Physiotherapy students’ self-reported assessment of professional behaviours and skills while working with young people with disability

Abstract

Purpose: To quantify self-reported changes in student professional behaviours and skills after a 10-week community-based experience. Method: Twenty-eight physiotherapy students (22 women, 6 men; mean age 21.9 years, SD 2.9) were each matched with a young person with Down syndrome, who was randomly allocated to an intervention or control group. The intervention group completed a 10-week, twice a week progressive resistance training (PRT) programme. The control group completed a 10-week, once a week social programme. Before and after the experience, the students completed a self-reported assessment of their skills in prescribing and supervising PRT, professional behaviours, confidence and the likelihood they would work with people with intellectual disability in the future. Between-group differences were analysed using analysis of covariance with baseline measures as covariate. Results: There were between-group differences for 7 items rating skills implementing PRT, in favour of the intervention group, but not for any other outcome. Across both groups, students self-reported positive changes in their professional behaviours, confidence and the likelihood they would work with people with intellectual disability after the programme. Conclusions: A 10-week community-based experience produced changes in physiotherapy student professional behaviours. Students who completed the exercise programme self-reported an improvement in their professional skills relating to PRT.

• Implications for Rehabilitation

• Community-based experiences working with young people with disability offer physiotherapy students the opportunity to development their professional behaviours, skills and confidence.

• Students who completed a 10-week experience working with a young person with Down syndrome reported they were more likely to work with people with intellectual disability in the future.

• Improvements in the students’ skills in delivering progressive resistance training were only found for the students who completed an experience that included an exercise intervention.

     

Group aquatic training improves gait efficiency in adolescents with cerebral palsy

Purpose.?To evaluate the effect and feasibility of a 10-week group aquatic training programme on gait efficiency in adolescents with cerebral palsy (CP). The secondary purpose was to determine the exercise intensity during aquatic training in a heterogeneous group of adolescents with CP and to investigate the impact of the training programme on the musculoskeletal system.

Method.?Twelve ambulatory adolescents with spastic CP were recruited. They participated in 20 aquatic training sessions (45?min twice a week). Three physical therapists and a sports teacher supervised the training sessions. Participants wore a heart rate monitor to assess sessions' intensity and a floatation device as appropriate. The primary outcome measure was gait efficiency as measured by the gait energy expenditure index (EEI). The secondary measures were (1) gait spatiotemporal parameters, (2) maximal isometric knee strength and (3) gross motor function.

Results.?Ten adolescents completed the training programme. No adverse effect was reported. Average exercise intensity was mild to moderate for more than half of the training session. A significant reduction of the EEI and the heart rate during walking was observed following the training programme. No significant change was observed on secondary outcome measures.

Conclusions.?Group aquatic training increases gait efficiency in adolescents with CP. This improvement is related to systemic cardiorespiratory adaptations. Group aquatic training programme is feasible in adolescents presenting CP at different levels of severity.     

The perceived benefits and barriers to exercise participation in persons with multiple sclerosis

Purpose.?The purpose of this study was to examine the perceived benefits and barriers to exercise participation in persons with multiple sclerosis (MS).

Method.?A cross-sectional postal survey comprised of 93 adults with MS was conducted. Participants completed the Exercise Benefits and Barriers Scale (EBBS), Spinal Cord Injury Exercise Self-Efficacy Scale (EXSE), Multiple Sclerosis Impact Scale, Disease Steps Scale and International Physical Activity Questionnaire.

Results.?Forty-three percent of the participants were classified as exercising individuals (EX group) as compared with non-exercising individuals (non-EX group). Participants in the EX group reported significantly higher scores on the EBBS and EXSE. Items related to physical performance and personal accomplishment were cited as the greatest perceived benefits to exercise participation and those items related to physical exertion as the greatest perceived barriers to both the EX and non-EX groups.

