TRACK 1: Diversity and Inclusion in Learning
ID 104 – A current changing on a Polish physiotherapy market in comparison with other European countries
Dalia Woźnica1, Rita Hansdorfer-Korzon1, Maciej Krawczyk2
1Medical University of Gdańsk, Poland; 2Polish Chamber of Physiotherapists, Poland
Background
Physiotherapy in Europe is dynamically developing in main directions: clinical, regulatory and structural. Poland introduced a new advocacy to PT market. PT has become a regulated, independent medical profession of public trust managed by The Polish Chamber of Physiotherapists representing almost 70.000 PTs. Despite differences, Europe represents the voice of 600,000 PTs. Comparison of PT market’s system solutions regarding demography, regulations, education and professional competencies is needed.
Methods
The survey has been sent by E-mail to 41 ERWCPT members as an online link. Representatives from 32 countries sent back the questionnaire. The results were shown in the form of maps.
Results
In the period of 3 years study, 5 (16%) countries improved its regulations. The main differences in the characteristics of the Polish and European PT market concerned the education system and law regulations. Poland represents 1 out of 3 (9%) countries with a 5-year curriculum. There are eight countries (25%) which established National Chamber. Analyzing demographic aspects Polish PT constitutes the 3rd largest group in Europe and the second biggest Chamber. Is also the youngest group on the European market regarding the age and third among most migrated professionals. The average monthly PT salary in Europe is 2307,5 euro with the lowest 500 euro in Poland and 300 euro in Montenegro. The scope of basic competences was at a similar level, while the physiotherapist in Poland differed significantly in the lack of advanced scope both on private and public sector. Far now only 8 (25%) from analyzing countries legally allow direct access to PT on a public Health System, excluded Poland. Ten countries (31%) require a physician’s referral for physiotherapy, including Poland.
Discussion and conclusion
Limitation was the need for results reevaluation due to dynamic changes on the market. Standardized research tools should be developed to further validate such diverse data. Two directions of changes have been visible: structural, which occurred mostly among Middle-East European countries and professional regarding new or advanced scopes-among countries with a higher professional tradition. Advance scopes of practice and professional independence do not correlate with a level of education, salary or recommended regulations.
Keywords: Europe, physiotherapy systems, comparison
ID 113 – Preparing physiotherapists to direct access in the diversity of health care systems – European framework for physiotherapists further education
Ursula Eckler1,7, Alesander Badiola-Zabala2, Marja-Leena Lähteenmäki3, Eija Mämmelä4, Carmen Suárez-Serrano5, Tarja Svahn6
1FH Campus Wien, University of Applied Sciences, Austria; 2Blanquerna School of Health Science, Ramon Llull University, Spain; 3Tampere University of Applied Sciences, Finland; 4Oulu University of Applied Sciences, Finland; 5University of Seville, Department of Physiotherapy, Spain; 6Seinäjoki University of Applied Sciences, Finland; 7Physio Austria, Austria
Background
Mobility of health professionals in diverse societies demands common developmental trends of the European physiotherapy education. As one of future influential issues being identified is physiotherapy as “best point of service”. This becomes reality with the possibility of self-referral to physiotherapist’s consultation. Along with research, this is effective and cost-saving.
Purpose
The aim of this work is to develop a clear, transparent and future-oriented framework for physiotherapist’s further training leading to autonomous practice including treatment of patients without referral.
Approach/Methods
The basis for the framework was defined by performing literature research including references concerning experiences with patient´s self-referral. Key aspects and requirements of direct access were identified. Finally, the framework was generated in multinational discussion in ENPHE’s working group professional issues.
Results
The entry-level curriculum of most countries prepares the physiotherapy students working as autonomous practitioners. Depending on the national health system the workplace enables autonomous practice with direct access. The framework describes the level of advanced scope of practice for first contact practitioners. They are able to deal with complex decision-making processes in the management of patients who are triaged directly to physiotherapists.
Discussion/Limitation
Career paths of European physiotherapists with common understanding of physiotherapists as first contact practitioners might also be a factor of success for primary health care, highly promoted by transparency of diverse competences of various professions interacting in the team. In countries where physiotherapist´s scope of practice is not related to an autonomous profession, basic competencies stated in ESCO profile are to be completed during entrance level education.
Conclusion
Gathering concepts concerning direct access showed three main perspectives: (1) Direct access is the perspective of health system based on national laws and regulations in the purpose of each country. (2) First contact practitioner is the perspective of physiotherapist. It depends on competencies gained through education and working experience. (3) Self-referral is the perspective of patient/client/society. It depends on how physiotherapists market their profession. Describing the physiotherapist´s way to first contact practitioner offers a comprehensive help to streamline the development of physiotherapy including mobility of graduates as well as recognizing national responsibilities.
Keywords: direct access, scope of practice, competences
ID 130 – “Mental health is all physiotherapists’ business”. IOPTMH Guidelines for the implementation of mental health issues in education programs
Michel Probst1,2,3
1IOPTMH; 2AXXON, Belgium; 3KU Leuven, Belgium
Background
Mental health problems are of major public relevance. It is the leading predictor of years lived with disability worldwide. The consequences of mental health problems are devastating for the person and society as a whole. Mental health problems are often associated with physical health comorbidities while vice versa chronic physical conditions often result in mental health problems.
The slogan “Mental health is all physiotherapists’ business” underlines the necessity to integrate specific courses on mental health into the curriculum of physiotherapy education programs. However, mental health courses are still not part of most European physiotherapy curricula.
One of the core goals of the International Organization for Physiotherapy in Mental Health (IOPTMH) is to encourage improved standards of physiotherapy practice in mental health care and to support the development of high-quality physiotherapy education.
Methods
In the last 10 years, the IOPTMH developed a broad knowledge for recommending minimal requirements concerning mental health courses physiotherapy educational programs.
Results
This knowledge resulted in the Educational Standards Document. The Educational Standards Document is a guideline or reference document, which IOPTMH provides for schools of physiotherapy and physiotherapy associations which intend to implement mental health courses in educational programs (entry-level physiotherapy program, and specialized physiotherapy education in mental health). Attention is given to the following key elements of physiotherapy in mental health: (a) physical activity, exercise and physical fitness, (b) sensory, body and movement awareness, (c) stress and tension regulation including relaxation, (d) closeness/touch/massage, (e) physio-education (include lifestyle, pain), (f) pediatric psychiatry specific elements, and (g) old age psychiatric specific elements.
Discussion & conclusion
These standards provide a clear and detailed description of the knowledge, skills and attributes expected of a competent physiotherapist working in general physiotherapy or in areas of mental health care, including psychiatry, general hospitals or private practice. The participants will gain knowledge about the background (why?) and the content (what?) of relevant mental health issues in physiotherapy educational programs.
Keywords: mental health, psychiatry, education
ID 174 – The educational effects of the stratum interprofessional education program on the students of rehabilitation disciplines
Toshinori Shimoi
Japanese Physical Therapy Association, Japan
Background
There are two major issues in the quantitative study about the educational effects of interprofessional education (IPE). First, we hardly have a longitudinal study of the IPE program. Second, there is little report about the effects of the IPE program on students of each discipline. The purpose of this study is to clarify the effect of the stratum IPE program on attitudes toward professional identities in the students of rehabilitation disciplines with a retrospective cohort study.
Methods
The International University of Health and Welfare (Otawara Campus) has three schools and eight departments; nursing, physical, occupational and speech therapies, orthoptics, radiological sciences, social services and health management (welfare services, medical management), and pharmacy, and has run the stratum IPE program for over three years for 2nd to 4th-grade students. The widely adopted Interdisciplinary Education Perception Scale (IEPS) was administered to 201 students from nine disciplines who completed the stratum IPE program from 2014 to 2016 and from 2015 to 2017 at five points in time. We classified the nine disciplines into hypothetical groups. We conducted a two-way ANOVA (factor 1: discipline; factor 2: time course) on each hypothetical group, then explicitly set the groups without the main effect between disciplines. Next, a one-way ANOVA was performed for each group based on its time course and the effect size η2 was calculated. This study was conducted with approval from the International University of Health and Welfare Ethics Committee (14-Io-88).
Results
As a result, the nine disciplines were divided into three groups: higher, middle, and lower identified. The students of the rehabilitation disciplines, including physical therapy, were classified into the higher identified group. Regardless of the group, students increased the IEPS as the program progressed (η2 = 0.05–0.17).
Discussion
The findings of this study indicate that students of the rehabilitation disciplines, including physical therapy, have a higher professional identity from low grades compared to students in other disciplines and can increase their professional identity through the IPE program.
Conclusion
The stratum IPE program is one of the best ways to bring the students of rehabilitation disciplines up to high-quality healthcare professionals.
Keywords: interprofessional education, educational effect, IEPS
ID 195 – Interprofessional objective structured clinical examination (iOSCE) – Development of a competence-oriented test format for interprofessional learning
Marietta Handgraaf, André Posenau, Christina Groll
University of Applied Sciences Bochum, Germany
Background
In interprofessional learning literature articles about competence-oriented test formats hardly exist. If different health professions are integrated in one learning module, the number of students grows and the organizational efforts become more difficult. Therefore, the University of Applied Sciences in Bochum, Germany, developed an interprofessional objective structured examination (iOSCE) for the module “interprofessional case conferences”, where five health professions (physiotherapy, occupational therapy, speech&language therapy, nursing and midwifery) with about 200 students go through. The focus is on communication skills and the ability to make shared goalsetting and decision-making for an interprofessional care plan.
Methods
A group with experts from five health professions searched for an iOSCE-format in order to check communicative competences in interprofessional case conferences. They discussed an organizational frame for the iOSCE which ensures the control of the stations: paper cases, which are based on each other and a special iOSCE-rater scale. The examiners were trained by the expert group.
Results
For the iOSCE a simulation of a case conference with four flip open paper cases was developed. When 200 students (in interprofessional groups of five students each) are examined, four flip open paper cases, five examination rooms, ten examiners and two examination days are necessary. At the iOSCE-stations, the students from 3 to 4 professions perform a case conference with different aspects. They meet the patient in different settings. The criteria of the interprofessional rater scale are based on the developed framework for the case conference.
Discussion
The organizational frame of an iOSCE with 200 students is possible. The iOSCE represents a competence-based test format for interprofessional learning and is accepted by the examiners. Further research has to be done with regard to the validity and reliability of the iOSCE-rater scale.
Conclusion
The iOSCE is a competence-based test format. Large student groups can perform communication skills in interprofessional settings.
Keywords: interprofessional education, communication, test format
ID 212 – Sustainable Internationalization in Higher Health Care Education: The Case of a Norwegian- South African collaboration in Physiotherapy Education
Tone Dahl-Michelsen, Michael Rowe
Norwegian Physiotherapist Association, Norway
Background
Internationalization is recognized as an important part of higher education. Currently, not only traditional exchange, however also Internationalization at Home (IaH) and learning outcomes addressing intercultural competences are suggested to move future higher education forward. This paper describes the outcome of an international collaboration between two Physiotherapy Departments in Cape Town (SA) and Oslo (Norway).
Methods
The empirical data includes student’s assignments, focus group discussions, field notes from seminars, and field notes completed as part of the two projects leaders’ experiences. The data is scrutinized by thematic analysis.
Results
The results indicate that the design of this project offers sustainable internationalization experiences to all physiotherapy students, not only those who go on traditional exchange. Through the work on their assignment and by giving and receiving feedback (online) to a student from the other university, as well as participating in seminars, students develop intercultural competence(s). Indeed, students develop awareness and enhance their understanding of both possibilities and limitations of the influence of societies and environments on learning, health and rehabilitation. Bilateral student and staff exchange offer unique possibilities to develop (digital and online) learning resources.
Discussion (including limitations)
Participation in the project enhances students’ understandings of South-Africa and Norway as two societies representing very different ways of living (organizing and functioning of health care, education and rehabilitation). For example, students’ experience differences between the physiotherapy approaches; i.e., the Norwegian students are very occupied with advantages of the nature and want their patients to be active outdoors, an idea that seems strange to the SA students and leads to interesting discussions in both universities. Regarding relational aspects of physiotherapy, students experience similar values in both contexts.
One limitation of the study is that only two universities have been included, thus there is a need to conduct similar studies including other universities.
Conclusion
We suggest that international cooperation projects like this one not only help students learn about other health systems but also make them aware of the taken-for-granted knowledge and assumptions they have with respect to their own social, educational and health contexts.
Keywords: internationalization at home, Norway, South-Africa
ID 219 – Contextualizing physiotherapy education: Exploring physiotherapist’s perceptions working in humanitarian crisis to inform the formation of a new curriculum
Konstantinos Papakonstantinou1, Nikolaos Stathopoulos1, Alexandros Souvatzis2, Nikolaos Marinos3
1Metropolitan College, Greece (in collaboration with QMU, Edinburgh); 2Physiotherapist, Manual Therapist, Sport Physiotherapist. Coordinator of Doctors of The World-Greek Delegation Physiotherapy Team; 3Orthopaedic Surgeon, Assistant Clinical Curator of Second Orthopedic Clinic of “Vostaneio” General Hospital of Mytilene. Special Secretary of BoD of Doctors of The World-Greek Delegation
Background
Greece has been one of the European countries affected greatly by the refugee crisis that has been unfolding for half of a decade. This humanitarian crisis has posed important challenges for healthcare providers, most of whom were academically and clinically unprepared to meet the needs of refugee’s asylum seekers. The current study aimed to explore the needs of physiotherapists and their perceived experience during their work in a non-governmental organization, Doctors of the Word, Greece, that offers physiotherapy services to this specific group of patients.
Methods
The study used a qualitative design. Semi-structured interviews of licensed physiotherapists were conducted. Interviews lasted approximately 40 minutes each. Questions explored participants’ perceived readiness to offer services, perceived educational, clinical and emotional needs, and perceived barriers to care. Data were analyzed using thematic analysis.
Results
The extracted themes were mostly based around practical experience issues and the need to update physiotherapy education to enable professional change. Specific need areas included: better understanding of diversity and inclusion, more experience of population with multiple co-morbidities and traumas, emotional support of health workers and update of professional standards and policies.
Discussion
The issues identified highlighted the need to reform and differentiate the rationale of the curriculum (implementing the Habermas’s theory of knowledge that considers curriculum as a social and cultural construction) and meet the demand of the new emerging circumstances (locally and globally). The data gathered guided the development and enriched the content of specific modules enhancing the acquisition of high-level communication skills, cultivating multicultural approach, familiarizing students with the concept of inclusiveness and compassion, supporting their professional (promoting health for the community) and personal development (behavioral change) enabling them to deal with this specific group of patients.
Conclusion
Participants identified a range of issues most of which were then addressed by a new physiotherapy degree curriculum with the view to better prepare future graduates.
Keywords: humanitarian crisis, curriculum development, physiotherapy
ID 256 – Internationalization@home: a sustainable opportunity for the future
Carla Mendes Pereira1,3,4, Marika Heiskanen2,5, Margarida Sequeira1,3,4 Gabriela Colaço3, Antti Sillanpaa5, Eija Mammela2,5, Madalena Silva1,3,4
1Portuguese Association of Physiotherapists, Portugal; 2Finnish Association of Physiotherapists, Finland; 3School of Health, Polytechnic Institute of Setubal, Portugal; 4Centre for Interdisciplinary Applied Research in Health (CIIAS), Polytechnic Institute of Setubal, Portugal; 5: Oulu University of Applied Sciences, Finland
Background
International experiences during higher education constitute a privileged opportunity to develop intercultural competences, however only 20% of students have the possibility to travel and benefit from internationalization. Internationalization@home may be an alternative to provide all students such opportunity. The aim of the project was to develop an opportunity to enable the students to discover and learn about cultural and professional issues through selected topics and activities, planned to create a dialogue and cooperation between them.
Methods
Two Physiotherapy European institutions developed an internationalization@home opportunity for undergraduate physiotherapy students. Preparatory meetings took place online. Curriculum plans were analyzed in order to identify the moments at which different themes/concepts were being explored in each curriculum. Two themes were identified to explore in an inter-cultural environment. Based on this, activities were initially planned to be implemented through-out the first-year. At the end of each year, an online meeting with the teachers involved took place, to assess the process and introduce improvements for the coming year.
Results
In three years of implementation, 255 students have been involved, working in international groups of 4/5 students. The students make a presentation at home for their peers and teachers, which has been developed together. Various topics of the Physiotherapy history and cultural differences in both countries are explored.
Discussion
The initial plan of working on two themes was proven too ambitious. Communication issues were identified by the students and there was a different expectation for the output. On the second and following year, clearer criteria for the output was gradually defined. Cultural differences regarding the teaching and learning have been identified, as well as differences regarding daily routines and time management.
Conclusions
According to the teachers’ perception, international experiences at home are an opportunity to develop intercultural competences. With the project, students demonstrated an increased knowledge about the partners’ culture and Physiotherapy European history, improved their ability to use a foreign language effectively in a professional context and improved their ability to use web-based communication tools. The perception of the students’ needs is being investigated in order to inform the future development of the project.
Keywords: internationalization@home, intercultural competences, physiotherapy
ID 139 – A method to integrate sustainable development in education
Elvira Lange1, Eva Holmgren1, Annie Palstam2
1Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Sweden; 2Institute of neuroscience and physiology, department of clinical neuroscience, Sahlgrenska academy, University of Gothenburg, Sweden
Background
Focusing on the links between environment and health could be an important driving force for a more sustainable development of society, and in physiotherapy. To reach the Agenda 2030 the University of Gothenburg since 2014 apply a system with Sustainability labeling of courses and programs to increase the integration of sustainable development in the education. The labeling enables systematic follow-up of actions on sustainability. Courses could be labeled sustainability focused or sustainability related. We aim to describe our ongoing work to integrate sustainable development in the curriculum of the physiotherapy program at the University of Gothenburg.
