How physiotherapists perceive,interpret, and respond to the ethical dimensions of practice: A qualitative study

The profile and reach of physiotherapy has expanded in areas of extended scope of practice, and broader engagement with population needs beyond the individual treatment encounter. These changes raise increasingly complex ethical challenges evidenced by growth in physiotherapy-based ethics studies and discussions. This paper examines how a broad cross section of Australian physiotherapists perceive, interpret, and respond to ethical challenges in their work contexts and how professional codes of conduct are used in their practice. Using an interpretive qualitative methodology, purposive sampling of 88 members of national clinical special interest groups were recruited for focus group discussions. Narrative-based and thematic data analysis identified ethical challenges as emerging from specific clinical contexts, and influenced by health organizations, funding policies, workplace relationships, and individually held perspectives. Five themes were developed to represent these findings: (1) the working environment, (2) balancing diverse needs and expectation, (3) defining ethics, (4) striving to act ethically, and (5) talking about ethics. The results portray a diverse and complex ethical landscape where therapists encounter and grapple with ethical questions emerging from the impact of funding models and policies affecting clinical work, expanding boundaries and scope of practice and changing professional roles and relationships. Codes of conduct were described as foundational ethical knowledge but not always helpful for “in the moment” ethical decision-making. Based on this research, we suggest how codes of conduct, educators, and professional associations could cultivate and nurture ethics capability in physiotherapy practitioners for these contemporary challenges.     

Body weight support through a walking cane in inexperienced users with knee osteoarthritis

BackgroundWalking canes are a self-management strategy recommended for people with knee osteoarthritis (OA) by clinical practice guidelines. Ensuring that an adequate amount of body-weight support (%BWS) is taken through the walking cane is important as this reduces measures of knee joint loading.Research question1) How much body weight support do people with knee OA place through a cane? 2) Do measures of body weight support increase following a brief simple training session?MethodsSeventeen individuals with knee pain who had not used a walking cane before were recruited. A standard-grip aluminum cane was then used for 1 week with limited manufacturer instructions. Following this, participants were evaluated using an instrumented force-measuring cane to assess body weight support (% total body weight) through the cane. Force data were recorded during a 430-metre walk undertaken twice; once before 10 min of cane training administered by a physiotherapist, and once immediately after training. Measures of BWS (peak force, average force, impulse equal to the average cane force times duration, and cane-ground contact duration) were extracted. Using bathroom scales, training aimed to take at least 10% body weight support through the cane.ResultsBefore training, the average peak BWS was 7.2 ± 2.5% of total body weight. Following 10 min of training, there was a significant increase in average peak BWS by 28%, average BWS by 25%, and BWS impulse by 54% (p < 0.05). However, individual BWS responses to training were variable. Duration of cane placement increased by 22% after training (p = 0.02). Timing of peak BWS through the cane occurred at 51% of contact phase before training, and at 53% after training (p = 0.05).SignificanceA short training session can increase the transfer of body weight through a walking cane. However, more sophisticated feedback may be needed to achieve target levels of BWS.     

健脾疏肝汤结合物理疗法治疗溃疡性结肠炎44例

目的:观察健脾疏肝汤结合物理疗法治疗溃疡性结肠炎的临床疗效。方法:选取2014年1—12月本院治疗的溃疡性结肠炎患者88例,随机分为观察组和治疗组,每组44例。对照组给予健脾疏肝汤治疗,观察组在对照组治疗的基础上给予物理疗法治疗。结果:观察组腹痛评分、便血评分、腹泻评分、肠镜下结肠黏膜病变评分均优于对照组(P0.05);观察组有效率97.73%,对照组有效率84.09%,观察组优于对照组(P0.05)。结论:健脾疏肝汤结合物理疗法治疗溃疡性结肠炎疗效显著。     

创伤性面瘫物理疗法的临床研究

目的 比较超短波加离子导入疗法（A组）与电刺激加离子导入疗法（B组）治疗创伤性面瘫的效果。方法 对39例创伤性面神经损伤患者进行临床对照研究，通过量化面神经功能评价、神经电图检查及面神经功能的主观评价比较面神经损伤的治疗效果。结果 创伤性面瘫以青年男性多见，损伤程度以中、重度为主；对于神经损伤轻、中度患者,A组与B组均能促进神经恢复，B组神经功能开始恢复时间早于A组。对于神经损伤重度患者，A组与B组神经恢复率高于对照组，两组均不能减少并发症出现率。结论 超短波加离子导入疗法与电刺激加离子导入疗法均能促进面神经损伤的恢复，但对于减少并发症发生率并无帮助。