Investigating factors influencing 4th-year physiotherapy students' opinions of cardiorespiratory physiotherapy as a career path

Recruitment and retention issues in cardiorespiratory physiotherapy (CRP) have led to concerns for the future of this specialist area of physiotherapy. This study evaluated the career choices of student physiotherapists and elicited factors that influenced their perceptions of CRP. A postal questionnaire to two schools of physiotherapy in New Zealand and two in Australia was administered. Final year students were randomly selected and invited to complete the questionnaire. Details of respondents' clinical experience, future career intentions, and perceptions of CRP as a specialism were ascertained. A response rate of 61% (n=149) was obtained. Although the majority of respondents had undertaken cardiorespiratory placements, only 3% of respondents reported being "extremely interested" in specializing in CRP. The variety and timing of clinical placements and educational and clinical supervision were key factors that had the potential to both positively and negatively influence students' opinions of CRP. An understanding of the role of CRP beyond that of inpatient care appeared limited. To promote uptake of CRP as a career option, clinicians, educators, and managers should strive to provide positive clinical placements and educational opportunities. The extensive scope of clinical practice of cardiorespiratory physiotherapists could be a greater focus within physiotherapy curricula.     

Investigating factors influencing 4th-year physiotherapy students' opinions of cardiorespiratory physiotherapy as a career path

Recruitment and retention issues in cardiorespiratory physiotherapy (CRP) have led to concerns for the future of this specialist area of physiotherapy. This study evaluated the career choices of student physiotherapists and elicited factors that influenced their perceptions of CRP. A postal questionnaire to two schools of physiotherapy in New Zealand and two in Australia was administered. Final year students were randomly selected and invited to complete the questionnaire. Details of respondents' clinical experience, future career intentions, and perceptions of CRP as a specialism were ascertained. A response rate of 61% (n?=?149) was obtained. Although the majority of respondents had undertaken cardiorespiratory placements, only 3% of respondents reported being “extremely interested” in specializing in CRP. The variety and timing of clinical placements and educational and clinical supervision were key factors that had the potential to both positively and negatively influence students' opinions of CRP. An understanding of the role of CRP beyond that of inpatient care appeared limited. To promote uptake of CRP as a career option, clinicians, educators, and managers should strive to provide positive clinical placements and educational opportunities. The extensive scope of clinical practice of cardiorespiratory physiotherapists could be a greater focus within physiotherapy curricula.     

Physiotherapy management of minimal cerebral dysfunction in Australia: current practice and future challenges

The aim of this study was to identify strategies currently used by Australian physiotherapists involved in the management of children with minimal cerebral dysfunction (MCD) as a first step in exploring the role of physiotherapy in this area. A questionnaire was developed containing both closed and open ended questions regarding physiotherapy assessment and intervention in the management of MCD. A total of 464 subjects were reached through Australian Physiotherapy Association resources, of which 76 per cent responded. Of these respondents, 31 per cent (n=105) were involved in the management of children with MCD. Analysis of survey responses revealed a highly eclectic and inconsistent approach toward the assessment and treatment of children with MCD by Australian physiotherapists. These findings present a strong challenge to current physiotherapy practice in this client group. The present diversity of practice suggests an urgent need to establish more consistent assessment procedures and methods of outcome measurement.     

Work-related musculoskeletal disorders affecting members of the Chartered Society of Physiotherapy

Objective

To estimate the prevalence of work-related musculoskeletal disorders from a snapshot sample of members of the Chartered Society of Physiotherapy (CSP); the trade union, educational and professional body for physiotherapists, physiotherapy assistants and physiotherapy students in the UK. The distribution of musculoskeletal disorders against different variables, including age of therapist, years in practice and clinical specialty, was also investigated. We set out to highlight the job tasks that injured physiotherapists associated with their complaint and to identify any preventive strategies that injured physiotherapists adopted to prevent re-injury.

Design

A self-administered questionnaire was posted to a randomly selected sample taken from the membership database of the CSP.

Participants

Ten percent (n = 3661) of registered physiotherapists, physiotherapy assistants and physiotherapy students on clinical placement.

