Preparedness of new graduate Australian physiotherapists in the use of electrophysical agents

Objective

To determine the perceptions of physiotherapists concerning the preparedness of new graduates to use electrophysical agents (EPAs) in clinical practice.

Design

An observational cross-sectional questionnaire was developed and demonstrated to be reliable and valid.

Participants

The questionnaire was mailed to all registered physiotherapists in Australia in 2005 (n = 12,893).

Results

In total, 3538 questionnaires were returned complete. Two forms of non-responder analysis indicated that the sample and their associated responses were representative of the Australian physiotherapy population. Eight out of 10 new graduates felt prepared to use EPAs that are common in Australian clinical practice. However, 80% felt underprepared to use a range of other EPAs. Similar trends were found when new graduate preparedness was examined from the perspective of physiotherapists who were working with or mentoring new graduates. However, experienced physiotherapists rated preparedness lower than the new graduates themselves (χ² = 525.7, P < 0.01).

Conclusions

These findings raise questions about the adequacy of entry-level education and the level of competence expected of new graduates for the safe and effective application of a range of EPAs upon entry to the workforce. The findings indicate the need for clearer guidelines on the levels of competency expected of new graduate physiotherapists in Australia.     

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 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.     

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.     

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.     

Journal readership amongst Australian physiotherapists: a cross-national replication

This study, a replication of one carried out in England, describes a survey of journal readership by physiotherapists in hospital practice in Australia. The results reveal that, besides a high and widespread readership of newsletters, more than 90 per cent of respondents read journals other than the Australian Journal of Physiotherapy. There was moderate but extensive readership of other physiotherapy literature, while readership of non-physiotherapy literature was infrequent but widespread. Respondents who were registered for postgraduate education displayed a more extensive readership. A comparison of the studies in England and Australia reveals the similarity of results between those with a degree background in both countries.     

Electrotherapy usage trends in private physiotherapy practice in Alberta

Electrotherapy is a common treatment intervention administered by physiotherapists. Owing to a lack of scientific reporting of modality usage, particularly within Canada, it was the purpose of this study to survey all private practitioners registered within the Province of Alberta. A total of 208 clinicians representing 41% of the population sample, responded to the survey. Results indicated hot packs followed by ultrasound, ice, transcutaneous electrical nerve stimulation (TENS) and interferential were the most frequently used modalities. With the exception of ultrasound, these findings differed considerably from previous reports of modality usage. Statistical comparisons, using Fisher's exact test of independence, revealed frequent use of TENS was greater amongst older clinicians and clinic owners (p < 0.05) while male therapists used biofeedback more often than female colleagues (p < 0.05). No significant differences were found between therapists trained at the University of Alberta and those educated elsewhere. Peer influence within the geographically and politically defined sample population may explain the relatively few between-group differences. Future research should target additional population samples plus continue to monitor trends within previously studied groups.     

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.     

Standing with assistance of a tilt table in intensive care: a survey of Australian physiotherapy practice

Although tilt tables are used by physiotherapists to reintroduce patients to the vertical position, no quantitative evidence is available regarding their use within intensive care units (ICUs) of Australian hospitals. The purpose of this study was to evaluate the use of tilt tables in physiotherapy management of patients in ICUs across Australia. Ninety-nine physiotherapists working in Australian public ICUs were contacted via mail and asked to complete a questionnaire regarding their use of tilt tables in practice. Reasons for the use of the tilt table, contraindications, commonly used adjuncts, monitoring, and outcome measures were also investigated. Eighty-six questionnaires were returned (87% response). The tilt table was used by 58 physiotherapists (67.4%). The most common reasons for inclusion of tilt table treatment were to: facilitate weight bearing (94.8% of those who tilt); prevent muscle contractures (86%); improve lower limb strength (81%); and increase arousal (70%). The tilt table was most frequently applied to patients with neurological conditions (63.8%) and during long-term ICU stay (43.1%). Techniques often combined with tilt table treatment included upper limb exercises (93.1%) and breathing exercises (86.2%). Standing with assistance of the tilt table is used by the majority of physiotherapists working in Australian ICUs. A moderate level of agreement is demonstrated by physiotherapists regarding indications to commence tilt table treatment and adjunct modalities combined with standing with assistance of the tilt table.     