Conclusion.?When compared with previous studies conducted in the general population, the participants in the present study reported different perceived barriers to exercise participation. Furthermore, awareness of the benefits of physical activity is not sufficient to promote exercise participation in persons with MS. Perceived exercise self-efficacy is shown to play an important role in promoting exercise participation in persons with MS.     

A randomized trial comparing a group exercise programme for back pain patients with individual physiotherapy in a severely deprived area

Purpose.?To compare a group exercise programme known as the Back to Fitness programme with individual physiotherapy for patients with non-specific low back pain from a materially deprived area.

Method.?This was a randomized controlled trial including 237 physiotherapy patients with back pain lasting more than six weeks. Participants were allocated to either the Back to Fitness programme or to individual physiotherapy, and followed up at three months and 12 months after randomization. The main outcome measure was the Roland Disability Questionnaire. Secondary measures were: SF12, EQ5D, Pain Self-Efficacy Scale. Health care diaries recording patients' use of health care resources were also collected over a 12-month period.

Results.?There were no statistically significant differences in change scores between groups on the primary outcome measure at three months (CI ??2.24 to 0.49) and at 12 months (CI ??1.68 to 1.39). Only minor improvements in disability scores were observed in the Back to Fitness group at three months and 12 months respectively (mean change scores; ??0.89, ??0.77) and in the individual physiotherapy arm (mean change scores; ??0.02, ??0.63). Further analysis showed that patients from the most severely deprived areas were marginally worse at three month follow-up whereas those from more affluent areas tended to improve (CI 0.43 to 3.15).     

Effectiveness of a community-based low intensity exercise programme for ambulatory stroke survivors

Purpose.?To establish the feasibility and effectiveness of a community-based exercise programme for ambulatory patients with stroke discharged from rehabilitation

Method.?Eighteen participants were recruited 3–12 months after onset of first stroke. Using a time series experimental design, the group completed a baseline period of 4 weeks (A1), a group exercise programme of low-intensity progressive resistive exercise and functional tasks for lower limb muscles (B) and repeat assessment after cessation of exercise (A2). Fitness instructors delivered sessions at Leisure Centres twice weekly for 14 weeks with physiotherapy support and the minimum attendance requirement was 16 sessions. Measures included muscle strength, gait velocity, Berg Balance Scale and Nottingham Extended Activities of Daily Living.

Results.?Lower limb muscle strength improved after training (ANOVA, p?<?0.02). Paretic knee extension strength increased from 43.4?±?5.9 to 60.4?±?6.8 Nm after 16 exercise sessions. Walking velocity increased significantly (ANOVA, p?<?0.001), from 0.54?±?0.07 to 0.75?±?0.08 m/s (t?=??3.31, p?<?0.01). Balance and everyday function were also significantly improved (p?<?0.003). There were marked individual variation in the response to training, and those who completed additional training did not show benefit.

Conclusions.?This community-based exercise programme was feasible and delivered positive improvements in physical function for participants. Further issues raised for investigation include the individual response to training and the benefits of extended training.     

Vocational training integrated into inpatient psychosomatic rehabilitation – short and long-term results from a controlled study

Purpose.?The aim of this study was to determine the impact of a vocational training programme on short- and long-term results after psychosomatic rehabilitation.

Method.?1,590 inpatients were screened for vocational integration. A high-risk group of 266 patients was randomly assigned to the vocational training programme plus psychosomatic treatment; treatment- as- usual served as a control condition. An occupational training was conducted at local companies, closely integrated into psychosomatic treatment. Vocational attitudes and adjustment were studied at intake, discharge, three, 12 and 24 month follow-ups.

Results.?More than half of the study participants were unemployment and/or long-term work-disabled harbouring strong negative attitudes toward return to work. Forty-six percent of the intervention group declined from participation, but complied with follow-up investigation. At discharge, participants of the vocational training programme had become more optimistic regarding resuming work. One year following discharge, participants of the training programme reported less absence from work. After 24 months, vocational adjustment had improved considerably among programme participants, and declined among controls and refusers.