Main instrument

Questionnaire based on the Standardised Nordic Questionnaire.

Results

Reported career prevalence of work-related musculoskeletal disorders in members of the CSP was 68%. Previous 12-month prevalence was 58%, and 42% reported musculoskeletal symptoms in the last 12 months that lasted for more than 3 days. The low back was the body area identified by 44% of injured respondents as their most significant injury. Nearly one-third (32%) of injured respondents first experienced their worst injury within 5 years of graduation. A greater number of respondents (59%) were aged 30 years or under when their most serious injury occurred. Injured respondents rated ‘performing the same tasks over and over’, ‘working in the same position for long periods’ and ‘treating a large number of patients in 1 day’ as the three most influential job risk factors contributing to injury.

Conclusions

Younger physiotherapists and newly qualified graduates appear to be most in need of intervention services aimed at reducing injury rates. Official action is undermined by injured physiotherapists seeking informal treatment from colleagues rather than reporting injury to their manager, helping to keep work-related injury a hidden problem. Physiotherapists should be encouraged to report workplace injury, and barriers to official reporting should be identified.     

Attitudes of European physiotherapy students towards their chosen career in the context of different educational systems and legal regulations pertaining to the practice of physiotherapy: implications for university curricula

ObjectivesDifferences in the organisation of educational systems and regulations pertaining to the practice of a profession can influence the attitudes of students towards their chosen career and their perceptions of employment possibilities. The aim of this paper was to discuss the different educational systems and legal regulations pertaining to the practice of physiotherapy in selected countries of the European Union (EU), and to present some conclusions regarding the influence of these differences on the perceptions of first-year physiotherapy students on their chosen career.DesignQuantitative questionnaire-based study.SettingTwenty-one university-level schools in the Czech Republic, Latvia, Malta, Poland, Spain and the UK.ParticipantsSix hundred and sixty-seven first-year physiotherapy students.ResultsThe mean response rate was 74%. Most students (79%) reported that a personal interest was the main reason why they had decided to study physiotherapy (79%). Most students from Spain and the Czech Republic reported that, on completion of their studies, they would like to work as physiotherapists (61/120, 51% Czech Republic; 140/250, 56% Spain), compared with only 4% of Polish students (P < 0.001). Most students from Poland and Spain were not familiar with employment opportunities in their respective countries (202/250, 81% Spain; 212/250, 85% Poland), and claimed that it is difficult to find employment as a physiotherapist in their country. Most students from the Czech Republic, Latvia, Malta, Poland, Spain and the UK claimed that it is easy to find a job in other EU countries.ConclusionMost physiotherapy students chose their course because of an interest in physiotherapy. They were not familiar with employment possibilities for graduates, and believed that it is easier to find work in other EU countries. Both factors may further aggravate the problem of unemployment among physiotherapists.     

Teaching physiotherapy students to “be content with a body that refuses to hold still”

In recent decades, physiotherapists have become concerned with cultural, economic, philosophical, political, and social questions and have been exploring more flexible ways of speaking about and practicing physiotherapy. While recognizing the need to embrace a broader range of perspectives, physiotherapy educators and other medical educators have been at a loss as to how to best achieve this. Drawing on two examples from South Africa and New Zealand, we seek to illustrate possibilities and barriers to teaching social sciences to physiotherapy students, specifically theories of embodiment as an alternative to the biopsychosocial model. We review each educator’s choice of embodiment theory in curriculum design and the role of the educator’s disciplinary background on teaching, learning, and assessing that learning. Against this background, we explore physiotherapy students’ experiences with theories of embodiment and possible transformative implications for their self-worth and/or professional practices. We suggest that students were able to explore physiotherapy’s relation to the body and the profession’s historical inattention toward the body as a philosophical/theoretical construct. From the lessons learned, some can perhaps be usefully passed onto others thinking of introducing a more diverse and inclusive approach of the body; one that we argue will be needed in the future.     