Patterns of chest physiotherapy in Australian Intensive Care Units

PURPOSE: The aim of this study was to identify the availability of physiotherapy services in Australian Intensive Care Units (ICUs) and articulate the roles that physiotherapists and nursing staff play in the provision of chest physiotherapy. MATERIALS AND METHODS: Telephone interviews with 71 clinical nurse managers and 6 physiotherapists of adult public Australian ICUs were undertaken. A structured interview schedule was developed from a review of the literature and a panel of experienced ICU clinicians and researchers to establish the frequency, components and personnel involved in the provision of chest physiotherapy. RESULTS: Almost 90% (n = 67) of ICUs had physiotherapists available during the week but over 25% (n = 22) had "on-call" service only on weekends. Less than 10% had weekday (n = 7) or weekend (n = 6) evening physiotherapy coverage. While nurses were involved in the provision of all aspects of chest physiotherapy, physiotherapists were primarily involved in airway suctioning, percussions, vibrations, positioning, and mobilization. CONCLUSIONS: The provision of chest physiotherapy services is often shared between physiotherapists and nurses, however, the actual therapies provided appears to vary depending on the provider. While strong evidence for chest physiotherapy procedures is lacking, the widespread use in the ICU suggests that it is an ideal setting for undertaking clinical research.     

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.     

Barriers and facilitators to achieving competence in lung ultrasound: A survey of physiotherapists following a lung ultrasound training course

Background and purposeLung ultrasound (LUS) is an emerging tool for acute respiratory physiotherapists. In Australia, there are a select few LUS training courses run for physiotherapists. Research to date has evaluated LUS training courses for physiotherapists in terms of knowledge and skill acquisition. The impact of LUS training on user competence and confidence and whether LUS is used in clinical practice has yet to be evaluated. This study therefore explored the impact of attending a physiotherapy LUS training course on acquisition of competence and confidence and the barriers and facilitators for physiotherapists in achieving competence in LUS.MethodsA quantitative survey containing 21 questions was distributed to 77 Australian physiotherapists.ResultsOf the invited physiotherapists, 39 (50%) completed the survey. Most participants were working in intensive care, in the public hospital setting. Binary logistic regression was performed and demonstrated no significant difference in the relationship between years of clinical experience and having confidence in performing or interpreting LUS images. There was also no statistical significance in the relationship between years of clinical experience and gaining competence and accreditation in LUS. Of the 39 responders, 20 physiotherapists had performed at least one LUS scan since completing training; however, most identified they never use LUS to inform clinical decision-making. Only one physiotherapist had gained accreditation through an ultrasound-governing body. The most frequently reported barriers to achieving competence were lack of clinical time to devote to training and lack of an LUS supervisor.ConclusionA majority of physiotherapists who participated in an LUS training course did not attain competence or accreditation, nor were they confident in performing LUS and interpreting images. Barriers exist that prevent intensive care physiotherapists from being able to use LUS in clinical practice. LUS is also not frequently used by acute respiratory physiotherapists to make clinical decisions.     

The occupational prestige of physiotherapy: perceptions of student physiotherapists in Australia

Within the framework of occupational prestige assessment, this survey was carried out amongst future physiotherapists in Australia to determine their perceived standing of physiotherapy relative to a range of occupations including several within the medical field. A questionnaire was administered to 258 undergraduate physiotherapy students. Twelve occupations were rated on six dimensions, ie levels of income, education, social standing, responsibility and usefulness, and the proportion of women. The results indicate that amongst future physiotherapists in Australia, their profession possesses relatively high status, together with solicitor, doctor and judge, and is differentiated from the proximate professions of nurse and chiropractor. These results are similar to those obtained from the Australian public, and are in distinct contrast to the perceptions of the profession that emerged amongst physiotherapy students in England. Physiotherapy in Australia is held in high esteem - it has a clear identity and professional status, and is likely to be seen as a desirable future occupation for both genders.     

Minimum standards of clinical practice for physiotherapists working in critical care settings in Australia and New Zealand: A modified Delphi technique

Objective: Achieving competency in critical care in entry-level physiotherapy courses across Australia and New Zealand is not essential, and accredited training for qualified physiotherapists working in critical care units is lacking. As a result, practice standards and training may vary. The objective was to establish consensus-based minimum clinical practice standards for physiotherapists working in critical care settings in Australia and New Zealand. Design: A modified Delphi technique, which consisted of three rounds of questionnaires, was used to obtain consensus on items. Setting: Australian and New Zealand critical care settings. Participants: A panel (n = 61) was invited from a pool of eligible physiotherapists throughout Australia and New Zealand (n = 93). Eligibility criteria were defined a-priori on the basis of possession of expertise and experience in the practice and teaching of critical care physiotherapy clinical skills. Main Outcome Measure: Questionnaires were disseminated electronically (either via email, or SurveyMonkey^®). Items were designated by participants as being ‘Essential/Unsure/Not Essential’. Consensus for inclusion was achieved when items were ranked ‘Essential’ by more than 70% of participants. Results: Fifty physiotherapists consented and participated in the initial Delphi round, of whom 45 (90%) completed all rounds. Consensus was reached on 199 (89%) items. The panel agreed that 132 (58%) items were ‘Essential’ items for inclusion in the final framework. Conclusions: This is the first study to develop a consensus framework of minimum standards of practice for physiotherapists working in critical care. The clinical utility of this framework now requires assessment.