Conclusion.?An intensive vocational training programme is effective in promoting positive attitudes to work, reducing work disability and promoting return-to-work. However, a randomized design may be not optimal; evaluation necessitates long-term follow-up.     

A small group aerobic exercise programme that reduces body weight is feasible in adults with severe chronic schizophrenia: a pilot study

Purpose.?To evaluate the feasibility and effects of an exercise programme on people with severe, chronic schizophrenia.

Method.?A single-group, pre-post pilot study incorporating a baseline familiarisation phase was followed by a 24-week, small-group aerobic exercise programme for up to 30-min each session, twice a week and a 30-min weekly walking session. Adherence was assessed by attendance, and by analysing the exercise supervisor's comments in a programme diary and in each participant's exercise logbook. Body weight, cardio-respiratory fitness (VO₂ max), walking endurance (6-min walk test) and psychiatric symptoms (the Positive and Negative Syndrome Scale) were measured at each time point.

Results.?Eight participants (6 men, 2 women; mean age 45 years, 9 months (SD 10 years, 1 month); mean body mass index 27.0 (SD 4.2)) attended a mean of 73%% of the scheduled exercise sessions, and 83%% of the walking sessions, with no adverse events and no dropouts. All participants displayed positive and negative behaviours during training sessions. There were significant reductions in weight (2.4%%) and body mass index (2.2%%), but no changes in other measures.

Conclusions.?It was feasible and safe to conduct a small-group aerobic exercise programme for adults with severe chronic schizophrenia that reduced body weight.     

Effects of a rehabilitation programme on daily functioning,participation, health-related quality of life,anxiety and depression in liver transplant recipients

Purpose.?Fatigue is a chronic problem in liver transplant recipients and may influence daily functioning and health-related quality of life (HRQoL). This study aimed to evaluate the effects of a fatigue-reducing physical rehabilitation programme on daily functioning, participation, HRQoL, anxiety and depression among liver transplant recipients.

Method.?Eighteen fatigued liver transplant recipients (mean age 51 years, 10 men/8 women) participated in a 12-week rehabilitation programme, which included supervised exercise training and daily physical activity counselling. We assessed pre- and post-programme health-related daily functioning, participation, HRQoL, anxiety and depression using questionnaires.

Results.?After the programme, patients showed improvements in daily functioning (23.6%, p?=?0.007), the participation domain ‘autonomy outdoors’ (34.1%, p?=?0.001), and the HRQoL domains ‘physical functioning’ (11.5%, p?=?0.007) and ‘vitality’ (21.5%, p?=?0.022). Anxiety and depression were unchanged post-programme.

Conclusions.?Rehabilitation using supervised exercise training and daily physical activity counselling can positively influence daily functioning, participation and HRQoL among fatigued liver transplant recipients.     

Short-term supervised inpatient physiotherapy exercise protocol improves cardiac autonomic function after coronary artery bypass graft surgery – a randomised controlled trial

Objective.?Coronary artery bypass grafting (CABG) is accompanied by severe impairment of cardiac autonomous regulation (CAR). This study aimed to determine whether a short-term physiotherapy exercise protocol post-CABG, during inpatient cardiac rehabilitation (CR), might improve CAR.

Design.?Seventy-four patients eligible for CABG were recruited and randomised into physiotherapy exercise group (EG) or physiotherapy usual care group (UCG). EG patients underwent a short-term supervised inpatient physiotherapy exercise protocol consisting of an early mobilisation with progressive exercises plus usual care (respiratory exercises). UCG only received respiratory exercises. Forty-seven patients (24 EG and 23 UGC) completed the study. Outcome measures of CAR included linear and non-linear measures of heart rate variability (HRV) assessed before discharge.

Results.?By hospital discharge, EG presented significantly higher parasympathetic HRV values [rMSSD, high frequency (HF), SD1)], global power (STD RR, SD2), non-linear HRV indexes [detrended fluctuation analysis (DFA)α1, DFAα2, approximate entropy (ApEn)] and mean RR compared to UCG (p?<?0.05). Conversely, higher values of mean HR, low frequency (LF) (sympathetic activity) and the LF/HF (global sympatho-vagal balance) were found in the UCG.

