Collaborative fieldwork education with student occupational therapists and student occupational therapist assistants

The profession of occupational therapy has a long history of working collaboratively with support personnel. This paper describes the process of a fieldwork education partnership developed between the McMaster University, BHSc (OT) Program and the Mohawk College, Occupational Therapist Assistant and Physical Therapist Assistant Program. Eight student occupational therapists and eight student occupational therapist assistants learned together in a variety of fieldwork settings, either in pairs or in groups. Both groups of students kept weekly journals of the experience and completed a post placement questionnaire. The journals were inductively analysed using a retrospective content analysis. The four emergent themes identified from the data are learning about each other's role, collaborative learning, impact on client care and future practice, and resistance to roles. Recommendations for future collaborations are discussed.     

Work-related musculoskeletal disorders in physical therapists: prevalence, severity, risks, and responses

BACKGROUND AND PURPOSE: Physical therapists are at risk for work-related musculoskeletal disorders (WMSDs). Little is known of how therapists respond or of what actions they take to prevent injury. The purpose of this study was to investigate the prevalence and severity of WMSDs in physical therapists, contributing risk factors, and their responses to injury. SUBJECTS: As part of a larger study, a systematic sample of 1 in 4 therapists on a state register (n=824) was surveyed. METHODS: An 8-page questionnaire was mailed to each subject. Questions investigated musculoskeletal symptoms, specialty areas, tasks and job-related risk factors, injury prevention strategies, and responses to injury. RESULTS: Lifetime prevalence of WMSDs was 91%, and 1 in 6 physical therapists moved within or left the profession as a result of WMSDs. Younger therapists reported a higher prevalence of WMSDs in most body areas. Use of mobilization and manipulation techniques was related to increased prevalence of thumb symptoms. Risk factors pertaining to workload were related to a higher prevalence of neck and upper-limb symptoms, and postural risk factors were related to a higher prevalence of spinal symptoms. CONCLUSION AND DISCUSSION: Strategies used to reduce work-related injury in industry may also apply to physical therapists. Increased risk of thumb symptoms associated with mobilization techniques suggests that further research is needed to establish recommendations for practice. The issues for therapists who move within or leave the profession are unknown, and further research is needed to better understand their needs and experiences.     

Acceptance of physical therapist assistant course work by programs preparing physical therapists

I developed and sent a questionnaire to the directors of entry-level physical therapy programs to determine if course work taken in an associate degree program could be credited toward requirements leading to a higher degree or certificate in physical therapy. I sent 86 questionnaires; 45 were returned. Results of the survey revealed that basic science courses taken by the physical therapist assistant (PTA) students are more likely to be credited (up to half of the respondents replied positively) toward a higher degree or certificate than are technical courses like therapeutic exercise, fundamentals of physical therapy, or physical modalities. Moreover, as many as 79 percent of the respondents reported that PTAs would not be granted transfer credit for their technical courses. Of those respondents whose programs do give credit for the technical courses, the courses are usually considered as elective hours. Although the concept of upward mobility appears to remain viable in the educational philosophy of the American Physical Therapy Association, students who view the associate degree program as an entry point into a physical therapy program must be aware of the problems of acceptance of PTA credits in an entry-level physical therapy program.     

Educational preparedness for physical therapists and occupational therapists in burn care.

The background of physical therapy (PT) and occupational therapy (OT) students in burn care training may be variable during their professional education. The purpose of this study was to evaluate whether professional programs in PT and OT are meeting the burn care educational needs of their students. PTs and OTs currently practicing in burn care were asked to give their opinion of the most important curricular topics related to burn care, report their perception of their own entry-level preparedness for burn care, recount therapy interns preparation for burn care internships, and recommend topics that should be included in a therapy program burn care curriculum. Therapists felt prepared in basic sciences and somewhat prepared in specific burn care practice topics. Study participants felt more prepared for burn practice if they completed an internship in burn care. Enhancing content on burn-related treatment interventions was the most common suggestion for curricular revision.     

Expanded role for the physical therapist. Screening musculoskeletal disorders.

The primary purpose of this study conducted at two army hospitals was to evaluate the feasibility of using the physical therapist as the primary 'screener' for patients presenting with a complaint of low back pain. The study was organized into two phases. A base line phase consisted of a data collection period under standard operating conditions. Patient waiting times, treatment times, and total care times were measured for patients presenting to various clinics with a complaint of low back pain. The same data were collected during a screeing phase in which all patients presenting with a complaint of low back pain were referred directly to the physical therapist for primary evaluation. An assessment of physical therapist and patient satisfaction and acceptance was made. The quality of care rendered in the screeing clinic was assessed through patient interviews, physician interviews, and record reviews. This concept and the quality of care rendered were found to be acceptable to the patient, the physician, and the physical therapist.     

Therapeutic approaches to fibromyalgia syndrome in the United Kingdom: a survey of occupational therapists and physical therapists.

BACKGROUND AND PURPOSE: This study sought information from occupational therapists (OTs) and physical therapists (PTs) working in rheumatology in the UK on their usual methods of treatment and management of patients with fibromyalgia syndrome (FMS). METHODS. Data were gathered by self-completion questionnaire on: work setting; referrals of FMS patients; usual treatment objectives; assessment and treatment approaches; perceived responsiveness of patients; and other perceptions of the management of FMS. Most data were in the form of frequency counts, with some ordinal scales and open responses. RESULTS: Responses were obtained from 142 therapists (71% response rate), of whom 47 OTs and 39 PTs managed patients with FMS. The foremost therapeutic objective was increased functional ability for OTs, and increased exercise tolerance and general fitness for PTs. Pain reduction or management was rated as the second objective for both groups. An endurance-based exercise program and energy conservation techniques were the most frequently utilized interventions. Patients with FMS were thought to be 'moderately responsive' to physical management. Predictors of outcome were considered to be largely psychosocial, rather than physical, in nature. CONCLUSION: These data provide a preliminary profile of current practice in the management of FMS among UK therapists and indicate certain differences in approach between OTs and PTs.     