Methods
To develop the integration of sustainable development in the curriculums of the physiotherapy program at the University of Gothenburg, a systematic work with revising curriculums has been performed and is continuing. During 2020, further development work will be carried out to design learning activities that highlight sustainable development as highly relevant in physiotherapy in relation to Agenda 2030.
Results
The physiotherapy program is labeled Sustainability related since 2019 and from spring 2020 all courses of the program are Sustainability related. This entails that at least one of the learning objectives includes sustainable development, and teaching and assignments targeting the subject, are included in the courses.
Discussion
Hard work has been required to reflect on possible integration of sustainability in specific physiotherapy courses and the work is not finished. However, the results show that physiotherapy education can be related to sustainability in several ways. One future challenge is to evaluate the results for the students of the integration of sustainable development in the curriculum of the physiotherapy program.
Conclusion
To systematize the integration of sustainable development in physiotherapy education, systematic labeling is a possible tool. Physiotherapy education is suitable to integrate with a sustainability perspective.
Keywords: sustainable development, curriculum, physiotherapy
ID 150 – What are the perspectives of physiotherapists in Ireland toward health literacy?
Karina Grehan1, Karina Grehan2
1ISCP, Ireland; 2National University of Ireland Galway
Background
Health literacy is the ability to access, understand and use the information to optimize health. People with low health literacy, have poorer health outcomes. Those with limited health literacy skills are more likely to be socially disadvantaged, have lower educational attainment, be older- be migrants and dependent on social welfare. Health literacy is an empowerment tool and facilitates self-management and as such is a key action area to improve population health. The WCPT identifies physiotherapists as having a role in health promotion, empowering patients and facilitating self-management, therefore knowledge of health literacy is important to physiotherapy practice. The aim of this study was to explore physiotherapist’s knowledge and experience of health literacy in practice.
Methods
This study used a qualitative design. Ethical approval was received from the Discipline of Health Promotion, NUI Galway. The sample was recruited through the Irish Society of Chartered Physiotherapists asking them to participate in the study. Twelve physiotherapists met the inclusion criteria and took part. Data collection used demographic questionnaires to gather contextual information and semi-structured telephone interviews using a topic guide based on study aims and objectives. Interview data were analyzed using thematic analysis.
Results
Themes identified included knowledge, physiotherapy practice, barriers, resources and improvements. Physiotherapists identified a varied knowledge of health literacy, with difficulties in giving an accurate definition of the term but able to identify potential at risk individuals. Practices employed, particularly communication methods adhered to recommendations for optimizing health literacy in practice, specifically the teach-back method. Physiotherapists were unfamiliar with many health literacy resources available to them and they identified the need for further education in this area.
Discussion
The concept of health literacy is evolving but, in line with other health professionals, physiotherapists need further education to optimize their practice in this regard. The use of teach- back was mentioned frequently however further research is needed to determine whether it is being used as recommended. Study limitations include a small sample that may have had an interest in health literacy.
Conclusion
This study highlights that physiotherapists have the potential to be leaders within healthcare systems to optimize health literacy.
Keywords: health literacy, physiotherapy practice, education
ID 154 – Development of Master’s Degree Programme in Musculoskeletal Physiotherapy in Tartu Health Care College (Estonia)
Eva Mengel, Ivi Vaher, Anna-Liisa Tamm
Tartu Health Care College, Estonia
Background
According to OSKA (a labor force monitoring and forecasting system) report, physiotherapists are trained in adequate amount in Estonia (Estonian Qualifications Authority 2017). However, feedback from employers shows that there is still lack of physiotherapists with specific practical skills and training (e.g. lack of musculoskeletal techniques). Tartu Health Care College (THCC; Estonia) has 20 years of experience in training physiotherapists at the undergraduate level, so THCC has the resources to develop a Master’s Degree program in physiotherapy. According to WHO (2018), musculoskeletal disorders are the second most common cause of disability in the world and the most common cause of chronic pain; so the THCC aims to open a Master’s Degree program in Physiotherapy with specialization to the Musculoskeletal System by 2021.
Methods
The curriculum has been developed on the basis of national (professional standard for Estonian physiotherapist, higher education law) and international guidelines (ENPHE, WCPT) and national strategies (lifelong learning, internationalization). In addition, the curriculum has been developed in collaboration with alumni, employers, Estonian Association of Physiotherapists and international partners of the THCC.
Results/Discussion
A three-year cycle based learning program in English has been developed to enable continuous working in the main work place. English-based learning provides an opportunity for international cooperation and mobility for students and teachers alike. The curriculum (120 ECTS) contains a large number of practical subjects focused on physiotherapy in musculoskeletal system and supervised practice of 27 ECTS. Furthermore, at 30 ECTS, students will acquire research skills that will enable them to continue their PhD level studies, or conduct independent field research. Limitations for opening the study group could be considered the fact that international learner may not find us, and the tuition is scheduled for a fee.
Conclusion
The planned Master’s Degree program will undergo international evaluation and is expected to be approved by spring 2021; and first students will begin their studies in the fall of 2021.
Keywords: physiotherapy, development, internalization
ID 176 – Does physical exercise help improve Health-Related Quality of Life in children with difficult-to-control epilepsy?
Gómez Conesa Antonia1,2, Ibáñez Micó Salvador3
1Asociacion Española de Fisioterapeutas, Spain; 2University of Murcia, Spain; 3Neuropediatrics Service, Virgen de la Arrixaca University Clinical Hospital, Murcia, Spain
Background
Epilepsy is a chronic brain disease characterized by recurrent seizures. It has a high prevalence in childhood, with symptoms that reduce self-esteem and quality of life (QOL). Physical exercise helps controlling seizures in adults with epilepsy, but its effect in pediatric population is unknown. The objective is to know if physical exercise improves QOL in children with difficult-to-control epilepsy.
Methods
Of 664 children with epilepsy treated in the regional pediatric neurology services, 52 met the inclusion criteria.
After signing the informed consent, 29 children (6–14 years old; 46.6% boys) were randomly assigned to 2 groups, 14 Experimental (EG) and 15 Control (CG). Both groups continued their pharmacological treatment, and EG received individualized indications to encourage the realization of physical exercise in school and free time, monitored by an activity wristband. In preparation for the end-of-degree work, two internal students as Physiotherapy Department performed the evaluations (pretreatment, 3 and 6 months), with measures of seizure number, hours of exercise, cardiorespiratory fitness, and QOL (QoLCE-55). A repeated measures ANOVA was performed, and as a measure of the effect size, the square eta η2 was calculated.
Results
The inter-rater and intra-rater reliability was excellent (ICC = 0.998) 24 children finished the study (12 in each group) without suffering epileptic seizures. EG showed an increase in the weekly exercise hours [F (2, 20) = 15.4467, p < 0,05; η2 = 0,4940); cardiorespiratory fitness [F (2, 20) = 60.54, p < .05; η2 = 0.753], and QOL [F (2, 20) = 5.5526, p < .05; η2 = 0,0222].The correlation between the number of hours of exercise and the QOL was positive at three (R = 0.95) and six months (R = 0.97).
Discussion
The sample size was smaller than desirable due to the selection criteria. It would be interesting to carry out a multicenter national study and corroborate the benefit of physical exercise in the QOL in children with epilepsy.
Conclusions
The program has been effective in increasing the hours of physical exercise, cardiorespiratory fitness and QOL in children with difficult-to-control epilepsy. There is a strong relationship between hours of exercise and QOL.
Keywords: epilepsy, physical exercise, quality of life
ID 233 – Lessons to learn from a study of use, effectiveness and satisfaction with mobility devices among children with physical disabilities
Svandis Bjork Gudmundsdottir, Bjorg Gudjonsdottir
University of Iceland
Introduction
Physiotherapy education programs are challenged with preparing students for practice in a diverse society. Children with disabilities and their families have distinct culture. To prepare students for pediatric practice, family-centered culturally competent care, assistive technology (AT) competences, and evidence-based practice (EBP) must be emphasized. Children with physical disabilities commonly use walkers and wheelchairs. Yet, there is a lack of studies on the use and effectiveness of mobility devices on activities and participation, and more research is needed on how satisfied, children with disabilities and their families, are with mobility devices and how they are serviced. It is important to evaluate the outcomes of AT provision to guide teaching in this area.
Aim
To examine the use and effectiveness of mobility devices among children with physical disabilities and the satisfaction with their mobility devices and related services.
Methods
Web-based survey was sent to parents of children with physical disabilities. The children were aged 6–18 years and used mobility devices. The use and effectiveness of mobility devices were measured with a questionnaire designed for this study. The satisfaction with the properties of the devices and related service was measured with the 12 items Quebec user evaluation of satisfaction with assistive technology (QUEST) 2.0.
Results and discussion
Response rate was 61,8% (N = 34). Most of the children used mobility devices associated with school and social life. For 80%, mobility devices had a positive effect on activities and participation; negative effects were minor. Analysis indicated overall satisfaction across all items of the Quest 2.0. There was no significant difference in participants’ satisfaction with items of the QUEST questionnaire between types of mobility devices with p = .16–1.00. No significant difference was in participants’ satisfaction between properties of the device and the related service (walkers p = .47, manual wheelchairs p = .08 and powered wheelchairs p = 1.00). The majority were satisfied with the size, safety and effectiveness of their device but less satisfied with weight and adjustments. Most participants were satisfied with the service, except the follow-up. The study had several limitations including small heterogenous sample size and self-reported data.
Conclusion
The results will guide organization of apediatric course.
Keywords: children with physical disabilities, mobility devices
ID 242 – Enhancing Cultural Communication Competency in the Undergraduate Physiotherapy Course
Carla Mendes Pereira1,2,3, Teresa Dias1,2, Inês Santos1,2, Carmen Caeiro1,2,3
1Portuguese Association of Physiotherapists, Portugal; 2School of Health, Polytechnic Institute of Setubal, Portugal; 3Centre for Interdisciplinary Applied Research in Health (CIIAS), Polytechnic Institute of Setubal, Portugal
Background
Effective communication is crucial when providing quality health care, however, linguistic and cultural barriers increase communication challenges. Despite the need for physiotherapists to offer culturally competent care, little is known about how cross-cultural communication skills are integrated in undergraduate programs.
Methods
A module incorporating advanced communication skills was designed in the physiotherapy undergraduate course, including the development of cross-cultural communication skills. Both knowledge of minority groups and cultural awareness were discussed. Challenging personal and professional ethnocentricity and analyzing strategies to address culture-sensitive issues during the subjective assessment were explored. Throughout the duration of the module, role-plays were undertaken by peers, simulating patients from four minority groups. Students and teachers’ evaluation of role-play were analyzed in tutorials, using the Communication Assessment Scale (CAS), in order to understand how each perceived the one’s own performance at cross-cultural communication. Written informed consent was obtained and confidentiality was guaranteed.
Results
The module was undertaken by 51 second-year students. A total of 194 assessments from 16 role-plays were analyzed. The average self-evaluation was 3.35 (SD = .54; from 1-totally disagree to 5-totally agree), peers’ evaluation was 3.7 (SD = .39) and teachers’ evaluation was 3.47 (SD = .58). Comparing role-play moments, the average evaluation conducted by teachers increased from 3.39 (SD = .61) to 3.73 (SD = .57), contrasting with the peers’ evaluation, which decreased from 3.75 (SD = .51) to 3.52 (SD = .34).
Discussion
Results showed that peers’ and teachers’ scores were higher than self-evaluation scores. This suggests the difficulty to perceive ones’ own cultural and communication competencies. The increased average scores obtained by teachers’ evaluation may indicate improvement of students’ cross-communication skills. Peers seemed to increase their awareness about communication skills, becoming more critical during evaluations about cultural differences. Using video-recorded role-plays seemed to promote their understanding about how to adapt communication skills with patients from ethnic minorities, despite the difficulty of students simulating patients.
Conclusion
By increasing cultural awareness, students are expected to anticipate cultural differences, integrate them into care and build trusted professional-patient relationships. Learning from giving feedback to others, discussing cultural issues and making sense of their own culture seemed to help students to increase their cross-communication skills.
Keywords: cross-cultural competency, communication, inter-cultural understanding
TRACK 2: Practice Education
ID 110 – A model of clinical reasoning: Attributes explain engagement in clinical reasoning
Esmerita R. Rotor
Philippine Physical Therapy Association, Philippines
Background
A challenge in physical therapy (PT) practice education is to develop clinical reasoning (CR) in students. The PT process requires clinical decisions, complicated by patient, work, and therapist contexts. Clinical reasoning is a necessary competency to allow appropriate decisions and actions within this process. Clinical reasoning is complex, context-driven and not easily observable; making this a challenging core competency to develop and evaluate in students. Despite extensive literature, there is still a lack of direction and focus in teaching, learning and assessment of CR for PT. This study aimed to develop a model of CR for PTs to give empirical evidence that can be used to guide teaching and learning.
Methods
Through an exploratory sequential research design, an instrument was developed inductively, validated by experts and pilot-tested for internal consistency. Then, using non-probability sampling, the instrument was used to survey 250 PTs. A partial least squares, structural equation modeling (PLS-SEM) approach was used to develop the model. Ethics approval was obtained for the protocol.
Results
The measurement model validated three constructs of CR, ‘Elements’ (n = 12 items), ‘Attributes’ (n = 14 items) and ‘Factors’ (n = 6 items). The structural models showed two independent variables, ‘Attributes that enable CR’ and ‘Factors that influence CR’ explained 47% of the variance of the dependent variable, ‘Elements of CR’. ‘Attributes’ was significantly associated with ‘Elements’ (β = .649, p < .05, f2 = .439), while ‘Factors’ was not (β = .094, p < .066, f2 = .027).
Discussion
Results indicate that specific attributes allow for engagement in CR. The models give evidence to foster the development of attributes in students and make this more explicit within the PT curriculum. The instrument developed provides indicators on how to measure dimensions of clinical reasoning. Further exploration to explain the variance of the Elements of CR and further understanding of factors of CR is warranted. The sampling procedure limits generalizations but gives a profile to which the model can be applicable to.
Conclusion
An empirical model of clinical reasoning shows that nearly half of the variance of CR is explained, and that attributes significantly contributes to elements of CR.
Keywords: clinical reasoning, PLS-SEM
ID 111 – E-Learning compared to conventional learning in practical physiotherapy education
Margit Eidenberger, Silvia Nowotny
University of Applied Sciences for Health Professions Upper Austria
Background
In physiotherapy education, models of e-learning were already introduced. They can support teaching and offer students the possibility for independent learning. Recent studies focused on e-learning as an additional method. Our objective was to determine whether e-learning shows the same results as conventional learning.
Methods
We performed a quasi-experimental equivalence trial (15% margin) with 3rd semester students learning a proprioceptive neuromuscular facilitation technique. The experimental group (EG) got electronical access to an educational movie and supplementary written material. The control group (CG) attended a 90 minutes standard lesson. Primary outcome was the practical competence. Secondary outcomes were the theoretical competence and the students´ satisfaction.
Results
Twenty-eight students volunteered and were randomized to the EG or the CG. Given the non-inferiority margin, e-learning was shown to be equivalent or potentially better than conventional learning. The satisfaction questionnaire showed significant differences in perceived level of difficulty, comprehension of verbal instruction and improvement of weaknesses.
Discussion
Seventy-seven percent of the EG, but only 29% of the CG fully agreed that difficulty was appropriate. This might be because the EG could watch the video multiple times and practice as long as they wanted. Thirty-eight percent of the EG, but 79% of the CG answered with “fully agree“ when asked for the easy comprehension of verbal instructions. The lecturer was experienced in delivering classroom lessons, while being recorded on video was an unfamiliar experience, which might have influenced the quality of teaching.
Based on teaching experience and the university´s grading system we chose a 15% non-inferiority-margin for our analysis. In medical experiments, a 10% margin is recommended. This could have influenced the comparison of the exam results. Students with e-learning were unsure, if the technique practiced was correct. Therefore, it is crucial to establish a final personal feedback session to dispel e-learning groups‘ uncertainties.
Limitations were the small sample size and a potential bias for a reliable non-inferiority margin.
Conclusion
Our results indicate that video-based e-learning can be implemented as an equivalent study tool in practical training. At least parts of lessons could be outsourced to a digital classroom.
Keywords: e-learning, practice education, proprioceptive neuromuscular facilitation
ID 131 – Three-dimensional learning through prosection laboratories and its importance in physiotherapy education
Smadar Peleg, Ruth Pelleg-Kallevag
Zefat Academic College, Israel
Background
Three-dimensional understanding of human anatomical structures is of vital importance in training physiotherapists. However, the inclusion of prosection laboratories requires the availability of a dissection room, anatomy models and trained anatomy instructors. Therefore, the aims of this study were threefold: to describe the process of adjusting the anatomy curriculum to the needs of the new era in physiotherapy; to describe the training of young physiotherapists in teaching anatomy to physiotherapy students; and to evaluate the efficiency of the training program. Additional objectives were to compare the achievements of students trained by junior vs. senior instructors and to assess the contribution of the prosection laboratory to students’ understanding in anatomy.
Methods
Eight physiotherapy graduates participated in a special training program and were incorporated as anatomy instructors. Five prosection laboratories were included in the anatomy curriculum. Questionnaires were used in order to evaluate junior instructors’ satisfaction rate with the training program, students’ satisfaction rate with the instructors’ performance and the efficiency of the prosection laboratories. Final exam results obtained under senior and junior instructors were compared. Ethical approval for this research was given by the College’s Ethics Committee.
Results
High satisfaction rates were given by the young instructors to the training program. In addition, there were high satisfaction rates for both the quality of the prosection laboratories and the quality of instruction given by the junior anatomy instructors. Moreover, high rates were given to the contribution of the prosection laboratory to the students’ knowledge and understanding in anatomy. There were no differences in final exam grades between students taught by senior instructors as opposed to junior ones.