Conclusions.?A short-term supervised physiotherapy exercise protocol during inpatient CR improves CAR at the time of discharge. Thus, exercise-based inpatient CR might be an effective non-pharmacological tool to improve autonomic cardiac tone in patient's post-CABG.     

Vision self-management for older adults: A pilot study

Purpose.?The aim of this study was to pilot test the vision self-management programme (VSM) a newly developed, 8-week self-management intervention. The programme is a structured, repeatable and theoretically derived programme for older adults with age-related vision loss (ARVL).

Method.?A pre-and post-test design was used, and involved 12 older adults with ARVL. The activity card sort, a measure of participation in life situations, was the primary outcome measure. Secondary outcome measures examining general health and vision specific domains were also used.

Results.?Participants reported a statistically significant increase in participation in life situations immediately following the VSM programme. However, whilst an increase in such participation was still present at 12-week follow-up, this was no longer statistically significant. In addition, the participants demonstrated statistically significant gains in both general health and vision specific domains. Although these findings are exploratory they suggest that the VSM may have both short and longer term benefits for older adults living with ARVL.

Conclusions.?Overall findings indicate that the participation in the self-management programme resulted in improved participation and health outcomes and support the need for further study using more rigorous designs.     

The effect of progressive resistance training on leg strength,aerobic capacity and functional tasks of daily living in persons with Down syndrome

Purpose.?The purpose of this study was to examine the effect of progressive resistance training on leg strength, aerobic capacity and physical function in persons with Down syndrome (DS).

Method.?Thirty persons with DS (age 28 SD 8 years) were assigned to an intervention or control group. The intervention group performed resistance training 2 days per week for 10 weeks. Participants performed tests to measure isometric and isokinetic knee extensor and flexor peak torque, peak aerobic capacity and timed performance on chair rise, walking and stair ascent and descent.

Result.?Persons with DS receiving the intervention significantly increased their isokinetic knee extensor and flexor peak torque [[Absolute change (post minus pre-value) was 17.0 SD 29.6 and 12.6 SD 18.9 N m, respectively]] and isometric knee extensor peak torque at angles of 45° (2.9 SD 23.2 N m), 60° (3.0 SD 22.9 N m) and 75° (14.2 SD 30.0 N m). These changes were significantly greater than in the control group. In addition, the time to ascend (?0.3 SD 0.8?s) and descend (?0.6 SD 0.9?s) stairs significantly decreased in the intervention group compared to the control group.

Conclusion.?These findings show that progressive resistance training is an effective intervention for persons with DS to improve leg strength and stair-climbing ability.     

Leisure participation for school-aged children with Down syndrome

Purpose.?To describe leisure participation for school-aged children with Down syndrome and to investigate how factors, classified by the World Health Organisation's International Classification of Functioning, Disability and Health, influence their leisure participation.

Method.?Families in Western Australia with a child aged 5–18 years with Down syndrome were surveyed in a population-based study (n == 208) in 2004.

Results.?One-third of parents reported that their child with Down syndrome had no friends although half reported two or more friends. Factors affecting number of friendships included the child's functional ability, behavioural issues and parent's availability of time. Those children with higher functional independence scores in daily tasks were more likely to have two or more friends than those with lower functional independence scores (OR: 1.02, 95%% CI 1.01–1.04 for a single point increase in WeeFIM score). All children participated in predominantly solitary and sedentary leisure activities.

Conclusions.?Leisure participation was affected by complex factors both within and external to the child with Down syndrome. Further investigation of the relevance of these factors to leisure may enable more satisfying and meaningful participation in leisure for school-aged children with Down syndrome.     

An observation-based intervention for stroke rehabilitation: experiences of eight individuals affected by stroke

Purpose.?To explore eight individuals’ experiences and responses to taking part in a personalised observation-based intervention for stroke rehabilitation.