The availability and usage frequency of real time ultrasound by physiotherapists in South Australia: an observational study

Background and Purpose . Real time ultrasound (RTUS) is an emerging imaging modality in physiotherapy. Anecdotal evidence suggests that it is being used as an assessment and biofeedback tool for various deep core stabilizing muscles. However, how and why physiotherapists use RTUS in the clinical setting has not yet been reported. Therefore, this study aimed to establish the availability and usage frequency of RTUS by physiotherapists in South Australia. In addition, the study aimed to describe how physiotherapists were using RTUS and how they were educated in its use. Method . A questionnaire was developed and mailed to all physiotherapists registered with the Physiotherapy Board of South Australia (n = 1328) between February and March 2007. Results . A response rate of 50% was achieved with 664 completed usable questionnaires returned. At the current time, only a small proportion of respondents used RTUS (11.6%), while slightly more had access to a machine (19.4%). RTUS was used most commonly for assessment (88.3%) and biofeedback (87.0%) of the abdominal (94.7%), pelvic floor (72.7%) and multifidus (54.5%) muscles. Of all respondents, 26.7% had trained in its use with most completing two hours or less of training. Conclusions . This is the first published study to describe how and why physiotherapists are using RTUS in clinical practice. RTUS appears to be a relatively uncommon modality potentially limited by insufficient access to equipment and educational opportunities. The findings highlight a greater need for education and training in the use of RTUS for physiotherapy practice. Copyright © 2008 John Wiley & Sons, Ltd.     

The physiotherapy management of patients undergoing thoracic surgery: a survey of current practice in Australia and New Zealand

Background and Purpose. Physiotherapy is considered an essential component of the management of patients after thoracotomy, yet the type of interventions utilized, and evidence for their efficacy, has not been established. The aim of the present study was to ascertain the current physiotherapy management of patients undergoing thoracotomy and the factors influencing practice among different providers. Method. A purpose‐designed postal questionnaire was distributed to senior physiotherapists in all thoracic surgical units throughout Australia and New Zealand (n = 57). Results. A response rate of 81% was obtained (n = 46). Pre‐operatively, 16 respondents (35%) reported assessing all thoracotomy patients. The majority of respondents (n = 44; 96%) indicated that all patients were seen by physiotherapists after surgery, with 29 respondents (63%) performing prophylactic physiotherapy interventions to prevent post‐operative pulmonary complications. Respondents reported that physiotherapy treatment was usually commenced on day one post‐operatively (n = 37; 80%) with the most commonly used treatment interventions being deep breathing exercises, the active cycle of breathing techniques, cough, forced expiration techniques and sustained maximal inspirations. Most respondents reported that patients first sat out of bed (n = 41; 89%), commenced shoulder range of movement (n = 23; 50%) and walking (n = 32; 70%) on day one post‐operatively. The majority of respondents reported that they offered no post‐operative pulmonary rehabilitation (n = 25; 54%), outpatient follow‐up (n = 43; 94%) or post‐thoracotomy pain management (n = 40; 87%). Respondents indicated that personal experience, literature recommendations and established practice were the factors which most influenced physiotherapy practice. Conclusion. Most patients after thoracotomy receive physiotherapy assessment and/or treatment in the immediate post‐operative period, but only one‐third were routinely seen pre‐operatively and relatively few were reviewed following discharge from hospital. Further studies are required to guide physiotherapists in determining the efficacy of their practices for patients undergoing thoracotomy. Copyright © 2007 John Wiley & Sons, Ltd.     

Physiotherapists and human immunodeficiency virus/acquired immune deficiency syndrome: knowledge and prevention: a study in Durban,South Africa