Reported use of technology in stroke rehabilitation by physical and occupational therapists

Purpose: With the patient care experience being a healthcare priority, it is concerning that patients with stroke reported boredom and a desire for greater fostering of autonomy, when evaluating their rehabilitation experience. Technology has the potential to reduce these shortcomings by engaging patients through entertainment and objective feedback. Providing objective feedback has resulted in improved outcomes and may assist the patient in learning how to self-manage rehabilitation. Our goal was to examine the extent to which physical and occupational therapists use technology in clinical stroke rehabilitation home exercise programs.

Materials and methods: Surveys were sent via mail, email and online postings to over 500 therapists, 107 responded.

Results: Conventional equipment such as stopwatches are more frequently used compared to newer technology like Wii and Kinect games. Still, less than 25% of therapists’ report using a stopwatch five or more times per week. Notably, feedback to patients is based upon objective data less than 50% of the time by most therapists. At the end of clinical rehabilitation, patients typically receive a written home exercise program and non-technological equipment, like theraband and/or theraputty to continue rehabilitation efforts independently.

Conclusions: The use of technology is not pervasive in the continuum of stroke rehabilitation.

• Implications for Rehabilitation

• The patient care experience is a priority in healthcare, so when patients report feeling bored and desiring greater fostering of autonomy in stroke rehabilitation, it is troubling.

• Research examining the use of technology has shown positive results for improving motor performance and engaging patients through entertainment and use of objective feedback.

• Physical and occupational therapists do not widely use technology in stroke rehabilitation.

• Therapists should consider using technology in stroke rehabilitation to better meet the needs of the patient.

     

Screening for musculoskeletal deviations--a challenge for the physical therapist. The Utah Study

We conducted an on-site examination in selected middle and junior high schools in Utah to determine the incidence of selected musculoskeletal deviations. During a regular school year, we screened 4,670 children. The students we examined represented a random sample of students in the sixth through the ninth grades from a population of 81,047 students. Among the 2,192 boys and 2,478 girls examined, we noted a total of 10,551 postural deviations. Eighteen categories of deviations of the musculoskeletal system were examined visually. Lordosis was the most common postural deviation seen (45%), and torticollis was noted least commonly (0%). Scoliosis was noted in 7% of the total population, with a girl-boy ratio of 2:1. Both the lack of body postural awareness we observed among the children and the significant findings of this study should warrant initiation of more responsible educational programs in the public schools. An apparent need for a uniform statewide screening program was demonstrated.     

Addressing occupational strains and sprains: musculoskeletal injuries in hospitals

Recognition related to the need for ergonomic design improvements among health care workers, management and administration, and equipment manufacturers is growing. The future should bring new concepts and innovations which can provide many benefits. Beyond the potential reduction in caregiver injuries, many possibilities exist to improve patient outcomes through better equipment design. As an additional benefit, applying the principles of ergonomics may enhance and increase caregiver productivity through a reduction of patient transfers required, and by minimizing staff required to ambulate patients. Another added value to applying ergonomics to equipment design is the development of convertible furnishing which could create a reduction in operating and capital expenses by reducing the need for some furnishings. Equipment such as cardiac chairs, sling scales, patient chairs, special rental surfaces, and other features might be incorporated into bed design. Ergonomic programs make sense and provide opportunities to create win-win situations throughout the health care industry. Current and future innovations will provide improvements resulting in outcomes from which everyone will benefit. These benefits include a higher quality of work life for health care workers and an improved quality of care for patients.     

Preventing occupational injuries: women's perception of risk from musculoskeletal exposures.

Perception of injury risk is associated with an individual's propensity to act. This study examined the relationship between women's demographic, occupational, and risk characteristics, and health and occupational stressors as predictors of their perceptions of injury risk to self and other women from occupational musculoskeletal exposures. This cross-sectional study included a random sample of women who were employed in the 12 months prior to survey administration (N = 123, 27% response rate). A telephone survey consisting of 154 items was administered in English or Spanish. For the perception of injury risk to self, the final multiple regression equation explained approximately 66% of the variance with significant unique contributions identified for bodily pain, occupational exposure to repeated strenuous physical activity or repetitive hand motion, perceived seriousness and controllability of the risk, and perception of risk to other women. Similarly, for perception of injury risk to other women, the final multiple regression equation explained approximately 57% of the variance with significant unique contributions identified for household size, occupational exposure to repetitive hand motion, familiarity of the risk, and perception of injury risk to self. Exposure experiences and risk characteristics were found to increase women's perceptions of risk from occupational musculoskeletal exposures.     

Patient engagement in rehabilitation therapy: physical and occupational therapist impressions

Purpose. The study is performed to examine the impressions of physical and occupational therapists on therapeutic engagement among their patients. Engagement in this context was defined as a patient's deliberate effort to work toward recovery by participating fully in their rehabilitation therapies.

Method. Using a survey approach, physical and occupational therapists (N = 199) from across the United States were asked about issues they have encountered in their daily practise that have acted as either barriers or facilitators of patient engagement.

Results. Fear of pain, depressed mood and cognitive issues were rated as the most frequently encountered barriers impacting patient engagement. Making therapy tasks meaningful and explicitly related to personal goals of the patient was the most commonly reported practise for enhancing therapeutic engagement.

Conclusions. The knowledge of therapists gained from day-to-day experience with patients in rehabilitation can be of use to other rehabilitation professionals in treating patients who are difficult to engage in the rehabilitation process.