Methods.?Eight participants who had experienced a cerebrovascular accident were recruited to a 16-week observation-based intervention. Participants were interviewed face-to-face to explore their responses to, and experiences of, taking part in the intervention. A list of topics, derived from the intervention process and earlier studies provided a provisional structure for the interview. All interviews were transcribed, coded and analysed using inductive content analysis to explore the impact of the observational intervention for these participants.

Results.?Three main themes emerged: physical function, behaviour change and DVD content. Lower order themes were also identified. These included: interaction with the physiotherapist; ability to complete tasks; and increased motivation to (re)engage in activities of everyday living.

Conclusion.?The findings suggest that a programme of action observation, linked to individualised and meaningful motor behaviours can provide a valid intervention for individuals affected by stroke by serving as a motivating agent to (re)engage in activities which they had believed they could not perform following their stroke. There was also evidence for positive affect on psychological wellbeing and motor function.     

A microswitch-based programme to enable a boy with multiple disabilities and minimal motor behaviour to choose among environmental stimuli

Purpose.?The present study assessed a microswitch-based programme designed to enable a nine-year-old boy with multiple disabilities and minimal motor behaviour to choose among environmental stimuli.

Method.?The programme relied on the boy's eyebrow movements, a microswitch to detect such movements, and a computer system to handle sets of allegedly preferred and non-preferred stimuli. For each of the 30 stimuli available in every session, the computer system provided a sample/preview of 2 – 3 seconds. During intervention, the boy's responding to a stimulus sample (i.e., moving the eyebrow and activating the microswitch) led the computer system to turn on that stimulus for 25 seconds. The boy's lack of responding led the computer system to present the next stimulus sample.

Results.?Intervention data showed that the boy's choice making (i.e., responding to a stimulus sample or avoiding to do so) was largely consistent with the alleged preference value of the stimuli, that is, he tended to choose the stimuli that were considered preferred and to bypass those considered non-preferred for him. The same performance was maintained during post-intervention checks, occurring 6 and 10 weeks after the end of the intervention, and over sets of stimuli not used during the intervention.

Conclusions.?The present microswitch-based programme may be considered useful to allow students with multiple disabilities an active choice (control) role in a stimulation-enriched environment.     

Chronic spinal cord injury pain: pharmacological and non-pharmacological treatments and treatment effectiveness

Purpose.?To describe pharmacological and non-pharmacological pain treatments used for chronic spinal cord injury pain (CSCIP) and current treatment effectiveness in a large Dutch population with a spinal cord injury (SCI).

Method.?Postal survey among 575 persons with SCI. The main outcome measures were the pain intensity score of the Chronic Pain Grade questionnaire, past and current pain treatments, and perceived effectiveness of current pain treatments.

Results.?Response rate was 49% (279 persons) and 215 respondents (77.1%) had CSCIP. Most respondents with CSCIP (62.8%) reported more than one pain type, of which neuropathic pain was most frequently reported (69.3%). Of this group with CSCIP, 63.8% was currently involved in some kind of treatment, but nevertheless high levels of pain (mean 52.8 on a 0–100 scale) were reported. Massage (therapy)/relaxation (training), anticonvulsants, and non-steroidal anti-inflammatory drugs (NSAIDs) were the most often used treatments. The current treatments that were most often perceived as effective were acupuncture/magnetising, cannabis/alcohol, physiotherapy and exercise, and massage (therapy)/relaxation (training). TENS/ultrasound and antidepressants were least often perceived as effective.

Conclusions.?Many SCI pain treatments have been tried. Acupuncture/magnetising, cannabis/alcohol, and physiotherapy and exercise were considered most effective. Further research is needed to establish effective SCI pain treatments.     

Physiotherapy in Afghanistan: an analysis of current challenges

Introduction.?Afghanistan has high levels of disability due to prolonged conflict. An important part of the reconstruction process in Afghanistan is strengthening health service capacity and, within this, rehabilitation services.

Aims:?To identify training needs of, and key issues affecting, Afghan physiotherapists.