This study determined what physiotherapists in Durban, South Africa know about human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), their attitudes towards patients and how they cope as individuals. Data were collected using a validated questionnaire. One-hundred-and-fourteen physiotherapists in Durban hospitals participated in the study. Seventy-two per cent of the questionnaires met the criteria for analysis. Ninety per cent of the participants believed that they knew about HIV/AIDS, but only 78% could identify all viral transmission modes. Of the 38 physiotherapists who believed that they knew the stages of an HIV infection, only 11% actually knew the stages, 28% could not explain them and 61% were vaguely aware. Fifty-six per cent of the respondents had treated patients who had died from HIV/AIDS. Only 38% of physiotherapists were completely at ease when treating HIV/AIDS patients despite the fact that 98% believed that physiotherapy was an integral component of the management of an AIDS patient. Fifty-one per cent of the respondents were unaware of support structures provided by their employers. The authors conclude that the perceptions of physiotherapists about their knowledge about HIV/AIDS do not stand up to scrutiny. Significantly more attention should be paid to the development, implementation and evaluation of the effectiveness of educational programmes on HIV/AIDS for physiotherapists in the workplace.     

The physiotherapy management of patients undergoing coronary artery surgery: A questionnaire survey

The current physiotherapy management of patients undergoing coronary artery surgery in 22 public and 13 private hospitals across Australia and New Zealand was examined using a questionnaire survey. Respondents were asked to identify assessment and treatment techniques used in the pre- and post-operative management. An 83 per cent response from physiotherapists was obtained. Ninety-four per cent of respondents reported that pre-operative assessment was performed routinely. Eighty-nine per cent of respondents indicated that all patients were treated routinely by physiotherapists in the post-extubation period. Positioning and deep breathing exercises were the most commonly used techniques for patients post-extubation. Factors determining treatment choice and the impact of research on current physiotherapy practice are discussed.     

Medical students’ awareness of the role of physiotherapists in multidisciplinary healthcare

Abstract

Background: Successful implementation of multidisciplinary healthcare approach may among other things depend on students' education and knowledge of the roles of healthcare professions other than their own. This study investigated medical students’ awareness of the role of physiotherapists in multidisciplinary healthcare teams. Methods: One hundred and ninety-eight medical students of the University of Maiduguri, Nigeria, participated in this study. Each student completed a self-administered questionnaire that obtained information on demographics, awareness of role of physiotherapists and educational sources of information as well as suggestions about other sources of information about physiotherapy. Chi-square test was used to analyze differences in awareness by gender and year of study. Results: Although rates of awareness regarding some physiotherapy roles were high, many of the medical students were unaware that physiotherapists can practice on first-contact basis and autonomously. About 60% of the students also viewed the role of physiotherapists in the health team as one of providing assistance for medical work. Clinical ward round was the most common source of information on physiotherapy although many of the students suggested classroom lecture as a preferred means of obtaining information. Year of study resulted in significantly different level of awareness (p?<?0.05) with a higher proportion of final year students exhibiting awareness of physiotherapists’ roles. Conclusion: Clinical ward rounds facilitated the students’ awareness of the role of physiotherapists. Interprofessional education involving lectures and clinical ward rounds may assist in building medical students’ level of awareness and appreciation of the physiotherapy profession.     

Evidence based practice: a survey of physiotherapists' current practice

Backgound and Purpose . Evidence‐based practice is the explicit use of current best evidence in making decisions about the care of individual patients and is a concept of growing importance for physiotherapy. The aim of the present study was to investigate Australian physiotherapists' self‐reported practice, skills and knowledge of evidence‐based practice and to examine differences between recent and experienced graduates, physiotherapists with low and high levels of training and physiotherapists working in private practice and hospital settings. Method . A survey was sent to 230 physiotherapists working in hospitals and in private practice. One hundred and twenty‐four were completed and returned. Results . Although 69.4% of respondents said they frequently (at least monthly) read research literature, only 10.6%, 15.3% and 26.6% of respondents, respectively, searched PEDro, Cochrane and Medline or Cinahl databases frequently, and only 25.8% of respondents reported critically appraising research reports. Recent graduates rated their evidence‐based practice skills more highly than more experienced graduates, but did not perform evidence‐based practice tasks more often. Physiotherapists with higher levels of training rated their evidence‐based practice skills more highly, were more likely to search databases and to understand a range of evidence‐based practice terminology than those with lower levels of training. Private practice and hospital physiotherapists rated their evidence‐based practice skills equally and performed most evidence‐based practice activities with equal frequency. Conclusions . Respondents had a positive attitude toward evidence‐based practice and the main barriers to evidence‐based practice were time required to keep up to date, access to easily understandable summaries of evidence, journal access and lack of personal skills in searching and evaluating research evidence. Efforts to advance evidence‐based practice in physiotherapy should focus on reducing these barriers. Copyright © 2006 John Wiley & Sons, Ltd.     