Discussion
The current study shows that careful planning of the anatomy curriculum and creating a special training program based on young physiotherapists enables the inclusion of 3D learning and practice, in a cost-effective manner. Our findings are applicable to a small to medium size student cohort. Further study is needed to establish whether similar results can be obtained involving larger numbers of students.
Conclusion
Prosection laboratories with near-peer teaching adjusted to the field of physiotherapy provide an added value in a cost-effective manner.
Keywords: anatomy education, physiotherapy education, near-pear teaching
ID 133 – Teaching soft skills as part of Interpersonal communication course in physiotherapy education
Lilach Lotan1, Ruth Pelleg-Kallevag1, Ola Jahashan-Douchi1, Orna Divon-Ofir2, Smadar Peleg1
1Zefat Academic College, Israel; 2 (MSR), Sheba Medical Center, Tel-Hashomer, Israel
Background
Teaching communication skills within a clinical context in physiotherapy (PT) is a challenging task. Typically, clinical courses in PT programs focus on theoretical knowledge and the acquisition of hard skills, pertaining to assessment and treatment. Less emphasis is placed on teaching soft skills, which relate to communication between therapist and patient such as empathy, trust, perceived professionalism. These skills form the basis for therapist–patient relationships in the clinical setting. The objectives of the interpersonal communication course were therefore to develop students’ soft skills in communicating with a patient, particularly teaching basic terminology in communication and developing interpersonal communication skills.
Methods
Initial training of the staff of the department of PT included: (1) a workshop for soft skills acquisition, (2) a workshop in writing case scenarios, focusing on therapist–patient interaction, (3) a workshop with video-based discussions of student simulations of the case scenarios. 2nd year PT students were given frontal lectures in interpersonal communication, and at the end of term participated in a simulation workshop at the Center for Medical Simulation (MSR), Tel-Hashomer, Israel. The workshop included various scenarios of patient-actor simulations that were video-taped. The case scenarios were designed to reflect a situation whereby the patient was un-cooperative with treatment, and the student needed to utilize soft skills in order to proceed. Among the characters the students were faced with were: a mother objecting to having her son diagnosed with developmental delay, a patient suffering pain after surgery to remove a tumor, and an opinionated patient refusing treatment by a student after total knee replacement.
Following the student simulations and based on the video recordings, debriefing in small groups of students took place. The objectives of these discussions were to reflect on the student’s choice of action, present positive feedback or suggestions for improvement regarding the manner in which the student responded to the patient, and deduce to similar cases in the future.
Summary and conclusions
During the interpersonal communication course, students were presented with the importance of soft skills for successful therapist–patient interaction. The simulations and group debriefing allowed for peer-learning in a safe environment.
Keywords: interpersonal communication, soft skills, simulations
ID 160 – Developing interprofessional reasoning skills within the physiotherapy curriculum.
Eva Ceulemans, Filip Staes, Geert Verheyden
KU Leuven – University of Leuven, Department of Rehabilitation Sciences, Belgium
Background
Interprofessional collaboration is a key component of physiotherapy service provision. Increasing interprofessional experience in combination with clinical placement may drive interprofessional learning. Our aim was to develop a course (3 ECTS) within the physiotherapy (PT) curriculum to enhance interprofessional understanding.
Methods
The course makes students interact with interprofessional teams within five PT domains: neurology, musculoskeletal, pediatric, geriatric, and law & ethics. The course is built around five classes and preceding these classes, students receive online information about real-life cases. Small groups of students (n = 5) prepare standardized group documents covering ICF, clinical presentation, treatment and interprofessional collaboration. These documents are submitted to and evaluated by the lecturers prior to the classes. After the class where there is interaction with the interprofessional team who treated the patient, an online individual self-evaluation is completed by each student. The final evaluation is based on an individual case report describing interprofessional collaboration at clinical placement, and a group reflection. The course was evaluated through online student evaluations using the KU Leuven evaluation system (Likert-scale based evaluation on multiple topics ranging from 1 “totally not agree” to 6 “totally agree”).
Results
Around 250 students participated in the course in the academic year 2018–19, leading to 50 small groups of students progressing through the course. Students scored the importance of this course within the curriculum an average of 4.63/6. They scored their satisfaction about the quality of education on average 4.61/6 and the supervision for this course on average 4.52/6. Student suggestions mainly focused on logistic aspects of the course.
Discussion
The introduction of this new interprofessional course was well received by the students based on the student evaluation including positive comments with regard to real interprofessional teams presenting real cases, diversity of PT domains, and structured individual and group feedback provided on written assignments. The fact that this course was first taught in the year 2018–19, might warrant caution when interpreting our results.
Conclusion
Our interprofessional course seems to develop interprofessional collaboration, enriching the understanding of the role as a physiotherapist within an interdisciplinary team.
Keywords: interprofessional skills, interdisciplinary teams, group assignments
ID 168 – Dutch consensus on communication skills required for Physical Therapist students at a Bachelor level
Sandra Lakke1, Wim van Lankveld2, Evelien Kinds2, Janke Oosterhaven3
1Hanze University of Applied Sciences Groningen, Department Physical Therapy, The Netherlands; 2HAN University of Applied Sciences Nijmegen, Research group Musculoskeletal Rehabilitation, Institute of Health Studies, The Netherlands; 3: HU University of Applied Sciences Utrecht, Department Innovation and Care, The Netherlands
Background
Communication is one of the effective common factors in Physical Therapy interventions. Therefore, physical therapists (PT) must be educated in communication competencies. At this moment there is no consensus on the topics that needs to be incorporated in the PT curriculum at Bachelor level. Therefore, there is a need for consensus between PT Universities in the Netherlands to determine communication competencies for a starting PT.
Methods
Three rounds of Delphi survey were administered. All 11 Dutch PT universities participated, with each institution recruiting two experts: one lecturer (teacher, educator) in communication and one practicing PT. In the first round all items of the European consensus for a core communication curriculum in health care professions were included, [i] supplemented to include specific communication learning outcomes extracted from the physical therapist competence profile from the Royal Dutch Society of Physical Therapists (KNGF). Furthermore, the participants were invited to add learning outcomes. Each learning outcome was rated on a 5 point Likert scale (not important-extreme important). A predetermined threshold of 75% agreement was used to define consensus.
Results
After three Delphi rounds consensus was reached resulting in a set of 95 communication learning outcomes for Bachelor PT Education: 62 learning outcomes were retrieved from the European consensus, 22 from the Dutch physical therapist competence profile and 11 were suggested by the Delphi participants. The additional items suggested by the expert panel where highly specific for PT (e.g. Give effective exercise instructions), or related to behavioral change (e.g. Uses techniques of Motivational interviewing).
Discussion
Only Dutch participants were included which limit the generalization of these results to other countries curricula.
Conclusion
This study developed consensus between all Dutch Universities for required communication competencies for the starting PT. The next steps are to compare curricula of the different PT universities and to align these curricula for communication competencies for the beginning PT.
[i] Bachmann, C., Abramovitch, H., Barbu, C. G., Cavaco, A. M., Elorza, R. D., Haak, R., … & Rosenbaum, M. (2013). A European consensus on learning objectives for a core communication curriculum in health care professions. Patient education and counseling, 93(1), 18–26.
Keywords: communication, education, physical therapy
ID 171 – Reflections on the ongoing evolution of simulation-based learning modules to prepare students for clinical placement
Neil Tuttle, E L Laakso
Australian Physiotherapy Association, Australia
Background
Simulation-based learning (SBL) is a rapidly evolving field in physiotherapy education. One focus of SBL has been to increase clinical placement capacity by replacing clinical hours with SBL hours. SBL can also increase clinical placement capacity by 1) improving student preparedness for placement, thus making students more attractive and productive for the host facilities and, 2) potentially reducing the need for repeated placements due to student failure. We have previously reported on controlled trials of two SBL modules, each of which was found to improve student clinical marks. Three additional SBL modules are included in our program focused on other aspects of professional education: communication, increasing student employability, and interprofessional practice. This presentation will follow the continuing evolution of this suite of SBL modules including not only the successes but also the challenges of integrating these modules into an already crowded curriculum.
Methods
A chronological and conceptual review of SBL modules and their integration within the physiotherapy curriculum.
Results
Although simulation has always been a part of physiotherapy education, the use of formal simulation is rapidly accelerating. In Australia, a crisis in the availability of clinical education placements resulted in significant government funding in the second decade of this century. At Griffith University, modules using telehealth to part-replace clinical placement were funded and well received by students, but scheduling difficulties made them unattractive to facilities that hosted placements. This experience highlighted that the benefits of simulation can go beyond merely replacing placement hours and triggered the development of a range of now-sustainable SBL activities to serve a range of needs throughout the curriculum.
Discussion
So, what have we learned? (1) Effective simulation starts with the learning objectives which can lead to a range of creative structures and forms; (2) Facilitation of simulation is a specific skill set that requires specific training and the skills can carry over into the classroom and clinic; (3) Simulation can be inherently motivating and does not require assessment to ensure student engagement and learning; and (4) More learning can occur in the reflection than in the doing.
Keywords: simulation-based learning
ID 180 – Examination of clinical reasoning in large groups of students: the use of online examination
Filip F Staes, Britt Vandendoorent, Geert Verheyden
KU Leuven, Department of Rehabilitation Sciences, Belgium
Background
Clinical reasoning is considered a cornerstone in clinical practice and educational programs. Educational programs face challenges in introducing these skills to students in order to make them ready for the profession. Evaluation of these skills is ideally done on an individual basis. Often, written cases are used with either open-ended questions or papers to be written. Besides intellectual reasoning, clinical reasoning also includes the skill of investigating patients. In large groups of students, this is a challenge. The aim is to report on our experience with online examination within the past few years, starting from one specific course and including opportunities and pitfalls.
Methods
In 2012, our team started to develop an online examination tool for clinical reasoning within our secured online teaching and learning environment (Blackboard-based). This was done in collaboration with different university services. One of the courses involved is “Musculoskeletal Rehabilitation: lower limb”. Yearly, about 210–250 students follow this course that is based on a flipped-classroom design. The development of the online tool took care of all necessary elements of reliable and valid examination. The tool allows to include video material, pictures and different types of questions (multiple choice, multiple answers, essay, ….). During the development phase, multiple elements were evaluated (increase of stress level, usability, comparison with written format, ….). The course is evaluated with the university evaluation system (multiple questions ranging from 1 “totally not agree” to 6 “totally agree”).
Results
In total 90% of students think the online examination tool has good usability and 92% thinks it adds value as an examination tool. Stress levels were elevated in 42% of the students. Satisfactory reliability measures on questions were obtained. Evaluation of the course shows an average satisfaction score of 5.06/6. Students describe this type of evaluation as good practice.
Discussion
Online examination of clinical reasoning in large groups can be done in a reliable and valid way, with student satisfaction.
Conclusion
Based on student feedback, online examination adds value to clinical reasoning evaluations. Multiple courses currently use this approach.
Keywords: clinical reasoning, examination, online
ID 193 – Training needs of physiotherapists for the successful implementation of early mobilization in intensive care units in Germany
Marietta Handgraaf, Ariane Demirci, Christian Grüneberg
University of Applied Sciences Bochum, Germany
Background
Early mobilization in intensive care units (ICU) has shown positive results in terms of safety and mobility in international studies. Although the topic is gaining relevance in Germany, there are no standards developed for early mobilization application in practice or the theoretical background in the context of education. In 2019, the physiotherapy faculty of the University of Applied Sciences in Bochum, Germany, conducted a nationwide online-survey about the implementation of early mobilization by physiotherapists in ICUs. This contribution focuses on the identified training needs for ICU physiotherapists.
Methods
The German Hospital Register was used to manually search for eligible physiotherapy departments in Germany. They were contacted via e-mail and were asked to distribute the online-survey. Inclusion criteria were clinics with more than a total of 100 beds and the presence of ICUs. Psychiatric and pediatric hospitals were excluded.
Results
Three hundred and fifty-one employees of 880 included hospitals participated in the online survey of which 93.7% (n = 329) were physiotherapists in an ICU. Three hundred and forty-nine participants indicated that 83.1% of their patients received early mobilization within 72 hours (according to guidelines). Most mentioned criteria for the selection of interventions were the state of consciousness and respiratory situation of the patient (81%)
Assessments played a minor role (23.9%, n = 84) in the decision for and the selection of interventions. Only 19.1% (n = 67) of the respondents stated that algorithms exist for the decision of the appropriate intervention. The need for training was identified for the implementation of measurement instruments and algorithms for early mobilization. No considerable differences could be found between university and general hospitals.
Discussion
Early mobilization on the ICU is applied by most of the participants. Most of the early mobilization is not based on assessments. Algorithms hardly exist. A further differentiation, especially the integration of clinical knowledge, interprofessional teamwork and physiotherapeutic practice, should be investigated in detail.
Conclusion
Training needs of physiotherapists working in ICU could be identified for early mobilization on ICU. Especially algorithms and assessments need to be integrated in practice.
Keywords: early mobilization, ICU, training needs
ID 199 – Toward 10 Years of World Physiotherapy’s Education Accreditation Service for Physiotherapy Entry Level Programs
John Xerri de Caro1, Margot Skinner2, Aimee Stewart3, Daniel Wappenstein4, Marcelo Cano5, Pablo Davó Cabra6
1University of Malta, Malta; 2University of Otago, Dunedin, New Zealand; 3University of the Witwatersrand, Johannesburg, South Africa; 4Sociedad Ecuatoriana de Fisioterapia; 5Universidad de Chile, Santiago de Chile; 6World Confederation for Physical Therapy
Background
Accreditation is a quality assurance process utilizing aspect of review and assessment according to pre-defined standards. The World Confederation for Physical Therapy Accreditation Service commenced in 2011 and provides international benchmark for entry-level physiotherapy programs in countries which are WCPT member organizations, and others working toward membership.
Methods
The WCPT developed the process to enable accreditation, with or without conditions, to be granted when the standards have been demonstrated. An integral part of the process includes the assessment of clinical education and the research strengths. Independent reviewers appointed by the Accreditation Committee of WCPT undertake onsite visits and assess programs against the published guidelines. Accreditation may be granted for up to a maximum of five years, with annual reporting against recommendations being a condition. As the service approaches a decade of operation it is timely to evaluate its outcomes.
Results
By January 2020, 19 programs had been through the review process and 17 hold an accreditation award. Inquiries by institutions have increased steadily, and there are several programs in the final application stages. Two programs have been re-accredited, meaning that they completed one full 5-year accreditation cycle and applied for a subsequent review with successful outcome. One other program is in the late stages of re-accreditation and the expectation is for this to be completed in the summer of 2020. Nine programs are currently fully accredited. Two of these programs were awarded full accreditation following the 1st annual report and three following the 2nd. Eight programs hold an award of 5-year accreditation with conditions. Two programs have had their accreditation status withdrawn. Countries where programs hold accreditation include China, Lebanon, Jordan, Columbia, Egypt, Spain, Hungary, Finland and Turkey.
Discussion
The requirement for each program to report annually against reviewers’ recommendations and program developments keeps the process robust. The accreditation service provides a pathway for international accreditation and benchmarking which may be in addition to an existing national accreditation. The service aims to contribute to the development of professional education internationally, leading to improved quality of entry level physiotherapy programs.
Keywords: education accreditation, quality, WCPT
ID 202 – The Development of CULTVATE Model Guideline: Designs Valid Programmatic Clinical Portfolio (Pro-CP) for Assessment of Clinical Competence
Bhavani Veasuvalingam
Newcastle Medicine, Malaysia
Background
The objective of this research is to develop an assessment model called “CULTVATE” to serve as a design guideline for assessment developers in designing a programmatic clinical portfolio (Pro-CP) to measure clinical competence at the workplace. This innovation is important to facilitate in designing a robust Pro-CP that will be able to overcome the international challenges in designing assessment to measure competence at the workplace.
Methods
Five qualitative approaches undertaken to collect data to construct an assessment model called “CULTVATE”. A Delphi expert panel consensus focus group discussion (FGD) with key informants to gather opinion, a systematic review of current assessment practices of competence performance in physiotherapy, narrative review on theories underpin the assessment of competence and interview with clinical instructors and clinicians. The five strategies provided data for the construct of “CULTVATE” model.
Results
The “CULTVATE” model consists of four functional phases that guide assessment developers in designing a robust Pro-CP to measure competence performance at the workplace. “CULTVATE” acronym is explained in four phases of the model. The first phase: prepare a clearly written C-Clinical Competence Learning Outcome. Second phase: guides in designing portfolio by U–Utilizing the Principles of Authentic Assessment. Third phase: T–Training the users of the instrument to address the credibility of Pro-CP. The final phase: embedding a V–Valid and Authentic Feedback system in design, followed by T–Testing performance based on Authentic Assessment Rubric and finally to present the E-Evidence of Learning Artifacts in the pursuit of lifelong learning.
Discussion
In order to overcome the challenges of authentic assessment at the workplace, a robust assessment design that can address common pitfalls of workplace assessment is required. CULTVATE is a preliminary theoretical model developed with sound theoretical principles of current contemporary assessment principles to provide a promising platform for assessment designers in guiding to develop Pro-CP that would be able to measure complex competence performance. The overarching principle of competency-based assessment derived from outcome-based education underpins the model with the consideration of programmatic assessment model proposed by Vleuten with elements of criterion-referenced assessment rubric imprinted with a strong feedback system to foster learning.
