiotherapy, using a novel self-evaluation instrument. Even if physiotherapists evaluate themselves as competent in ethics, further exploration is needed for ethical awareness. Also the patients’ viewpoints about ethically competent care should be considered, to better ensure ethical safety of the patient. (shrink)

Next SectionEvidence based medicine is rightly at the core of current medicine. If patients and society put trust in medical professional competency, and on the basis of that competency delegate all kinds of responsibilities to the medical profession, medical professionals had better make sure their competency is state of the art medical science. What goes for the ethics of clinical trials goes for the ethics of medicine as a whole: anything that is scientifically doubtful is, other things being equal, ethically (...) unacceptable. This particularly applies to so called orphaned fields of medicine, those areas where medical research is weak and diverse, where financial incentives are lacking, and where the evidence regarding the aetiology and treatment of disease is much less clear than in laboratory and hospital based medicine. Examples of such orphaned fields are physiotherapy, psychotherapy, medical psychology, and occupational health, which investigate complex syndromes such as RSI, whiplash, chronic low back pain, and chronic fatigue syndrome. It appears that the primary ethical problem in this context is the lack of attention to the orphaned fields. Although we agree that this issue deserves more attention as a matter of potential injustice, we want to argue that, in order to do justice to the interplay of heterogeneous factors that is so typical of the orphaned fields, other ethical models than justice are required. We propose the coordination model as a window through which to view the important ethical issues which relate to the communication and interaction of scientists, health care workers, and patients. (shrink)

It may be unethical to deny children with cystic fibrosis access to ethically approved clinical trials from which they might benefitDespite advances in nutritional management, aggressive antibiotic usage, and physiotherapy, cystic fibrosis remains a life limiting illness with high morbidity that imposes considerable burdens on children and families.1 Although survival to 40 years is predicted for children born in 1990s, the median age of death in 2003 was 24.2 years .The pathophysiological features of CF are produced by a defective (...) gene on chromosome 7, resulting in the defective production of a protein that regulates cellular ion transport. Defective ion transport is thought to lead to increased mucus viscosity , with poor airway clearance, recurrent bacterial infection, lung damage, and death.Gene therapy , the insertion of a normally functioning gene into deficient host cells using a suitable vector, is a potential treatment or cure for diseases produced by single gene defects—for example, CF. Gene therapy does, however, have potential or actual risks, leading many to suggest that evidence of efficacy in adults should be demonstrated before trials are conducted in children. Many serious diseases in adults such as CF have their onset in childhood. If early treatment provides greater hopes of benefit, children may be more appropriate targets for GT in CF than adults. It may be unethical to deny them access to properly constructed, ethically approved clinical trials from which they might benefit.Since research in children should be scientifically valid, in the child’s best interests, and the subject of valid consent, this article will consider these parameters in relation to trials of GT in children with CF. Because of the importance of consumer participation in the design of research we present the results of a questionnaire about GT trials delivered …. (shrink)