Entry-level physiotherapists' strategies to lower occupational injury risk in physiotherapy: a qualitative study

The purpose of this study was to identify entry-level physiotherapists perceptions of workplace injuries in private practice and the strategies they may use to reduce occupational injury risk in physiotherapy. Seventy-nine final year physiotherapy students were presented with a private practice workplace scenario, recent injury statistics, and common job risk factors in physiotherapy and were required to choose between the options of being a salaried employee or contractor and to discuss self-management strategies. This question was part of a substantive written examination that is a compulsory aspect of the final assessment for these students. Students identified nine categories for self-management and reducing injury risk with the majority of students choosing the option of being a contractor in preference to being a salaried employee. Regardless of the preferred employment option, students tended to select self-management strategies that would have a negative impact on income and service delivery and may be reflective of the relative inexperience of these students in private sector workplace settings. Given the high prevalence of work-related musculoskeletal disorders (WRMDs) in the 5 five years postgraduation, the findings from this study highlight the need for educational institutions and employers to address occupational health and risk factors in physiotherapy, which would include education on prevention as well as appropriate self-management strategies within each workplace.     

Entry-level physiotherapists' strategies to lower occupational injury risk in physiotherapy: A qualitative study

The purpose of this study was to identify entry-level physiotherapists perceptions of workplace injuries in private practice and the strategies they may use to reduce occupational injury risk in physiotherapy. Seventy-nine final year physiotherapy students were presented with a private practice workplace scenario, recent injury statistics, and common job risk factors in physiotherapy and were required to choose between the options of being a salaried employee or contractor and to discuss self-management strategies. This question was part of a substantive written examination that is a compulsory aspect of the final assessment for these students. Students identified nine categories for self-management and reducing injury risk with the majority of students choosing the option of being a contractor in preference to being a salaried employee. Regardless of the preferred employment option, students tended to select self-management strategies that would have a negative impact on income and service delivery and may be reflective of the relative inexperience of these students in private sector workplace settings. Given the high prevalence of work-related musculoskeletal disorders (WRMDs) in the 5 five years postgraduation, the findings from this study highlight the need for educational institutions and employers to address occupational health and risk factors in physiotherapy, which would include education on prevention as well as appropriate self-management strategies within each workplace.     

A Prospective Study of Complications of Cervical Spine Manipulation

Abstract

Complications or adverse responses to cervical spine manipulation, particularly neurovascular compromise, are well documented in the literature. However, the rate of incidence of such adverse responses in manipulative physiotherapy has not been documented, indicating a need for well-designed prospective studies to accurately determine the associated risk of these procedures. To this end, a pilot study trialling a prospective adverse response reporting system was undertaken over a three month period in New Zealand. Twenty manipulative physiotherapists were approached to participate by reporting and describing any adverse responses to cervical spine manipulation they experienced over this time. Nine manipulative physiotherapists were able to participate and reported only one minor incident, a temporary, mild exacerbation of neck pain. It was calculated that the incidence rate for this study was 0.21% per manipulation and 0.42% per patient. The sole notable problem encountered with the methodology was the moderate response rate.     

Which knowledge? An examination of the knowledge at play in physiotherapy with children

This article explores how knowledge is expressed and enacted in the practice of physiotherapy with children. The empirical material was generated through close observation of seven physiotherapy treatment sessions involving 7 children between 6 and 11 years old and 5 physiotherapists. Observations were undertaken by the first author, whose post-session written notes, along with comments and questions, constitute the database of this article. Through processing and analysis of data, we have written and present three experiential anecdotes as basis for further analysis and discussion. The article shows how children take initiative during therapy and display playful knowledge both of their body, moving capacity and of the equipment and tasks introduced. The physiotherapists seem to tend to emphasize physiological knowledge relating to the body, its functions and the “dangers” of pathological movement patterns. As a result, physiotherapists and child clients appear caught in a kind of stagnant co-existence where their connection and contact are at a standstill and there is little exchange of knowledge between them. We argue that, for therapy with children to develop along qualitative and creative lines, physiotherapists need to explicitly recognize children as humans of knowledge and embrace their playful contributions as significant to therapy.     