Keywords: assessment, competence and programmatic portfolio
ID 205 – Quality indicators for educational objectives and quality improvement purposes, based on the KNGF-guideline Hip and knee osteoarthritis
Mitchell van Doormaal1, Simone van Dulmen2, Guus Meerhoff1, Philip van der Wees2
1KNGF, Amersfoort, The Netherlands; 2Radboud University Medical Center, IQ Healthcare, Nijmegen, The Netherlands
Background
Guideline adherence shows to be a challenge in physiotherapy practice. Quality indicators have the potential to improve guideline adherence and to guide quality improvement initiatives. We aimed to develop a set of quality indicators for educational objectives and quality improvement purposes, based on the guideline Hip and Knee Osteoarthritis (OA) of the Royal Dutch Society for Physical Therapy (KNGF).
Methods
All steps were conducted in collaboration with an expert group of physiotherapists, OA experts, patient representatives, and health insurers. The development process consisted of four steps: 1) analysis of the scientific literature regarding OA indicators, 2) nomination of relevant topics from the guideline OA, 3) development of draft indicators based on scientific literature and the nomination of relevant topics, 4) consensus procedure to assess the concept indicators on their perceived clinical relevance and feasibility for implementation.
Results
Based on the nominated topics from the guideline OA and literature analysis, 15 draft indicators were assessed by the expert group. After two panel meetings, six process indicators and two outcome indicators were included in the set. The process indicators included: use of the International Classification of Functioning, Disability and Health (ICF) Core Set for OA, provision of patient education, prescription of strength, aerobic and functional exercises, prescription of exercise therapy conform recommended risk profiles after total joint arthroplasty, and using measurement instruments to evaluate pain and physical functioning. The outcome indicators evaluated the measured change in physical functioning and the number of supervised treatment sessions.
Discussion
We developed a widely endorsed set of quality indicators. To implement these indicators, two issues need to be further investigated: 1) inclusion of the quality indicators to the National Registry for physiotherapists so data can be collected, and 2) development of a learning environment for physiotherapists to enable the use of these data for quality improvement.
Conclusion
Based on the guideline OA, quality indicators were developed for educational and learning objectives, involving all relevant stakeholders. Implementation of the indicators will be the next step in order to improve guideline adherence and quality of physiotherapy care.
Keywords: quality indicators, guidelines, osteoarthritis
ID 207 – A study of physiotherapy and speech and language therapy students´ perceptions of clinical practice in a maximum care hospital
Elliott Judith1, Marion Grafe1,2, Helga Breitbach-Snowdon2, Anke Markfort2, Friederike Störkel1
1University of Applied Sciences Muenster, Germany; 2Muenster University Hospital, Germany
Background
Clinical education forms a core component of the training of physiotherapy (PT) and speech and language therapy (SLT) students. However, little research is available on students’ experiences and perceptions when exposed to real-life clinical practice and how this may affect their future learning and professional attitudes. Therefore, the aim of this study was to investigate students´ reflections and experiences of their first-time exposure to real-work-life in a maximum care hospital setting in Germany.
Methods
At the very beginning of their education (first year), mixed groups of three PT and SLT students accompanied and observed an expert therapist (PT, SLT and occupational therapy) during two hours of everyday clinical practice. The observation was carried out according to a standardized observation protocol. A briefing prior and an in-depth debriefing was conducted together with both students and expert therapists. Protocols of the discussions were analyzed using thematic analysis according to Braun and Clarke focusing on the identification of latent themes. The results encompass four years of execution providing data of 137 students and 24 expert therapists.
Results
The following three main themes were identified: perception of non-clinical influences during real-life therapy processes, recognition of emotional interdependencies during therapeutic interaction and detection of pivotal relational elements in therapeutic relationships. Watching experts interact with their patients offers a valuable insight into how they communicate, solve problems and conduct themselves in the workplace environment. The students perceive real-life clinical practice in a maximum care hospital as an overwhelming emotional experience. They show a great sensitivity to patients’ complex relational needs which forms the basis for effective therapeutic engagement and sound future clinical practice.
Conclusion
The findings suggest that first year physiotherapy and speech and language therapy students benefit largely from the observation-based learning approach. Students should be encouraged to reflect upon their emotional experiences and learn how to justify their decisions both emotionally and analytically. Education should acknowledge the role of emotions in the clinical environment and investigate the emotions associated with decision-making processes.
Keywords: observation-based learning, patient-therapist-relationship, qualitative research
ID 213 – UK practice education: What’s the problem represented to be?
Jo Etherton1, Sally Findlow2
1University of Essex, United Kingdom; 2Keele University, United Kingdom
Background
Assessments drive student learning. For consistency and transparency across varied practice settings and assessing practice educators (PE’s), education institutions provide validated assessment tools for use with their students. However, for students, these tools prioritize the development of some knowledges and skills over others. For PEs, they inform expectations of student activities and define acceptable/unacceptable behavior. Thus, they direct the ‘daily practise’ of practice education (PE). In describing such tools as ‘practical texts’, Bacchi (2009) positions PE as a socially constructed phenomenon, constructed upon assumptions and values. This paper outlines some of the ways practical texts offer insight into the understanding and problematizations of PE, and how they themselves may contribute to the persistence of PE challenges, e.g. capacity, by limiting what it is possible to think and do about them.
Aim
Identify a problem representation(s) of practice education.
Methods
Bacchi’s (2009) What is the Problem Represented to be? (WPR?) framework was adopted to interrogate the PE assessment grid used by the University of Essex. Although novel in physiotherapy, WPR is an established tool for practical text analysis in other academic fields. WPR? is a flexible framework of six interrelated questions:
What is “the problem?”
What presumptions and assumptions underlie this representation of “the problem”?
How has this representation come about?
What does it leave as unproblematic?
What effects does it produce?
How/where has it been represented and defended?
Results
Initial analysis suggests the problem is ‘unprofessional behavior’. The possibility of students behaving unprofessionally frame each assessment criteria. The tool’s construction, contents, and associated instructions are based upon neo-liberal values. e.g: students are expected to be proactive in addressing their learning needs: “Demonstrate the ability to recognize and take responsibility for their own learning needs and identify areas for future development”.
Discussion/conclusion
PE is problematized as a mechanism to mold students into self-regulating professionals. Governmentality theory suggests this problematization is concerned with ‘normalizing’ populations, which offers insight into why PE’s may perceive their role to be one of gatekeeping. PE development perceived to challenge this role, e.g. models reducing direct supervision opportunities may be dismissed easily.
Keywords: assessment, problematization
ID 223 – Does a short training session based on peer dialogue impact decision-making in assessment?
Emer Barrett1, Marian McGuiness2, Anne O Connor3, Lucy Alpine1
1Trinity College Dublin, Ireland; 2Physiotherapy Department, Cavan General Hospital, Ireland; 3School of Allied Health, University of Limerick, Ireland
Background
Universities require consistency in assessment across all placement sites to ensure reliability. Research has highlighted variation in work-based assessment which may undermine the integrity of the assessment process (O’ Connor et al. 2017). Clinical physiotherapists act as the primary supervisor and assessor of student performance combining the challenging roles of teacher, mentor and evaluator. In Ireland, dedicated tutors are available to support educators in larger placement sites and contribute to the decision-making process of grading. However, in many smaller placement sites, educators act as the sole assessor and must rely on their own judgment to grade performance.
During a practice education study day focused on assessment, a project was carried out to investigate whether a short training session based on peer dialogue impacted on the grades awarded by educators.
Methods
All physiotherapists attending a practice education study day were requested to watch two video vignettes depicting a “poor” and “very good” student performance. Participants scored the student’s performance before and after a facilitated peer dialogue, using three selected learning outcomes from the national physiotherapy work-based assessment tool.
Results
Fifty-three of the 56 (95% response rate) physiotherapists who attended the study day took part. The median supervision experience of participants was 12 months (IQR 4–60) and the median number of students supervised per year was 3 (IQR 2–5). When judging the poor performance video, participants decreased the scores awarded on 53.5% (n = 85) of occasions and increased on 3.1% (n = 5) following peer dialogue. When assessing the good performance, participants decreased their scores on 37.4% (n = 58) of occasions and increased on 12.9% (n = 20). Between-group analysis demonstrated no significant differences based on gender, access to an onsite tutor, years qualified or clinical specialty.
Discussion
Practice educators amend their scores following a shared decision-making process with their peers. As practice education contributes to approximately one-third of the final Physiotherapy degree mark, reliance on a single assessor may limit the transparency and accuracy of grading in these high stakes assessments.
Conclusion
Consideration of assessment approaches used by other medical professions, such as the use of multiple assessors is warranted.
Keywords: assessment, work-based assessment
ID 232 – Programmatic Assessment to support self-directed learning
Marjo Maas, Anke van Erp, Joost van Wijchen
HAN University of Applied Sciences, Nijmegen, The Netherlands
Background
In September 2019 the physiotherapy department of the HAN University of Applied Sciences implemented programmatic assessment (PA) in the pre-clinical stage of the program. PA aims to optimize the learning function and decision-making function of assessment. Timely provided feedback from multiple perspectives is critical to PA. This study aims to assess the learning function of PA, focusing on diagnostic and treatment skills.
Methods
During the first semester, 140 students were provided with performance feedback from teachers, peers and senior students. Students invited their feedback provider by sending a digital feedback form with performance indicators that could be scored on a scale from 1 = much improvement needed to 5 = excellent including room for written feedback. Adding a personal learning question was optional. All feedback was based on direct or video-based observation and collected in a digital portfolio.
We sampled indicator scores and written feedback reports from the portfolio’s after obtaining an informed consent. Mean teacher and student scores for diagnostic and treatment skills were calculated. Written feedback was analyzed using thematic analysis.
Results
In a period of 20 weeks, students received on average 2 times teacher feedback and 6 times peer feedback on performance indicators for diagnostic and treatment skills. Average teacher scores for diagnostic skills: 2,59 (SD 0,96), student scores 2,84 (SD 0,84). Average teacher scores for treatment skills: 2,51 (SD 0,91), student scores 2,89 (0.87).
Analyses of written feedback reports showed that students are able to critically evaluate their peers, although their perspective is different from teachers. Their feedback was detailed, representing a broad perspective. Teacher feedback was indicator bound, with a focus on clinical reasoning. High-quality feedback was related to clearly formulate learning questions.
Discussion
This study shows that PA may support self-directed learning, if students clearly formulate learning questions. Students are able to take the assessor role, however the feedback reports show that students and teacher scores look similar, but cannot be compared because they represent a different perspective.
Conclusion
PA facilitates the feedback process, supporting the learning function of assessment. Further research on the student perspective is necessary.
Keywords: programmatic assessment, clinical skills, self-directed learning
ID 239 – Supervision Models in Physiotherapy Practice Education: Student and Practice Educator Evaluations
Lucy Alpine, Anne Belton, Emer Barrett
Trinity College Dublin, Ireland
Background
Ensuring the quality of practice placements is an essential component in creating competent physiotherapy graduates. Physiotherapy placements are currently delivered using a variety of supervision models which includes the traditional 1.1 model, which places one student with one educator. A number of collaborative models also exist, which typically pair two students with an educator but may also represent more than one educator collaborating to supervise one or more student(s). To date, research does not support the benefit of one supervision model over another. The aims of the study were to establish the supervision models used in physiotherapy practice placements and to determine the student and educators’ evaluations of the quality of these placements.
Methods
This was a cross-sectional study set in clinical sites providing placements for physiotherapy students in Ireland. Participants consisted of educators and students completing placements in 2015/16. A questionnaire which measured 18 indicators linked to quality-assured placements was used. Eight additional indicators in the practice educator questionnaire addressed overall feasibility of the supervision model. Two open-ended questions captured comments on the benefits and challenges of each model.
Results
The majority (75%, n = 84) of participants reported a 1:1 (one student: one supervisor) supervision model, 14% (n = 16) reported a 1.2 (one student: two supervisors) model and 9% (n = 10) a 2.1 (two students: one supervisor) model. There was generally positive agreement with the questionnaire indicating that all placements, irrespective of supervision model were positively evaluated by participants. Students, however, reported a more negative evaluation compared to educators in indicators related to communication, feedback and the student–educator relationship. Productivity and time commitment were more negatively rated by educators.
Discussion
The traditional 1:1 model remains the most widely used supervision model in physiotherapy practice placements, with collaborative models accounting for less than one-quarter of placements. All supervision models scored well on quality indicators, with benefits and challenges associated with each.
Conclusion
As physiotherapy services are delivered in many contexts and environments, the availability of a variety of supervision models offers choice to placement providers and universities to utilize the model that best suits their service.
Keywords: supervision models, quality practice placements
ID 241 – Teaching Direct Access – Analyzing key criteria in physiotherapeutic entry-level education
Carissa Klupper1, Barbara Gödl-Purrer2
1University of Applied Sciences for Health Professions Upper Austria, Austria; 2University of Applied Sciences Joanneum, Austria
Background
In many countries worldwide, patients have the right to access physiotherapeutic treatment without previous medical referral. A possible introduction of Direct Access (DA) in countries where legal frameworks currently prohibit DA would inevitably lead to an extension of the competence of physiotherapists and their scope of practice. In order to cover the subject-specific required additional qualifications in entry-level education (ELE), this paper intended to develop a universal key criteria catalog.
Methods
Based on literature, a deductive-conceptual analysis was conducted, consisting of four consecutive steps:
Literature research in the field of Clinical Reasoning and Direct Access
Development of a review tool (four checklists, total of 34 Items)
Review tool application on the Austrian and Dutch entry-level competency profile of physiotherapists
Derivation and synthesis of key criteria (20 Items) based on the application results
Results
Twenty key criteria were identified to correlate with the teaching and learning of competences necessary for DA. Found criteria can be divided into four subgroups:
Clinical reasoning (9/20)
Knowledge (4/20)
Cognition (2/20)
Metacognition (5/20)
Discussion
The increasing number of countries where DA is applied signifies a need for a new model of care. In order to encourage its implementation, subject-specific qualifications and competences need to be taught in ELE to ensure a high-quality therapeutic decision-making and treatment of patients. The primary limitation of this paper is the lack of existing information on which criteria to implement in ELE and how to implement it in order to achieve necessary qualifications and competences. This study is therefore subject to the author’s bias and presents the need for further developmental research.
Conclusion
Key criteria must first be independently verified and validated for correctness. If the results are confirmed, the catalog could be implemented in existing curricula, where it should be assessed for effectiveness in a test phase and integrated if it has significant positive impact on student qualifications and competences. If so, the implementation of the key criteria in physiotherapeutic curricula would represent an optimization of educational quality in relation to DA qualifications, irrespective of the legal interpretation of the professional scope of practice.
Keywords: direct access, entry-level education, clinical reasoning
ID 251 – Interprofessional teaching for medical and physical therapy students to learn anatomy and clinical examination of the lower spine and hip
Carlos González Blum1,2,3, Robert Richter2, Reinhard Fuchs1,3, Florian Sandeck2,3, Stephan Heermann1
1Institute for Anatomy and Cell Biology, Department of Molecular Embryology, Faculty of Medicine, University of Freiburg, Germany; 2Furtwangen University, Faculty of Health, Safety and Society, Germany; 3Gesundheitsschulen Südwest GmbH, Germany
Background
Pain of the lower back is a frequent symptom and is treated by different health professions. Anatomical as well as clinical knowledge is utmost important for all professions involved in this field. Here, we present a model that brings together an interprofessional team of experts to teach functional and clinical anatomy to medical and physical therapy students.
Methods
Two groups of medical students (n = 60) and physical therapy students (n = 61) were designated to two interprofessional clusters. Three workshops, each lasting 40 minutes, provided specialized training, such as the conduction of orthopedic tests, palpation of anatomical structures and demonstrations of human anatomical joint prosections. A questionnaire evaluated subjective anatomical and clinical knowledge, and the amount of knowledge gained from peer group participants and from the instructors.
Results
A total of 132 students participated in the pre-course evaluation and 97 students completed the post-course evaluation. Eleven students included in the pre-course evaluation and five students included in the post-course evaluation could not be assigned to a study program. Scores for all combined groups (pre-post) showed an increase of 11.7% (P < .001). Medical students from both clusters had the highest improvement (17.6% and 19.9%) in comparison to their physical therapy counterparts (9.1% and 5.8%) (P < .001). Sub-question analyses showed that students learned from each other as well as from an interprofessional team of guiding instructors.
Discussion
Participation in the course was compulsory for physiotherapy students and voluntary for medical students, which could have led to a selection bias, regarding motivation to learn. This could have contributed to the greater growth in learning and the corresponding score for participating medical students.
Conclusion
This course offers an appropriate and effective model that brings together an interprofessional team of experts to teach functional and clinical anatomy to medical and physical therapy students. Study results demonstrated an increase in subject-specific competencies in functional and clinical anatomy of the lower spine and hip. Medical students demonstrated the highest increase in subjective knowledge, which highlights the usefulness of this course early in the medical education. All students learned from the exchange with interprofessional group members as well as from the instructors.
Keywords: interprofessional education, functional anatomy, clinical examination
ID 263 – Interprofessional Collaborative Education: A Tool to Improve Communication, Critical Thinking and Practical Skills in a Multicultural Context
Veena Raigangar1, Lori Maria Walton2, Mini Sara Abraham3
1Department of Physiotherapy, University of Sharjah, Sharjah, U.A.E; 2Department of Physical Therapy, University of Scranton, Pennsylvania, USA; 3Department of Nursing, University of Sharjah, Sharjah, U.A.E
Background
As physiotherapists in practice, our goal is to deliver patient-centered care as a multidisciplinary team. However, students are often taught in ‘silos’, with limited interaction across disciplines. Interprofessional education provides a pedagogical approach to foster collaborative learning environments, provides a venue for students to practice as part of an interprofessional team enhancing professional behavior and clinical competence.
Methods
A descriptive-analytical study of a culturally diverse student body of (n = 61) physiotherapy, (n = 27) nursing students, enrolled in obstetrics and gynecology curriculum within their respective disciplines was conducted at a local university within the UAE. Fifteen different cultures were represented in both cohorts. A collaborative practical class was designed and conducted including: (1) a short description of material by faculty members from nursing and physiotherapy (2) demonstration of antenatal, labor, post-natal exercise progressions. Students were paired with at least one PT and one Nursing student per group to practice practical interaction of skills. Pretest and posttest reflection and two focus group interviews conducted separately following the session were analyzed.