Methods.?20 interviews and clinical accompaniment of 15 physiotherapists/physiotherapy assistants (APA) carried out in the second quarter of 2003. Analysis was using a grounded theory approach.

Results.?Five themes emerged: (1) Low professional profile of physiotherapy; (2) Difficult working conditions; (3) Difficulty identifying personal training needs; (4) Difficulty with clinical reasoning at undergraduate level; (5) Variable levels of clinical competence.

Discussion.?Many of the challenges facing Afghan physiotherapists are not unique to Afghanistan but are exacerbated by a lack of government recognition of the profession. War has isolated Afghan physiotherapists from completed professional links and consequently the undergraduate curriculum had not matched developments in other comparable countries. This has contributed to the difficulties therapists' experience with current clinical reasoning and accessing new practice developments. Culture also influences attitudes towards training and has restricted female travel and access to education.

Conclusions.?Core training needs include disability sensitization, reflective practice and clinical reasoning. The physiotherapy curriculum needs updating and links with ongoing research need to be established to keep abreast of new developments.     

Patient centered goal-setting in a subacute rehabilitation setting

Purpose.?The purpose of this research is to describe current practices in goal-setting within a subacute rehabilitation setting from the perspective of therapists representing the disciplines of occupational therapy, speech pathology and physiotherapy.

Method.?Qualitative semi-structured email interviews were conducted with therapists from the Geriatric Assessment and Rehabilitation Unit of an Australian hospital. Therapists were required to respond to questioning with reference to identified rehabilitation patients with stroke.

Results.?Three approaches to goal-setting were identified: therapist controlled, therapist led and patient centred. Goals aimed at the ICF levels of impairment and activity limitations were predominant. Barriers to a patient centered goal-setting approach largely outweighed facilitators. Potential successful resolutions were offered to overcome these barriers.

Conclusions.?The inability of patients to participate fully in the goal-setting process largely determines the approach taken by therapists. This influences the level of patient centeredness incorporated into the goal-setting process. Goals expressed at the level of impairment, by therapists, may be stepping stones to perceived patient goals at the levels of activity and participation. Barriers to a patient centered approach can be overcome through education of the patient and family regarding the nature of the injury and modification of communication between therapist and patient.     

Educating patients: Self-Management approaches

Purpose.?To review and evaluate approaches to educating patients with fibromyalgia syndrome (FMS).

Methods.?A narrative literature review was undertaken to summarize the published literature on patient education for FMS patients.

Results.?A number of studies contain specific education strategies while others are combined with exercise or movement therapies or cognitive-behavioural therapy.

Conclusions.?Self-efficacy provides an effective theoretical model from which to understand how patients change as a result of education strategies that focus on self-management. Programmes that combine education with cognitive-behavioural techniques and exercise are most effective in enhancing self-efficacy and decreasing symptoms of FMS.     

The effects of problem-solving skills training based on metacognitive principles for children with acquired brain injury attending mainstream schools: a controlled clinical trial

Purpose.?To investigate the effects of an explicit problem-solving skills training programme based on metacognitive principles for children with acquired brain injury (ABI) who attend mainstream schools.

Method.?Thirty-two children with moderate to severe ABI studying in mainstream schools were allocated randomly by matched pairs to either an experimental or a comparison group. The participants in the experimental group received problem-solving skills training based on metacognitive principles, while those in the comparison group were on a waiting list to receive the experimental intervention shortly after the intervention in the experimental group had been completed. All participants were measured pre- and post-intervention using measures of abstract reasoning, metacognition, problem-solving functional behaviour in the home environment or social situations and individual goal-directed behaviour.

Results.?Significant differences in post-test scores were found for all measurements between children in the experimental group and those in the comparison group, using the baselines of dependent variables, years of schooling and the full IQ scores as the covariates.

Conclusion.?The results of this study supported the use of explicit problem-solving skills training to improve daily functioning for children with ABI, and the need for a larger-scale, randomised controlled study with long-term follow-up.