An exploration of undergraduate nursing and physiotherapy students’ views regarding education for patient handling

Aims and objectives. To ascertain the views of undergraduate student nurses and physiotherapists regarding their education in patient handling. Background. Musculo‐skeletal injuries are an important cause of staff sickness absence and attrition from the nursing profession and are a recognised problem within the physiotherapy profession. Nurses and physiotherapists are at risk of musculo‐skeletal injuries as a result of their role in assisting patients with movement. Methods. A questionnaire survey was undertaken of undergraduate nursing and physiotherapy students (n = 371) at one university. Results. Most students agreed that university teaching about moving and handling prepared them for clinical practice (64%). Over a third reported that they had never undertaken a written moving and handling risk assessment in clinical practice (38%). Almost half of the sample (40%) admitted undertaking unsafe moving and handling activities. Half (50%) also stated that they would rather ‘fit’ into the team than challenge unsafe practice. Almost a third (29%) stated that they had begun to experience pain since becoming a student. There were significant differences between nursing and physiotherapy students. Physiotherapy students were more likely to report being supervised when moving and handling and reported being more assertive about adhering to safe practice. Conclusions. The well‐being of both nursing and physiotherapy undergraduate students is threatened when students undertake work placements in clinical settings. University‐based education in safe patient handling, though important, can be undermined by workplace settings where unsafe practices occur. Collaboration is needed between university educators, managers and practice‐based mentors to support students to maintain safe approaches to moving and handling patients. Relevance to clinical practice. A third of students reported developing pain since becoming a healthcare student. Students entering their professions already injured may leave the workforce owing to poor physical well‐being. It is vital that the clinical workplace supports safe systems of working.     

Physiotherapists’ and general practitioners’ views of self-referral and physiotherapy scope of practice: results from a national trial

Aim

To establish the views of physiotherapists and general practitioners (GPs) on self-referral and physiotherapy scope of practice.

Design

Survey questionnaire design utilising both qualitative and quantitative questioning.

Setting

Twenty-six general practices throughout Scotland.

Participants

Sixty-four physiotherapists and 97 GPs with direct experience of implementing systems of self-referral to physiotherapy in primary care in Scotland.

Method

Questionnaires containing a mix of open and closed questions were distributed at the end of a year-long data collection period of a national trial (2003-2005). Responses were analysed by clinician group: GPs and physiotherapists.

Results

An overall response rate of 73% (117/161) was achieved. High levels of comfort with, and confidence in, physiotherapists acting as first point of contact practitioners were reported by 96% (67/70) of GPs, and just 6% (3/47) of physiotherapists reported not being comfortable. More than 78% (91/117) of all clinicians indicated that there could be possible and definite benefits for musculoskeletal patients if physiotherapists were involved in monitoring and prescribing non-steroidal anti-inflammatory drugs, issuing sickness certificates and requesting X-rays, although this was more strongly supported by physiotherapists (>88% vs >63%; P < 0.001). Seventy-eight percent (35/47) of physiotherapist respondents felt that physiotherapists could accept self-referrals very ably, 47% (21/47) felt that not all physiotherapists were sufficiently experienced, and 16% (7/47) reported the need for additional training before physiotherapists could undertake this role. Only 34% (16/47) of physiotherapists felt that the public understood what physiotherapy is and what it can offer.

Conclusion

The concept of physiotherapists working as first point of contact practitioners is strongly supported by the majority of GPs and physiotherapists. Potential benefits for patients were identified if physiotherapists undertook extended roles with regard to other aspects of musculoskeletal management. There is a need to address both professional and public awareness of physiotherapy and self-referral specifically.