Results
Pretest reported 45% of students being ‘unsure’ about working together. On observation, the students exhibited communication difficulties in the beginning but after practicing they became interactive and friendly. Furthermore, during the posttest, 95% of students reported they “felt ‘sure’ about working with each other” preferring more classes taught similarly. Furthermore, students commented they “enjoyed the interaction between the faculty”, which enhanced “level of comfort and ease with learning new material”. Five percent (n = 5) still felt ‘unsure’ with this methodology of teaching. Note taking from focus group interviews revealed that students most enjoyed the practice sessions and felt that it enhanced their knowledge as well as attitudes toward other professions and cultures. Students reported the practical, inter-collaborative session was effective to learn new skills, inspired them to read about different health professions.
Discussion
Interprofessional collaborative education sessions provide a unique setting to enhance communication, critical thinking and practical skills within the context of a multicultural setting. Limitations include single group retrospective observation.
Conclusion
Interprofessional, cross-cultural collaborative education is a valuable method to enhance communication and learning in a practical educational setting.
Keywords: interprofessional, collaborative, cross-cultural teaching and learning
ID 266 – Burnout vs Resilience in Physiotherapy Personnel: A Preliminary Comparative Study of Students and Clinicians
Joy Karges, Aliya Chaudry
American Physical Therapy Association, United States of America
Background
The 21st-century healthcare environment is infiltrated with stress that eventually leads to burnout. This study had a two-fold purpose: (i) identifying resilience and burnout scores within doctorate of physiotherapy students (SPTs) and practicing physiotherapy clinicians (PTs); and (ii) determining largest stressors and coping strategies for combating stress for SPTs and PTs.
Methods
Resiliency was determined by analyzing coping strategies to stressors whereas burnout was identified by emotional exhaustion, reduced personal accomplishment, and depersonalization. It was hypothesized that PTs would display higher levels of resilience compared to SPTs due to their level of experience dealing with adversity and potential long-term gains in personal fulfillment. Enrolled SPT and PT subjects participated in an online survey about burnout, resilience, academic, and lifestyle-related stressors, coping strategies for academic and lifestyle-related stressors, and demographic markers. Resilience and burnout were measured using Connor-Davidson Resilience Scale (CD-RS) and Maslach Burnout Inventory (MBI) respectively. SPSS was used for data analysis.
Results
Twenty-seven SPT and 21 PT subjects completed the study. For PTs, the highest occupation-related stressor was workload; and communication with others was the highest stress reliever. The main lifestyle-related stressor for PTs was the weather and the main coping strategy was exercise. For SPTs, exams were the highest academic stressor and exercise was the highest stress reliever. The main lifestyle-related stressor for SPTs was not being able to communicate/spend time with loved ones; whereas simply spending time/communicating with family was the main coping strategy. Finally, comparing SPTs to PTs, the SPTs demonstrated lower emotional exhaustion (P = .008) and higher personal accomplishment (P = .004). Additionally, when comparing year 1 and year 2 SPTs, preliminary data indicated that year 2 SPTs demonstrated higher resilience (P = .034) and lower emotional exhaustion (P = .000) scores than year 1 SPTs.
Discussion
Identifying potential stressors early can enable physiotherapy administrators and educators to institute timely change and avoid burnout. Limitations of study were its small sample size, one university affiliation of PTs and limited geographic diversity of SPTs.
Conclusion
PTs demonstrated higher resilience, lower emotional exhaustion, and higher personal accomplishment than the SPTs. However, SPT resilience increased and exhaustion decreased as students progressed through their entry-level education.
Keywords: burnout, resilience, physiotherapy
ID 112 – Impact of physiotherapist’s experience on the reliability of knee goniometry done with 3 tools and agreement between tools
Nathalie Yaël Pauwen1, Servais Charline2, Roggeman Auriane2, Diolez Mae2, Peetrons Philippe3, Souhail Farid4, Balestra Costantino2, Robert Annie5, Deboeck Gaël1
1Cardio-pulmonary exercice laboratory FSM-ULB, Belgium; 2HE2B-ISEK, Belgium; 3Radiology Dpt of Iris Sud Hospitals, Belgium; 4Physiotherapy Dpt of Iris Sud Hospitals, Belgium; 5IREC-EPID UCLouvain, Belgium
Background
Results on the estimations of intra and inter-raters reliabilities of knee angles done with different goniometers have shown promising results (1)(2)(3). Those encouraging results were confirmed by the few studies that stratified reliabilities through examiner’s experience, with small numbers of experimenters, without sampling method reported (4)(5). We therefore aimed to review the intra and inter-raters reliabilities of knee angle’s estimation, done with different tools used in clinical setting, among physiotherapists with various professional experiences, following sample size requirements for reliability design (6).
Methods
Twenty-six physiotherapists measured 12 fixed knee angulations, with a Visual Evaluation (VE), a Small Plastic Goniometer (SG) and a Large arm Goniometer (LG). Estimations with the tools were always done one at a time (VE, SG, LG) and for each tool used, the 12 knees were randomly assessed 3 times by each physiotherapist. Examiners were stratified in ‘Novice’ (0–10 yrs since graduation), ‘Confirmed’ (11–20 yrs since graduation) and ‘Experimented’ (>20 yrs since graduation).
Results
1. Excellent intra-examiners reliabilities were confirmed for the three means: Mean of ICCINTRA [SD] – VE: 0,976[0,029]; SG: 0,972[0,051]; LG: 0,991[0,020].
2. Good to excellent inter-examiners reliabilities were estimated with a bootsrap technique (20 samples of 11 physiotherapists assessing 11 knees), with the best reliability using LG: 0,951[0,041]. Nevertheless, using the SG, reliabilities are substantially decreasing in the subgroup of ‘Confirmed’ physiotherapists graduated since 11–20 yrs: ICCINTER = 0,539 (n = 6). The latest are showing very poor inter-examiners reliabilities when using SG less than 12 times/year: ICCINTER = 0,278 (n = 3), when working at their private practice: ICCINTER = 0,379 (n = 3) and paradoxically, when having orthopedic specialty: ICCINTER = 0,426 (n = 4).
Conclusion
Our results confirmed good to excellent intra and inter-reliabilities whatever the tool used but raises to some caution related to the Small Goniometer: confidence gained through experience might lead to an increase of systematic errors, affecting the inter-examiners reliability of knee goniometry (frequency of use, solo/team setting, specialty). This should help the debate on continued education for physiotherapists in the field of practical skills in goniometry, especially with the small goniometer, mostly used in clinical setting.
Keywords: reliability goniometry education
ID 243 – ‘Book to Bedside’ – Are our physiotherapy students engaged in Evidence-Based Practice? A multi-site review
Criona O’Donoghue1,3, Martine Darcy2,3, Jeanne Keddy2,3
1Our Lady’s Hospice and Care Services, Ireland; 2St. Vincent’s University Hospital, Ireland; 3University College Dublin, Ireland
Background
The value of Evidenced-based Practice (EBP) in the clinical setting is well recognized but there appears to be a mismatch between the current evidence and what is implemented in practice. It is recognized that the discipline and culture of engaging in EBP should not begin as qualified practitioners but be an integral part of the preparation for clinical practice. The development of a work-ready set of graduates with EBP skills may enhance the changing culture of engagement with EBP among physiotherapists.
Methods
Four EBP workshops were introduced during clinical placement. The impact of the workshops was evaluated using the self-reported EBP Profile Questionnaire 2 (EBPQ2), administered pre and post placement. Within-group change in the questionnaire domains of Relevance, Terminology, Confidence, Practice and Sympathy were evaluated using Wilcoxon signed rank test. A Likert scale questionnaire was used to evaluate the workshops.
Results
Thirty-seven students completed EBPQ2 Questionnaires pre and post placement. Within-group change post clinical placement/s that included the EBP workshops demonstrated significant changes in the following domains: Relevance (mean change 4.179, p ≤ 0.01), Terminology (mean change 13.873, p ≤ 0.01), Practice (mean change 5.135, p ≤ 0.01) and Confidence (mean change 9.981, p ≤ 0.01). No significant change was noted in the sympathy domain (mean change 0.929, p = .151). Evaluation questionnaires identified that most students agreed or strongly agreed that the workshops enhanced their EBP skills.
Discussion
Changes in EBP domains that were evident on introduction of EBP workshops may not necessarily translate into consistent engagement in EBP as students join the workforce. There are many potential barriers to implementing EBP – lack of appraisal skills, volume and quality of emerging literature and conflicting results. Graduates equipped with EBP skills required for making evidence-based healthcare decisions may enhance EBP implementation in their future workplaces. Further research with a comparator group is required to identify if the changes in the EBPQ2 are directly attributable to the placement workshops.
Conclusion
Clinical placement that included workshops in EBP was perceived by physiotherapy students to enhance their EBP skills and were associated with significant changes in domains of EBP.
Keywords: evidence-based practice, practice education, physiotherapy students
ID 246 – National level analysis of the Bachelor thesis development in the Spanish universities: 10 years after Bologna process
Ana María Martín- Nogueras1,2, Sonia Souto-Camba1,3, Jose Ríos-Díaz1,4, Raquel Chillón-Martínez1,5, Sergio Hernández-Sánchez1,6, Maria del Carmen García-Ríos1,7
1Spanish Asociation of Physiotherapist, Spain; 2University of Salamanca, Spain; 3University of A Coruña, Spain; 4Antonio de Nebrija University, Spain; 5Centro Universitario San Isidoro, Spain; 6 Miguel Hernández University, Spain; 7Granada University, Spain
Background
The Bachelor Thesis (BT) was incorporated as a subject of the Spanish Physiotherapy Degrees (PTD) in 2008. Each university applies its own criteria in relation with number of ECTS, temporality and type of work. Our aim was to map the current state of the BT in Spanish universities after 10 years of its initial development.
Methods
Descriptive study was conducted with a structured search (January 2020) of the 53 Spanish university websites offering PTD. Registered variables were the number of admitted students in the PT program, number of ECTS assigned to the BT, temporality, type of work, availability of a BT guide and evaluation system.
Results
Fifty-six of 75 PTD were analyzed. Nineteen were excluded for being double degree. The average number of students admitted per year in the PTD in Spain is 85 (24–360). The number of ECTS assigned to the BT varies between 6 and 12. In 59% of cases, at 8thsemester. The BT type, 43% were about scientific literature reviews, 23% research-based products, 20% clinical cases, 14% research projects, 13% PT treatment plan, 5% Objective and Structured Competency Exam and 7% others. The evaluation system considers the supervisor and evaluation commission reports and a public and oral dissertation with a panel is mandatory in most universities. There were no significant differences in any variable between private and public PTD.
Discussion
The number of new students admitted to the PTD in Spain each year allows us to estimate that around 4,778 BT/year are defended. This implies an increased workload in management (high human resources to coordinate, supervise and evaluate the BT). The response of the Universities to this challenge was diverse. We found heterogeneity of BT types, ECTS workload and assessment between universities.
Limitations
The research method through the websites could let outside some cases with unavailable information in the website.
Conclusion
BT come to PTD programs without a previous tradition in it and multiple solutions were applied. A reflection and a discussion forum on these issues would be desirable in order to define the best methodologies for their implementation and evaluation.
Keywords: Bologna process, bachelor thesis, physiotherapy
ID 250 – Simulated patients in physiotherapy education – an approach to promote the development of empathic responses toward patient-centered care
Carmen Caeiro1,2,3, Inês Santos1,2, Teresa Dias1,2, Carla Pereira1,2,3
1Portuguese Association of Physiotherapists, Portugal; 2Polytechnic Institute of Setubal, School of Health, Physiotherapy Department, Portugal; 3Polytechnic Instutude of Setubal, Center for Interdisciplinary Applied Research in Health (CIIAS), Portugal
Background
A course in narrative reasoning aiming to promote clinical reasoning capabilities toward patient-centered care has been implemented in the undergraduate physiotherapy curriculum. After participating in this course, students have emphasized an increasing capacity to understand and communicate with patients. Since these findings have emerged from qualitative research focused on students` perceptions, it becomes important to explore the impact of this course on students` approaches to patients. Thus, this study aimed to explore students` empathic responses to simulated patients` emotional needs.
Methods
Simulated-based education has been introduced in order to assess the students` responses to patients` concerns and emotional cues. Simulations were carried out in the first and last sessions (10 weeks later) of the course. Twelve students volunteered to participate in 24 simulations with a professional actor, who was instructed regarding the content of clinical cases (neurologic, musculoskeletal and cardio-respiratory disorders) and communication issues (e.g. angry, silent, vulnerable or aggressive patients). The sessions were video recorded and coded for patients` expressions of emotional distress and students` responses using a validated behavioral coding scheme (the Verona Coding Definitions of Emotional Sequence – VR-CoDES).
Results
Two independent researchers coded 24 video records (12 pretest and 12 posttest). A total of 194 cues and concerns were codified. The percentage of cues and concerns explored by the students improved from 61% (pretest) to 76% (posttest), which was indicative of students` enhanced awareness of patients` emotional expressions. Two hundred and thirteen students` responses to cues and concerns were also codified regarding provision or reduction of room for further disclosure. Students` explicit and non-explicit responses providing room for patients to express their problems increased from 27% (pretest) to 48% (posttest).
Discussion
The results demonstrated an improvement in students` empathic responses, which has been considered as an indicator of patient-centered communication. The participation of a professional actor allowed more realistic simulations, however, the camera could have affected the students` performance.
Conclusion
A course in narrative reasoning seems to increase physiotherapy students` skills for patient-centered communication. The VR-CoDES may be used as an educational strategy to operationalize the development of patient-centered interviewing approaches in physiotherapy undergraduate curricula.
Keywords: communication, patient-centered care, simulation-based education
ID 257 – Using Peer-Mentoring to increase clinical skills in Physiotherapy Education: A Comparison of 3 Approaches
António Alves Lopes, Hugo Santos
Alcoitão School of Health Sciences, Portugal
Background
In the context of health sciences, there is a need for constant evolution across the scope of professional skills. However, for this continuous development, it is necessary that professionals develop a series of characteristics, such as the ability to teach and learn in multidisciplinary contexts. Mentoring has been widely used in the education of health professionals in order to improve student involvement and the quality of learning experiences. Objective: The aim of this study was to compare students’ satisfaction with three different styles of mentoring in three different areas Cardiorespiratory, Neuromuscular and Musculoskeletal. One of the styles was directed to specific tasks to perform, the second was directed to specific learning objectives and the third style was free, with no specific tasks or objectives.
Methods
In the Physiotherapy Bachelor course and during one semester, the students of the second year were organized in small groups and distributed to them a group of mentors of the third year. Each mentor had a specific area and a specific mentoring style. Orientation support was given at least 3 times during this process. An online questionnaire was developed and used to identify perceptions about the outcomes and satisfaction of all participants in the mentoring process.
Results
The main results showed great satisfaction with the mentoring process in both groups (students and tutors). The students refer the importance that the tutor had in consolidating theoretical knowledge, clinical reasoning and practical skills. Both groups expressed that the process was very rewarding and are eager to repeat this experience. Regarding the comparison between mentoring styles, students preferred mentoring with more directed than free styles.
Discussion
Mentoring facilitates learning opportunities for 2nd graders in the topics covered and can also increase the leadership and teaching skills of 3rd graders, both outcomes have the potential to benefit future professional roles. In relation to the process of Peer-Mentoring, a good organization and objectives/tasks well established by the responsible teacher seem to be fundamental to the overall success.
Conclusion
The promotion of peer-mentoring could facilitate peer-to-peer learning opportunities for students and promote leadership and teaching skills in future professionals.
Keywords: physiotherapy students, peer-mentoring
ID 270 – Simulation-based learning experiences: an innovative tool for confidence and social skills in physiotherapy degree
Cristina Bravo Navarro, Manel Domingo Corchos, Aimar Orio Sallent, Antoni Font Canyelles, Montserrat Solsona Carbonell, David Barranco i Reixachs, Francesc Rubi Carnacea
Universitat de Lleida, Spain
Background
Simulation-based learning experiences (SBLE) in recent years have highlighted as a tool for learning knowledge and skills within the health professions. In particular, at the degree of physiotherapy, it has shown the same effectiveness as other alternative strategies in education and is valid at first levels in the degree of physiotherapy. We postulate that simulation approach is useful and effective for the development of professional career and social skills.
Methods
The goal of this experience is to show the effectiveness and satisfaction of the physiotherapy students about SBLE, in this case, about identifying psychosocial factors and pain management. Twenty-four students, of first and third year of the double degree in physical therapy and nutrition, participated in a SBLE. They were evaluated by teachers; answered a satisfaction questionnaire and answered an open question about their experience with SBLE. Qualitative data were analyzed using the Georgi’s method.
Results
Four categories were obtained from qualitative data: personal perceptions, acquired skills, Usability in professional setting, and satisfaction. Regarding teachers evaluation, more than 55% competence was fully demonstrated. Satisfaction questionnaires. Satisfaction questionnaires showed that 87,5% of students believe that SBLE is a useful pedagogic tool and for their future professional career.
Discussion
Despite the lack of evidence of the utility of SBLE in physical therapy degree, our results suggest that it could be an effective tool for preparing our students for their professional development.
Conclusions
Simulation as a tool for learning in physiotherapy seems to be effective since learning goals and skills were acquired. Moreover, students refer a high level of satisfaction and the experiences they describe are trustworthy, useful and applicable. Future studies are necessary for integrating competences and skills in physiotherapy degree.
Keywords: physical therapy, education, simulation
ID 280 – Evaluating the Postgraduate Year 1 program at the Physiotherapy Department: Understanding effectiveness and needs of trainers and trainees
Asila Alia K O Noordin, June Feng Cai Eng, Caroline Shi Ling Chua
KK Women’s and Children’s Hospital, Singapore
Background
Training for Physiotherapists in their first-year post-graduation (PGY1) was restructured in 2018 to provide comprehensive on-the-job training at KK Women’s and Children’s Hospital, Physiotherapy Department in Singapore. The new training structure consists of a curriculum with lesson plans, competency checklists and the mini-CEX tool to assess and provide feedback to trainees. However, the effectiveness of this training structure has not been evaluated since implementation from the trainer and trainee’s perspective. The primary goal of this study is to understand the perceived effectiveness of this training structure, with a secondary goal of understanding the training needs from both trainers and trainees.
Methods
Two separate online questionnaires were conducted with all the physiotherapy trainers and trainees involved in the PGY1 program. Questions were targeted at understanding perceptions of the current training structure, the utilization of the mini-CEX and the feedback process. These included “yes/no” and open-ended questions to understand the reasons for their choices and to obtain suggestions for improvements.
Results
All eligible staff completed the questionnaires (trainers: n = 14; trainees: n = 6). Only one trainee and one trainer felt that the training structure was satisfactory. Two trainees (33.3%) felt that the purpose of the mini-CEX was not clearly explained. All trainees felt that the feedback received were unbiased. Trainees also felt that trainers needed to be clear with the training structure and objectives and have sufficient knowledge on use of the mini-CEX. Trainers identified their main training issues as lack of standardized rubrics for scoring the mini-CEX, as well as lack of training on using the mini-CEX and time for feedback.
Discussion
This study has identified knowledge gaps and differing views of trainers and trainees. Future studies with focus groups should be conducted to provide more in-depth understanding of the needs of trainers and trainees.
Conclusion
This study was essential to understand and improve the quality of on-the-job training, especially in an Asian setting where the trainer–trainee relationship is relatively hierarchical. Based on the feedback received, online training modules for trainers are being developed alongside workshops for trainees to encourage them to take ownership of their professional education.
Keywords: program evaluation, teaching methods, mini-CEX
TRACK 3: Science in Physiotherapy
ID 117 – Attitudes toward scientific research among undergraduate physiotherapy students in Austria
Stefan Tino Kulnik1,2, Markus Latzke3, Peter Putz2, Constance Schlegl4, Martina Sorge4, Silvia Meriaux-Kratochvila2
1Faculty of Health, Social Care and Education, Kingston University and St George’s, University of London, London, United Kingdom; 2Department Health Sciences, FH Campus Wien – University of Applied Sciences, Vienna, Austria; 3Department of Business, IMC University of Applied Sciences, Krems, Austria; 4Physio Austria, Vienna, Austria
Background
Education of physiotherapists in basic and applied science fosters evidence-based physiotherapy practice and enables research careers of physiotherapists. In Austria, where physiotherapists have been qualifying at bachelor level since 2009, attitudes toward scientific research among undergraduate physiotherapy students have not been explored.
Methods
Sixty-eight undergraduate physiotherapy students in Austria completed an anonymous cross-sectional online survey. The survey invitation was disseminated electronically in spring 2019 to student members of the professional association and via undergraduate education providers. Respondents rated research-related attitudinal statements and importance of generic and research-related aspects of job satisfaction. Data were analyzed descriptively.
Results
Respondents were in their first (n = 20/29.4%), second (n = 16/23.5%) and third (n = 32/47.1%) year of study. Most were female (n = 46/67.6%) and in age groups 18–25 (n = 44/64.7%) and 26–35 years (n = 21/30.9%). Thirty (44.1%) had a prior professional qualification. Forty-six (67.6%) reported no research experience whatsoever. The remainder had experience from mainly undergraduate physiotherapy research projects. Attitudinal ratings demonstrated general appreciation of the importance of research for patient care and for the development of the profession, e.g. 62 (91.2%) strongly agreed with the statement ‘research is crucial for the future development of physiotherapy’. Up to a quarter indicated strong interest in conducting research, e.g. in response to the statement ‘I can envisage applying for a research-physiotherapist post in the future’. Ratings for generic aspects of job satisfaction were high, e.g. ‘having a positive influence’: mean (SD) importance 6.4 (0.9) on a 7-point scale. Research-related aspects of job satisfaction were rated of high to moderate importance, e.g. ‘opportunity for physiotherapists to take on a researcher role’: mean (SD) importance 4.3 (1.7).
Discussion
Undergraduate physiotherapy students in this sample appreciated the importance of physiotherapy research for the benefit of the profession and for patient care. The findings identify a sub-group of students who indicate interest in a research career in physiotherapy. The study was limited by the small self-selected convenience sample, representing 4.9% of 1,392 undergraduate physiotherapy student places in Austria and possibly with a prior interest in research.
Conclusion
These exploratory findings indicate awareness and appreciation of the importance of scientific research among undergraduate physiotherapy students in Austria.
Keywords: attitudes, education, research
ID 146 – How guided self-study could promote learning in undergraduate physiotherapy students in Switzerland – a higher education feasibility study
Slavko Rogan1,2,3, Jan Taeymans1,2, Sandra Lakke4, Evert Zinzen2
1Bern University of Applied Sciences, Department of Health, Faculty of Physiotherapy, Switzerland; 2Vrije Universiteit Brussel, Department Movement Science, Faculty of Physical Education and Physiotherapy, Belgium; 3Akademie für Trainingslehre und Physiotherapie, Grenzach-Whylen, Germany; 4Hanze University of Applied Sciences Groningen, Groningen, The Netherlands
Background
The Swiss National Agency of Higher Education declared 25–30 hours workload equivalent to 1 European Credit Transfer System unit. This workload consists of 40% classroom attendance time to 60% time for self-study. To encourage self-study and therewith, the Bern University of Applied Science (Switzerland) developed a program aimed to organize students independent learning process using an andragogy or heutagogy approach.
The aim of this study is to measure the feasibility and effectiveness of the “guided self-study program” (G-S) on exam results.
Methods
Physiotherapy students from the first semester were allocated to either a G-S group (G-S) or control group (CG). G-S was offered in addition to the usual curriculum. G-S included six clinical cases within an eight-day cycle. Students received the clinical case description on day 1 of a G-S cycle. The students prepared the case in groups (days 2 to 7). Per casus, two time-slots for contact with the tutor were offered. At day 8 the students presented their results in plenum. Feasibility was operationalized as student’s responsiveness (criteria of success = 83% willingness to participate in G-S) and the degree of acceptability (criteria of success = semi-structured interview about quality of the cases, and workload). G-S effectiveness was measured by the final semester exam grade. Statistical analyses were conducted using an Intention-To-Treat approach.
Results
Students’ responsiveness was 23%. Quality of the cases was good and students’ workload during the G-SS period was high (>45 hrs/week). G-S compared to the CG scored significantly better on practical exam (p < .01) and on written exam (p < .04).
Discussion
This planned G-S program in its current form seems not feasible due to an overfilled timetable preventing students from the G-S to sufficiently prepare the clinical cases. Despite low feasibility, effectivity of G-S seems promising. Limitation was that confounding variables such as communication or motivation were not assessed and could be produced a bias.
Conclusion
Planning G-S earlier in the existing time schedule may avoid overload and improve students’ responsiveness. G-SS seems to positively affect learning success in undergraduate physiotherapy students when those were able to prepare the clinical cases.
Keywords: andragogy, higher education, self-study
ID 155 – Does rehabilitation changes gait kinematic parameters in total knee arthroplasty subjects? A prospective observational pilot study
Joel Pollet1, Chaira Arienti1, Barbara Piovanelli1, Riccardo Buraschi1, Stefano Negrini2
1IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy; 2Department of Biomedical, Surgical and Dental Sciences, University of Milan “La Statale”, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
Background
Total knee arthroplasty (TKA), is a routine surgical intervention. After surgery is common practice for every subject to undergo a period of rehabilitation to recover strength, range of motion and walking ability of the affected limb. Many evaluation scales have been developed to evaluate improvements during and after rehabilitation, but the walking ability has rarely been evaluated in the acute phase (3–30 days post-surgery). Aim of the study is to evaluate the effect of rehabilitation on functional outcomes scales and gait quality, through an optoelectronic system.
Methods
After receiving Ethical approval (4–16/12/2015), in a postacute rehabilitation hospital, subjects were recruited after receiving TKA; inclusion criteria were stable clinical conditions, and no neurological or rheumatic pathologies or previous surgeries at the lower limbs. International knee society score (IKSS), Barthel Index (BI), Numerical Rating Scale (NRS), Knee Flexion (KF), and gait analysis (GA) were assessed at hospitalization (T0) and discharge (T1). The GA system is a BTS DX-400, at least three walks were performed. Gait was allowed with one or two crutches according to needs. The rehabilitation program was based on restoring ROM and strength of the lower limb.
Results
Twenty subjects (67 ± 12 years, 11 females, 11 left knees) met the inclusion criteria. Subjects showed a significant difference between T0 and T1 in all the functional evaluation scales (P < .001) excluding NRS (P > .05). None of the GA parameters showed a significant improvement (P > .05). Neither the spatio-temporal parameters showed significant improvements (P > .05).
Discussion
This study highlights how rehabilitation improves knee function, but for what concerns gait quality, no improvements have been retrieved in the gait of patients. Rehabilitation focused on the functional competence of the subjects, gait in this perspective was completely neglected, changing the contents of the rehabilitation program could modify the results of this study. This study has a small sample size even if the results are quite significant, the study is still ongoing to include more subjects.
Conclusion
A conventional rehabilitation program is able to restore the knee function, but did not modify gait parameters, a specific focus on gait training should be included in the rehabilitation program of TKA.
Keywords: knee artrhoplasty, gait analysis, gait rehabilitation
ID 169 – Continuous learning for hospital-based physiotherapists: feasibility and effects of a tailor-made program to improve patient communication competency
Rudi Steenbruggen1,2, Linda van Heusden4, Marjo Maas2,3, Thomas Hoogeboom2, Paul Brand5,6, Philip van der Wees2
1Saxion University of Applied Sciences, Enschede, The Netherlands; 2Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands; 3HAN Instituut Paramedische Studies, Nijmegen, The Netherlands; 4Department of Rehabilitation, Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; 5University of Groningen and University Medical Center, Groningen, The Netherlands; 6Isala Hospital, Zwolle, The Netherlands
Background
Continuous learning in the dynamic environment of hospital-based physiotherapists can be quite challenging. The Dutch Association for Physical Therapy in Hospitals designed in this context a tailor-made quality improvement (QI) program to enhance the competency of communication with the patient. The tracer methodology for peer observation as known from quality systems like JCI and Qmentum was used in this new program.
Methods
Fifty physiotherapists from 16 hospitals took part in the study. In the first-round fixed dyads of physiotherapists visited each other within a period of two weeks. Visiting physiotherapists carried out a tracer for two hours, directly observing the daily work of the visited physiotherapists. Findings were scored on a feedback form with quality indicators to evaluate communication with the patient, using a 5-point Likert scale ranging from 1(much improvement needed) to 5 (no improvement needed). Afterward, participating physiotherapists received a feedback questionnaire to evaluate the feasibility of the QI program, using a 5-pt Likert Scale ranging from 1 (lowest) to 5 (highest). Half a year later the same procedure took place in a second round.
Results
Participating physiotherapists (57% women) had a mean age of 39 (SD 12) years and a mean working experience of 15 (SD 11) years. Working locations were university hospitals (32%), general teaching hospitals (37%), district hospitals (31%). On quality indicators for the patient communication competency, participants scored a medium of 4 (range 2–5) in the first round and 4.5 (range 2–5) after half a year, which was statistically significant (p < .001). Medium score of feasibility of the QI program was 4.0 points (range 1–5).
Discussion/Limitations
This study showed that there is room for improvement regarding the feasibility of the program, mainly on applicability of the feedback form with quality indicators. Moreover, intra- and inter-rater reliability and validity of the feedback form used during the tracers need further research.
Conclusion
In this study, a tailor-made IQ program for hospital-based physiotherapists concerning the competency communication with the patient seemed reasonably applicable and had a significant effect on participants, improving their competency of communication with the patient in half a year.
Keywords: competency, hospital, tracer
ID 172 – Student 4 Best Evidence as digital Problem-Based Learning method to improve Evidence-Based Practice competencies in physiotherapy students: an observational study
Chiara Arienti1, Stefano G. Lazzarini1, Joel Pollet1, Stefano Negrini2,3
1IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy; 2Department of Biomedical, Surgical and Dental Sciences, University of Milan “La Statale”, Italy; 3IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
Background
Evidence-based practice (EBP) is an essential element in delivering high-quality care, and healthcare professionals should make clinical decisions based on the best available evidence. The aim of this study is to evaluate the effectiveness of an EBP laboratory, using Students 4 Best Evidence (S4BE), an online community of students from all around the world who are interested in learning more about EBP, as an educational tool, to teach EBP competences to undergraduate first-year physiotherapy students.
Methods
We run an observational pretest-posttest study. The sample included 121 students (20.7 ± 2.7 years, M:F 73:47) attending a bachelor’s degree in Physiotherapy at an Italian University. The intervention consisted of the use of S4BE as digital technology of digital problem-based learning (DPBL) method to teach EBP competences. The evidence-based practice questionnaire (EBPQ2), a validated tool for the evaluation of EBP competences in the domains of Relevance, Terminology, Confidence, Practice and Sympathy, was used to evaluate EBP attitude, knowledge, skills, and practice at the beginning of laboratory and after 24 training hours and 2 months of clinical practice training. A within-group analysis has been conducted.
Results
One hundred and three students completed the training (drop-out rate: 15%) and were assessed using the EPBQ2. The students showed a significant improvement in all domains (p < .001), except in the sympathy domain, where the percentage score decreased from 71% to 60%. The best improvements were reached in terminology (54% to 65%) and in practice (41% to 55%) domains.
Discussion
The use of S4BE as digital tool of DPBL led to statistically significant improvements in four of the five domains addressed by the EPBQ2, showing its possible effectiveness in a undergraduate students context. Since the best improvement was found in the practice domain, it is likely that the clinical training performed simultaneously might have influenced the learning of these specific EBP competencies as well.
Conclusion
This study proposed an effective educational protocol, based on DPBL approach, using S4BE as new digital technology tool. Further research is needed to test the effectiveness of this educational protocol compared with traditional learning in physiotherapy students.
Keywords: evidence-based practice, students 4 best evidence, digital problem-based learning
ID 192 – Revision of the Dutch guideline for physical therapy in patients with low backpain; formulating easy to use recommendations
Nynke M Swart, Guus A Meerhoff
Royal Dutch Society for Physical Therapy (KNGF), The Netherlands
Background
The importance of physical therapy in patients with low backpain is recognized in scientific evidence and clinical practice. The recommendations for physical therapists concerning the diagnostics and treatment are described in the Dutch guideline for physical therapy in patients with low backpain. During the past years, the desire of guideline users toward a more easy to use clinical practice guideline (CPG) increased and the methodology to conduct practical recommendations improved. Therefore, the Royal Dutch Society for Physical Therapy (KNGF) decided to revise the Dutch CPG for patients with low backpain.
Methods
A guideline panel and review group with representatives of relevant stakeholders (for example, physical therapists, general practitioner, psychologist, occupational physician, neurologist and patients) was composed. Conform the approach developed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group, research questions for narrative or systematic reviews were formulated after focus groups with patients and physical therapists and consultation of experts. The evidence was synthesized by providing the estimates of the effect for each outcome and the quality of the evidence. A strong or conditional recommendation for or against an intervention was formulated by the panel, based on the evidence together with relevant considerations, as described in the GRADE evidence to decision framework.
Results
The revised CPG for patients with low backpain will be finished at the end of the summer of 2020. The preliminary results are the following. Three indications for physical therapy are distinguished based on the patients’ health status and abilities of self-management. Recommendations concerning the preferred treatment modalities are formulated, i.e. information and advice, exercise therapy, non-exercise modalities and behavior-oriented treatment. Also, specific recommendations on the frequency, intensity, type and time of the exercise therapy are formulated.
Discussion
Since guideline adherence remains challenging these days, it is important that the practical implications are considered during the guideline development process, to enhance the uptake of the recommendations in daily practice.
Conclusion
Based on scientific evidence, patient preferences and relevant considerations among relevant stakeholders, easy to use recommendations are formulated in order to stimulate guideline adherence among physiotherapists.
Keywords: guidelines, physical therapy, low backpain
ID 194 – Experience of clinical and academic exchange in a Center of Competence
Kim Caluwé1, Bart Vrijsen1,2, Hilde Feys2, Thierry Troosters2
1University Hospital Leuven, Belgium; 2Catholic University Leuven, Belgium
Background
In 2014 the Department of Rehabilitation Sciences (DRS) of KU Leuven and the Activity Center Physiotherapy (ACP) of the University Hospitals Leuven have set up a structured collaboration to optimize the clinical and academic interaction in the field of physical therapy, named the Center of Competence Physical Therapy (CC-PT). Our conducted research focuses on the setup, the progression and the experience of the first 5 years of the CC-PT.
Methods
A retrospective analysis was performed on the amount of exchange between the ACP and DRS. Currently, questionnaires are distributed among all physiotherapists participating in the CC-PT questioning their experiences, satisfaction and possible future improvements.
Academic staff had the opportunity to participate for a maximum of 0.1 full-time equivalent (FTE) in the clinical setting to maintain or improve their clinical skills. Staff working in the clinical setting had the opportunity to (1) participate for up to 0.2 FTE in research projects related to their clinical expertise or (2) support academic courses of the department.
Results
In 2014, 0.65 FTE academic staff participated in clinical work with an increase to 1.47 FTE in 2019 (0.74 FTE senior staff, 0.14 FTE postdoctoral staff, 0.59 FTE doctoral students). The amount of FTE of support to academic courses increased from 0.22 in 2014 to 0.94 in 2019. Annually, the number of clinical research applications by ACP members ranged from 8 to 13. The first year of the CC-PT 5 of 11 applications for clinical research was approved (0.40 FTE) while in 2019 5 of 8 applications were approved (0.55 FTE). Data from the questionnaires will be available soon.
Discussion
The amount of FTE has increased over the first years in both directions; university staff working in the hospital and hospital staff performing collaborative research or providing education. Data from the questionnaires will provide experience of people participating in the CC-PT project.
Conclusion
The CC-PT project was successfully initiated and now serves as a model for clinical-academic partnership where hospitals benefit from academic physiotherapists in their clinical services and the department benefits from having skilled clinicians assist in teaching.
Keywords: clinical research, education, clinical–academic partnership
ID 204 – Developing Scientific Reading Skills in Physiotherapy Education
Anne Kärki, Maija Kangasperko, Marika Kiviluoma-Ylitalo
Satakunta University of Applied Sciences, Finland
Background
The aim of the physiotherapy education is to support students to achieve scientific reading skills and abilities to assess the existing evidence of physiotherapy methods and practice. In the education Evidence-Based Rehabilitation online course is offered for the 1st year students. The aim of the course is for the student to understand the complexity of evidence-based practice.
The aim of this study was to find out what students learned and how they considered that their competences of critical reading developed.
Methods
A mixed-method study was carried out after the course on Moodle Learning Platform for two groups. One closed question defined how well the student has achieved competences. The options were I achieved the competences, some things were left unclear, I still need to study this area. Two open-ended questions concerned matters that were still unclear and what the students had learned well.
Results
In closed question, 22.9% of the students stated that they had achieved the competences required, 31.4% that the competences were partly achieved and 45.7% that they still needed to study this field. There was a difference between the responses of the groups. The group that took the course earlier experienced more need to study this field and the group that had it later felt more that some things were left unclear.
In the open-ended questions, the students stated that the topic was challenging and took a lot of practice. They wrote that more experience and practice were needed e.g. in scientific vocabulary, in the use of appraisal tools and in searching for reliable scientific articles. Students felt that they learned to read the articles in a more effective way. Students stated that this course developed especially the skills in reading scientific articles in a critical way, using practical tools and evaluating the level of reliability.
Discussion
The responses collected from students confirm the need for learning scientific reading and that timing was suitable. Results also reveal the need for further education in future.
Conclusion
Learning critical reading needs to be implemented in the physiotherapy education already at an early stage of the studies.
Keywords: education, evidence, reading
ID 208 – The effects of respiratory training in Parkinson’s disease: a systematic review
Veerle A. van Dongen1, Hanneke JG Kalf1, Philip J van der Wees2, Bastiaan R Bloem3, Maarten J Nijkrake1
1Department of Rehabilitation, Donders Center for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands; 2Department of Rehabilitation and IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; 3Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
Background
Signs of respiratory dysfunction are already present early in Parkinson’s disease (PD), but the effectiveness of respiratory training in PD is not well established.
Objective
The purpose of this systematic review is to give an overview of the effects of different respiratory training interventions in PD, based on the methodological quality of the studies.
Methods
A search strategy was performed in four databases: PubMed, Physiotherapy Evidence Database (PEDro), Cochrane Library and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Methodological quality of original full-text articles was assessed using the Cochrane Risk of Bias tool for randomized controlled trails (RCTs) and the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool for the non-randomized intervention studies.
Results
Six randomized controlled trials and four non-randomized intervention studies were included. Positive effects were reported for all included interventions: inspiratory muscle strength training (IMST), expiratory muscle strength training (EMST), air stacking, breath-stacking, incentive spirometry and postural training. Outcome measurements included respiratory muscle strength, vital capacity, swallowing safety, phonatory capacity and different optoelectronic plethysmography variables. In particular, EMST was the most included intervention within significant positive effects on peak cough flow, maximum expiratory pressure, severity of penetration or tracheal aspiration during swallowing and phonatory capacity.
Discussion
Respiratory training interventions showed improvement on respiratory function tests. However, it is prevalence for each stage, the moment when limitations and symptoms in daily activities occur, or which determinants are associated with respiratory dysfunctions are unknown. Future studies should pay more attention to well-designed studies within standardizing training devices, instruments and protocols.
Conclusion
Although the pathophysiology underlying respiratory dysfunction is not yet clear, we concluded that respiratory training is a promising intervention and should be considered when people with PD experience respiratory dysfunction.
Keywords: respiratory training, respiratory function, Parkinson’s disease
ID 211 – A novel smart balance board – testing feasibility with fit community-dwelling aging people
Mikko Julin, Tapani Risto
Laurea University of Applied Sciences, Finland
Background
The amount of emerging technology is growing in the modern rehabilitation settings. Added smart technology in the physiotherapy equipment will change the nature of the work. Thus, technology, digital applications and platforms should be important part in the future physiotherapy educations.
Methods
The purpose of this study was to evaluate the feasibility of a novel smart balance board for testing with a fit aging population. Standout (Smartifier LLC) is a regular balance board (40 cm diameter, 7 cm height), but has built in 3D accelerometer, gyrometer, and magnetometer. It connects to a smart phone or tablet via Bluetooth. One hundred and ninety-two persons (69 males, 123 females) took part for the testing. The mean age was 70 years (sd ± 4,4). The used test protocol was 30s stand on the board with eyes open. Standout gives detailed data of the test parameters, but only built-in scale results (0–100) were assessed. Null refers to the board touching the floor whilst 100 indicates fully balanced board. The participants performed also traditional 30s single leg stand (SLS, eyes open) and 8-foot-up-and-go (8UG) tests.
Results
The mean Standout score was 17,6 (CI 95% 16,1–19,1). The maximum score was 49 and the minimum score 0. For the SLS test, the mean time was 21, 4s and nearly half of the participants (46%) completed the full 30s. The mean time for the 8UG test was 4,4s (CI 95% 4,3–4,5). There was no correlation between the Standout and SLS tests (r = .107) or between the Standout and 8UG tests (r = −.086).
Discussion
The Standout balance board test proved to be challenging for many participants, but aroused positive interest among them. The test was safe and easy to administrate. As no correlations between the board and the other two tests were found, this suggests that the balance board test is an individual balance test. The inexpensive smart board reliability and validity tests will continue.
Conclusion
Balance is a complex concept. Technology supports physiotherapy work to implement new work methods and equipment into the daily actions. Education should incorporate reliable, valid, safe and novel technology in its core settings to support physiotherapy practise development.
Keywords: standout balance board, testing aging, novel technology
ID 217 – Physical Activity and Advanced Cancer: The views of Chartered Physiotherapists in Ireland
Grainne Sheill1, Emer Guinan2, Linda O Neill1, David Hevey3, Juliette Hussey1
1Discipline of Physiotherapy, Trinity College Dublin, Ireland; 2School of Medicine, Trinity College Dublin, Ireland; 3School of Psychology, Trinity College Dublin, Ireland
Objectives
The aims of this study were to a) describe chartered physiotherapists’ views on the role of physical activity for patients with advanced cancer and b) explore the exercise prescription practices of chartered physiotherapists for patients with advanced cancer.
Methods
A mixed-methods study design was used. Physiotherapists treating patients with advanced cancer in Ireland were eligible to participate. An on-line survey instrument was created, which included (a) A quantitative section that explored physiotherapists’ views on the role of physical activity for patients with advanced cancer, and (b) A qualitative section that explored physiotherapists’ prescription of physical activity for two patient case studies. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using content analysis.
Results
In total, 38 physiotherapists completed the study. Almost all (n = 36 (94%)) physiotherapists agreed with the statement “being physically active is important for patients with advanced cancer”, however the majority (n = 30 (80%)) stated that there was a need for further information to guide exercise prescription for patients with advanced cancer. Content analysis of case study responses demonstrated physiotherapists have a number of concerns regarding the prescription of physical activity to patients with bone metastasis. The most commonly reported concerns were increased fracture risk, the co-existence of osteoporosis and the risk of falls in this patient group.
Discussion
While the majority of physiotherapists perceived physical activity to be of benefit for patients living with advanced cancer, varying levels of confidence in prescribing physical activity to patients with metastatic disease were expressed. This may result in poor implementation of the positive findings of research studies in the clinical setting.
Conclusion
There is a need for more education and training around the role of physical activity for advanced cancer populations.
Keywords: physical activity, exercise, advanced cancer
ID 218 – Discovering barriers and facilitators of sustainable physical activity in patients with a chronic disease using storytelling methodology
J.J. de Boer1, A. Feleus1, A. Hesselink2, P. Siemonsma2, J. Verhoef2, M.A. Schmitt1
1Department of Physiotherapy, Rotterdam University of Applied Sciences, The Netherlands; 2Department of Physical Therapy & Faculty of Health University of Applied Sciences Leiden, The Netherlands
Background
Physical activity (PA) decreases the risk of chronic diseases and prevents worsening. Physiotherapists and nurse practitioners in primary healthcare face difficulties in supporting sustainable PA in inactive patients with a chronic disease, because 50–90% of patients are estimated to fall back in PA within a year. Evidence suggests the importance of a more personalized approach including a person’s context. This study explores implicit and more profound barriers and facilitators of sustainable PA as a first step in the development of a new approach for personalized support (BIBOZ-project).
Methods
To obtain more tacit and latent knowledge on the subject, data were gathered using storytelling. Storytelling allows participants to talk about their personal experiences without external constraints. It focuses on the meaning the participants give their story. Only narrative questions were asked. Perspectives of patients and healthcare professionals were collected. Audiotapes of the interviews were transcribed. Stories were drawn from the transcription. Open coding was done independently by four researchers, themes were constructed based on clustering.
Results
Twelve patients with a chronic disease who followed a PA-promoting program and eleven healthcare professionals involved in PA-promotion participated. Themes from the selected stories (n = 62) were: awareness and urgency, trust in one’s own capabilities and healthcare professional (competences and relationship), customizing PA considering personal interests and possibilities. Additionally, social aspects of PA, meaningful goals and activities, and success experiences were motivators. Prerequisites were: attention to the level of health skills (inter)professional collaboration, finances and transportation issues.
Discussion
Data were collected using an innovative method enabling us to include the context of the patient more profoundly. However, data collection was restricted to patients who followed a PA-promoting program. Analyses were conducted with a group of researchers trained together. Due to the large number of stories a selection was made based on relevance.
Conclusion
This study provides insight in profound and implicit facilitators and barriers of sustainable PA from both patient’s and healthcare professional perspective. These insights provide clues for patients and healthcare professionals and create a basis for the development of a methodology that supports a more personalized guidance to sustainable PA in primary health care.
Keywords: physical activity, sustainability, storytelling
ID 225 – Ethical situations in physiotherapy internationally: a focus on the European WCPT region
Andrea Sturm1, Caroline Fryer2, Roswith Roth3, Ian Edwards2
1Interuniversity College for Health and Development Graz, Austria; 2University of South Australia; 3University of Graz, Austria
Background
The aim of this study was to understand the type and frequency of ethical situations encountered by physiotherapists from all WCPT regions. This paper reports the profile of ethical situations reported in the European region.
Methods
An online survey of physiotherapists was conducted from October 2018 to May 2019. Ethical approval was gained from two Universities. Participants were asked for demographic data and to nominate if they experienced specific ethical issues in four practice contexts: physiotherapist–patient interactions, physiotherapists and their relationship with other health professionals, physiotherapists and the health systems they work in, and professional and economic-related issues. Descriptive statistics were reported and participant groups were compared using ANOVA tests. Multiple regression analyses were conducted to predict the experience of ethical issues.
Results
The response rate from the European Region of WCPT was 44.1% (n=535). Two-thirds (64.3%) of participants from the European WCPT region reported they learned about a code of ethics and 39% learned about ethical decision-making frameworks in their entry-level physiotherapy education. There were significant differences between WCPT regions in frequency experienced of some ethical issues with the European region reporting lowest frequency of economic-related ethical situations. The most frequent ethical issues in European WCPT were scarce resources affecting the quality of treatment (54.6% daily or weekly) and physiotherapy not accessible to all people who need it (39.7%).
Discussion
Entry-level physiotherapy education is not consistently preparing physiotherapists in Europe for the ethical complexity of workplaces. A strong foundation in ethics theory and reasoning is needed to support ethical practice of the profession and minimize practitioner moral distress. The higher frequencies of ethical issues involving societal systems suggest that physiotherapists need to have both the knowledge to reason the social dimensions of ethical practice and the skills to act for social change. The English language of the survey and internet requirement may have limited participation in some regions.
Conclusions
This is the first study to locate European physiotherapists’ experience of ethical issues in an international context of physiotherapy practice. This research can inform professional education to better prepare physiotherapists for the ethical challenges they will face in practice.
Keywords: ethics, education, entry-level
ID 231 – Designing and Implementing an Innovative Integrated Doctorate in Physiotherapy (DPT) Programme: Challenges in Curriculum Design and Programme Development
Dr Sivaramkumar Shanmugam, Dr Larissa Kempenaar, Dr Heather Gray
Glasgow Caledonian University, United Kingdom
Background
The demand for robust research evidence on which to base physiotherapy practice is critical to the profession. Barriers to embedding research in practice include organizational culture; lack of time; and difficulty in evaluating and interpreting published research (Scurlock-Evans et al., 2014). Traditionally, Physiotherapy programs at undergraduate and postgraduate levels have had some success in producing research output; however, time constraints within a busy curriculum have meant that the students’ research skills have not been fully exploited. Furthermore, confidence in applying research skills in practice is often lacking.
Partially due to financial pressures the engagement of qualified clinicians in doctoral study (Prof D, PhD) remains relatively low. The current and future challenge remains to embed research skills in practice and generates a research culture within the wider body of the profession.
Methods
Using a partnership approach with relevant stakeholders, a co-production methodology was used to conceptualize, design, develop and implement a DPT program that fully integrates research skills training with professional development.
Results & Discussion
The first DPT program in the UK that confers eligibility for state registration for license to practice and Chartered Society Physiotherapy chartered status was approved at Glasgow Caledonian University, Scotland, UK. This program integrates research, taught and practice-based elements across the program. The curriculum balances training for researcher development as well as professional development. This presentation will provide reflections on the lesson learned and the challenges in designing, developing and implementing the curriculum.
Through innovative assessment and teaching methods, DPT students develop the required competencies, not only in relation to their own development as researchers, but also within the context of workforce transformation in response to changing population, patient and service needs.
Conclusions
The process of designing and developing a DPT program is challenging, e.g. fitting in the statutory 1,000 practice-learning hours whilst ensuring the academic credibility of doctoral education. Success factors included the use of a clear conceptual model in defining the scope of the program and an approach that includes the future needs of the profession. To build research capacity and make an impact on practice, strong networks are needed between all stakeholders.
Keywords: doctorate in physiotherapy; program development; curriculum design
ID 235 – Influence of physiotherapists’ confidence in managing the patient and patient distress on therapeutic alliance in CLBP practice
Emanuel Brunner1,2, Wim Dankaerts2, André Meichtry3, Kieran O’Sullivan4, Michel Probst3
1University of Applied Sciences St.Gagellen, Switzerland; 2KU Leuven, Belgium; 3Zurich University of Applied Sciences, Switzerland; 4University of Limerick, Ireland
Background
The therapeutic alliance describes the collaborative «work together» aspect of the patient–therapist relationship. Physiotherapists often feel insecure managing chronic low back pain (CLBP) associated with psychological problems. Therapists’ uncertainty in dealing with psychological factors may influence negatively their ability to foster strong alliances with patients in CLBP practice. Associations between the alliance and therapist factors have never been explored in physiotherapy practice.
Purpose
The purpose of this study was to explore associations between patient-rated alliance, physiotherapists’ self-reported confidence in managing the patient and patient-reported psychological distress at treatment baseline.
Methods
Patients with CLBP (N = 21) self-reported their psychological status at baseline. After the intake session, physiotherapists self-reported their confidence (enthusiasm and competence) in managing the patient with CLBP. Patient-rated alliance was measured after the third physiotherapy session. A linear mixed model estimated associations between alliance (dependent variable), physiotherapists’ confidence and patient-reported distress.
Results
The linear mixed model estimated a positive interaction effect (therapist confidence * patient distress) on patient-rated alliance (estimated effect, β = 0.15; 95% Confidence Interval = 0.03–0.27).
Conclusions
Higher self-reported confidence in managing the patient with CLBP by physiotherapists was associated with higher patient-reported alliance after the third physiotherapy sessions. The positive effect of therapist confidence on patient-rated alliance appeared to be dependent on patient-reported psychological distress at baseline.
Implications
Physiotherapists should be aware of their potential influence on the process of developing the alliance in CLBP practice. Healthcare institutions may need to further invest to support physiotherapists in their skills and knowledge to deal with psychological distress in clinical practice and skills to foster strong therapeutic relationships with patients.
Keywords: therapeutic alliance, chronic low back pain, mental health
ID 248 – Digital learning designs in Physiotherapy Education – teachers experiences, attitudes and barriers
Nina B. Ødegaard, Tone Dahl-Michelsen
OsloMet, Norway
Background
In higher education, digital technology is expected to streamline, improve quality, reduce costs and enhance sustainability. Accordingly, innovative pedagogical approaches and student-centered teaching practice are expected. Research on didactics design in physiotherapy education has primarily focused on learning and pedagogy in clinical internship and limited research has been conducted on the teaching practice. The aim of this study is to explore teachers experiences with and attitudes toward digital (technology supported) learning design in teaching practices in physiotherapy education.
Methods
This study has an exploratory design and the empirical material is based on qualitative interviews with 12 teachers in three different physiotherapy educations in Norway. The following research questions are addressed: What experiences do teachers in physiotheraphy education have with digital learning design? What attitudes do teachers have in physiotherapy education to digital learning design?
Results
The preliminary findings indicate the use of digital technology to be varied. Most teacher displays positive attitudes toward a digital shift and emerging new teaching practices. Some teachers are worried about not meeting the expectations in technology-supported learning, however, few are critical to use digital teaching designs.
Discussion
Digital competence is a premise for teachers to choose digital learning and assessment. As the most important inspiration for teachers to change their practice is found to be learning from and with colleagues, there is a need for collaborative practices among teachers, and supporting and innovative leadership. Our discussion elaborates on conditions needed to empower digital learning design and digital competence in the physiotherapy education.
Limitation
The sample only includes one man. Although men are underrepresented in the physiotheraphy education, this is considered a limitation of the study.
Conclusion
The preliminary findings show variations in use and experiences in digital learning design among teacher in Norwegian physiotherapy education. Teachers demonstrate positivity toward emerging digital teaching practices in the field of physiotherapy education. There is a need to focus on collaborative practices and supporting and innovative leadership.
Keywords: digital learning design, innovative teaching practices, physiotherapy education
ID 276 – Studying the relation between the gender of authors in Physiotherapy and their scientific productivity, impact and collaboration: a bibliometric study
Lidia Carballo-Costa1, Rodrigo Costas2, Alejandro Quintela-del-Río3
1University of A Coruña, Faculty of Physiotherapy, Department of Physiotherapy, Medicine and Biomedical Sciences, A Coruña, Spain; 2Leiden University, Center for Science and Technology Studies (CWTS), Leiden, The Netherlands; 3University of A Coruña, Faculty of Physiotherapy, Department of Mathematics, A Coruña, Spain
Background
Statistical analyses have shown that the workforce in physiotherapy is composed of a majority of women. However, there are no data about the composition of the scientific community. Large-scale bibliometric analyses are useful to study the main authors in physiotherapy, and more specifically, their gender distribution. Advanced bibliometric indicators allow us to compare their scientific production, impact-based on citations- and collaboration.
This study aims to analyze the gender differences in the scientific production, impact and collaboration patterns of authors in physiotherapy.
Methods
This is a descriptive and retrospective bibliometric study. We identified publications about physiotherapy from Web of Science in the period 2000–2015, through a sophisticated methodology using keywords, journals and a publications-based classification. Then, we identified all the authors of these papers, and their gender was assigned algorithmically. The most productive authors were selected and all the publications were further identified. Finally, we calculated their academic age, and advanced bibliometric indicators of scientific production, citation impact (field normalized indicators) and collaboration.
Results
We have identified and assigned gender to 9,687 main authors in physiotherapy, of which 4,312 are women (44.5%) and 5,375 men (55.5%). Results show higher output productivity levels of men and significant higher scientific impact of women. Genders do not show differences in their national collaboration patterns, but men show higher international collaboration. Productivity and impact increase with academic age which is significantly higher in men.
Discussion (Include Limitations)
Since men are also older than women, their higher production can be explained by the higher academic age of men. Women tend to have a higher citation impact than men in terms of citations in all groups of age.
Our analysis excludes authors from some countries, especially from East Asia, due to unreliable gender determination of the first names in these countries.
Conclusion
The scientific workforce in physiotherapy is gendered balanced. However, men are older and more productive than women, although the scientific impact of women is higher. The mere measurement of productivity for evaluative purposes could be unfair for women.
Keywords: gender, physiotherapy, bibliometrics
ID 144 – Berg balance scale is suitable for assessment of patients with Guillain–Barré Syndrome at rehabilitation
Aleksander Zupanc
University Rehabilitation Institute, Ljubljana, Republic of Slovenia
Background
Patients with Guillain–Barré Syndrome have balance problems. Berg balance scale (BBS) was primarily developed for balance assessment of older adults. It has potential to use it for patients with Guillain–Barré Syndrome. The purpose was to evaluate convergent validity, responsiveness, minimal clinically important difference (MCID), floor and ceiling effects of BBS in patients with Guillain–Barré Syndrome at rehabilitation.
Methods
One hundred and twenty patients with Guillain–Barré Syndrome and polyneuropathy (aged 57.53 ± 15 years; range 16–85 years) who had completed rehabilitation were included in retrospective study from 2013 to 2018. At admission and discharge of rehabilitation, they were assessed with BBS, ten-meter walk test and six-minute walk test. Spearman’s correlation coefficient, paired sample t-test, effect size, and MCID (using the distribution-based method) were calculated. Floor and ceiling effects were defined with 15% of the minimal or maximal scale score.
Results
The average BBS was 25.1 points (SD 18.5) at admission and 40.6 points (SD 16.4) at discharge. Correlation with ten-meter walk test was very good at admission (ρ = 0.83; p < .01) and at discharge (ρ = 0.80; p < .01). Correlation with six-minute walk test was also very good at admission (ρ = 0.88; p < .01) and at discharge (ρ = 0.81; p < .01). After average 47.72 days of rehabilitation effect size of BBS was 0.9 (Cohen’s d). MCID of BBS was estimated to be nine points. Seven participants were scored with the lowest score of BBS (0 points) and five participants got the highest score of BBS (56 points) at admission. No participant was scored with the lowest score of BBS at discharge and 22 participants got the highest score of BBS at discharge.
Discussion and conclusion
Participants improved balance on BBS average 15.2 points (SD 14). Very good correlations with ten-meter walk test and six-minute walk test confirm convergent validity of BBS. It is highly responsive for changes during rehabilitation. There was no floor effect for BBS at either assessment time. Ceiling effect for BBS was not present at admission, but we identified it at discharge (18.64%). BBS is suitable for assessment in patients with Guillain–Barré Syndrome at rehabilitation.
Keywords: BBS, measurement tool, metric properties
ID 173 – Do the theoretic approach to information searching matter? A review on theoretic models
Daniel Ramskov1, Thomas Kjær2, Hanne Westerkam2, Helle Bønnelykke1, Dorte Drachmann1
1Department of Physiotherapy, University College of Northern Denmark; 2UCN Library, University College of Northern Denmark
Background
Continuous learning is important in physiotherapy, because new knowledge informs practice and advances the field. Working through an information search process is one method of continuous learning. Physiotherapy education should therefore embed theoretic models of the information search process in curriculum. However, theoretic models differ in content across the main tasks of an information search process. This study therefore aimed at describing differences in content of theoretic models focusing on information search.
Methods
A systematic search was performed to identify, publications presenting information search process models, applied in a learning environment, with students at least at bachelor level. The international databases PubMed, Library, Information Science and Technology Abstracts (LISTA) and ERIC were searched in May 2018, complemented by the national Danish databases bibliotek.dk and UC-Viden. Two independent reviewers screened all records for eligibility. Data on search formulation, selection of sources, interacting with sources and presentation of search results were extracted.
Results
N = 1294 records were screened and n = 18 articles meet inclusion criteria. Across the included articles, n = 23 models focused on the information search process. In included models 78% integrated search formulation, 52% included selection of sources, interacting with sources was part of 78% and 60% incorporated presentation of the information. Number of steps in the information search process models ranged from 2 to 11 steps.
Discussion
Important differences exist between theoretic models of the information search process. None of the information search process main tasks were present across all models, with selection of sources most often omitted. The range of steps necessary to complete the process varied greatly. These differences are important to consider when embedding a specific model in physiotherapy education curriculum. Because differences may influence the quality of the knowledge acquired when applying a specific information search process model.
Limitations
Theoretic models in physiotherapy education are often accompanied by teaching, which may contribute to a larger degree of detail in the less nuanced models. The current study could benefit from additional data on the interaction between teaching methods and theoretic models.
Conclusion
Differences in the level of detail and extent exist across theoretic models focusing on the information search process.
Keywords: continues learning, information search, literature review
ID 196 – Deficits of calf muscles strength and rate of force development after Achilles tendon rupture
Vaida Aleknavičiūtė
Šiauliai State College, Lithuania
Background
Calf muscles are important for the daily and high performance activities. The ability to produce a rapid rise in contractile force during the initial phase of voluntary contraction (RFD) is vital for individuals who need to counteract sudden perturbation in postural balance. We performed a longitudinal study of changes in calf muscle isometric MVC torque and RFD development after Achilles tendon repair (ATR) repair.
The aims of study were (1) to estimate the isometric MVC torque and RFD changes during plantar flexion (PF) and (2) to estimate the isometric MVC torque and RFD parameters during PF movements in the injured (IL) and non-injured (NIL) legs at the 1-year follow-up after ATR surgery.
Methods
Eight men who underwent ATR surgery and not less than 10 rehabilitation sessions were included. The subjects performed isometric PF movements at −15°, 0°, and 15°, and the MVC torque of RFD at 30 ms, 50 ms, 100 ms and 200 ms. Each participant performed 5 ankle flexion and extension repetitions. Isometric MVC torque and RFD were measured 7 times over a 1-year period.
Results
The PF muscles isometric MVC torque increased with time (p < .05) in the NIL (−15°, 0° ankle angles) leg and in the IL (−15° ankle angle). The PF muscles RFD increased with time (p < .05) in the NIL (15° ankle angle). After one year isometric MVC torque and RFD during PF remained greater (p < .05) in the NIL than in the IL.
Discussion
From a functional perspective, the increase in RFD is probably the most important strength adaptation afforded by resistance training in subjects with unilateral ATR surgery. Thus, any increase in contractile RFD becomes highly important, as it allows a higher level of muscle force to be reached in the early phase. This is also potentially reducing the risk of tendon re-rupture for subjects after ATR surgery.
Conclusion
Over the first year after unilateral Achilles tendon surgery, the (1) PF muscle isometric MVC torque and RFD increase in non-injured and injured legs. One year after Achilles tendon surgery, (2) calf muscle isometric MVC torque and RFD differences were observed between non-injured and injured legs.
Keywords: MVC torque, RFD
ID 252 – Undergraduate physiotherapy students’ attitudes toward older patients in French-speaking Switzerland
Emmanuelle Opsommer, Odile Chevalley, Philippe Demeulenaere, Irene Pegito
HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland
Background
For educational institutions, positively influencing the attitudes and behaviors toward older people is particularly important to ensure the quality of patient care in the future. Even if physiotherapy students do not demonstrate against attitude they tend to have low interest in working with older adults. The aim of this study, part of a larger, was to assess undergraduate physiotherapy students’ attitudes toward older people in French-speaking Switzerland.
Methods
Students of the three years of the BSc in physiotherapy completed questionnaires including the UCLA – Geriatrics Attitudes Scale (14-item GAS) and the Aging Stereotypes and Exercise Scale (12-item ASES) in one school of health sciences.
Results
One hundred and nineteen students (80 women) responded to the questionnaires, and responses were similar across the training years. Mean UCLA-GAS score was 48.5 ± 4.3. Mean UCLA-GAS score was slightly smaller for first year BSc physiotherapy students (47.2 ± 4.3) than for second and third years (49.2 ± 3.9). A high number of students believe it is society’s responsibility to provide care for its elderly persons (95%) and most old people are pleasant to be with (84%). Mean ASES score was 65.5 ± 6.5 with a positive range (5.5). There was a significant moderate correlation between GAS and ASES. While students believe that physical activity enhances older adults’ physical fitness (97%), spirits (97%) and psychological well-being (97%), few believe older adults are willing to organize their lives to exercise regularly (18%).
Discussion
GAS-scores were in the positive range (3.5) but slightly less positive than in studies with medical students (3.7 on a 5-point scale). Similar to other studies with younger individuals, while students believed exercise might be beneficial and of low risk for older adults, students had no positive beliefs about older adults’ psychological abilities to exercise regularly. In previous studies, older adults reported these beliefs as more positive. As limitation, we cannot generalize the results of this study conducted in a single institution to all French-speaking Switzerland.
Conclusion
In a canton where 20% of its population is over 65, training efforts to focus on improving attitudes toward older adults and increasing specific knowledge and skills of undergraduate physiotherapy students are nowadays still warranted.
Keywords: aging, attitude, education
ID 253 – Physiotherapy students’ perceptions toward the use of social Networking and e-Learning
Garyfallia Pepera, Zacharias Dimitriadis, Savvas Spanos, George Paras, Eleni Kortianou, Nikolaos Strimpakos, Eleni Kapreli
Clinical Exercise Physiology and Rehabilitation Laboratory, Physiotherapy Department, University of Thessaly, Lamia, Greece
Background
The use of social and eLearning media as a teaching and learning tool has been only minimally examined especially in health science education1. Therefore, the main purpose of this study was to identify, for the first time, the impact of Social Networking sites (SNSs) and eLearning platform (eClass) on the education and academic life of Greek students.
Methods
An electronic survey was conducted at the Physiotherapy Department, University of Thessaly, Greece. Undergraduate students (n = 330) were invited via e-mail to complete an anonymous, online questionnaire after providing their informed consent. The survey consisted of 35 questions regarding their demographic characteristics, their opinions SNSs use, their application into education and the use of e-Learning platform (eClass). The ethics committee of University of Thessaly approved this study.
Results
A hundred and four (104) students responded to the survey (56% females). It was found that 99% of students use SNSs and all of them use eClass. The students reported that they use SNSs to communicate with friends (54%), for entairtenment (23%) and for education purposes (5%). Eighty-seven percent of them believe that SNSs are addictive, whereas distraction (46%), low physical activity (18%) and affected interpersonal relationships (15%) were reported as additional negative consequences. Forty-four percent of students believe that SNSs can positively affect learning and education. A great majority (80%) of students reported that further training on SNSs can be highly effective on improving the academic performance and learning. Seventy percent of students supported that applying eClass to the education process is very helpful to construct and share knowledge.
Discussion
The current study revealed that students are familiar with SNSs and that they acknowledge their potential negative effects of their excessive use. On the contrary, students recognize their importance for both communication and education purposes. Most importantly, they highlighted their significance for academic performance and learning suggesting the development of appropriate guidance for their use.
Conclusion
Social networking sites and eLearning platforms comprise an integral part of students’ daily life concerning communication and education that should be accompanied by the development of appropriate guidelines for their optimal and beneficial use in education.
Keywords: physiotherapy students, healthcare education, social networking sites
ID 271 – Beliefs of Surinamese (medical and physiotherapy) students toward low back pain (LBP)
Nancy Ho-A-Tham1,2, Beverly Ting-A-Kee1, Neelam Lachman1, Charissa Jakaoemo1, Rashna Basantram1, Niels Struyf1,2
1Department of Fysiotherapy, Faculty of Biomedical Sciences, Anton de Kom Universiteit van Suriname, Suriname; 2Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Belgium
Background
Beliefs play an important role in the development and management of low back pain (LBP) and disability. Healthcare practitioners appear to have a strong influence on patients’ beliefs. Therefore, the main aim of this study was to assess the back beliefs of students of the Faculty of Biomedical Sciences, Anton de Kom University of Suriname.
Methods
Data were collected from physiotherapy (third year Bachelor and Master) and medical students (third and fourth year Bachelor) students. Beliefs about back pain and its consequences were assessed with the back beliefs questionnaire (BBQ). Other information collected was current history of LBP and knowledge regarding the biopsychosocial approach for LBP.
Results
Overall, 33 physiotherapy and 46 medical students participated in the study. Physiotherapy students had a significantly higher mean (SD) BBQ score compared to their peers in the medical program (34.7 (6.4) vs 29.6 (6.3); p = .001). Interestingly, 76.1% of medical students strongly agreed that LBP should be treated with rest compared to only 18.2% of physiotherapy students (p < .0001). A current history of LBP was present in 24.2% of physiotherapy and 19.6% of medical students. There was no significant difference in mean BBQ score between students with and without a previous or current history of LBP. Significantly more physiotherapy students (90.9%) compared to medical students (2.1%) reported learning about the biopsychosocial approach for LBP during their education (p < .0001).
Discussion
This is the first study to compare beliefs toward LBP among physiotherapy and medical students in Suriname. Research shows comparable results to our study, regarding more positive back beliefs among physiotherapy students compared to medical students. Previous or current experience of LBP had no impact on the beliefs toward LBP in our study. However, evidence on the influence of LBP status on back beliefs is conflicting. Factors such as culture that can shape the back beliefs of an individual were not accounted for in this study.
Conclusion
Physiotherapy students showed more positive beliefs toward LBP than medical students in our study. These results suggest that medical and physiotherapy students were exposed differently to the biopsychosocial model and back beliefs during their education.
Keywords: back beliefs, low back pain, students
ID 278 – Identification of the top actors – institutions and countries – producing research indexed in Physiotherapy Evidence Database (PEDro)
Lidia Carballo-Costa1, Zoe A. Michaleff2, Rodrigo Costas3, Alejandro Quintela-del-Río4, Jamile Vivas-Costa1, Anne Moseley5
1University of A Coruna, Grupo de investigación en intervención psicosocial y rehabilitación funcional, Department of physiotherapy, medicine and biomedical sciences, Faculty of Physiotherapy, A Coruña, Spain; 2Bond University, Faculty of Health Sciences and Medicine. Institute for Evidence-Based Healthcare, Queensland, Australia; 3Leiden University, Center for Science and Technology Studies (CWTS), Leiden, The Netherlands; 4University of A Coruna, Department of Mathematics, Faculty of Physiotherapy, A Coruña, Spain; 5University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Institute for Musculoskeletal Health, Sydney, Australia
Background
Physiotherapy Evidence Database (PEDro) is the largest physiotherapy specific database, and one of the most comprehensive databases indexing published articles which report the results of randomized controlled trials evaluating the effectiveness of physiotherapy interventions.
This study aims to identify scientifically active countries and institutions producing clinical trials, systematic reviews and clinical practice guidelines in physiotherapy, and to analyze and compare their scientific production and normalized citation impact, along with the temporal evolution.
Methods
This is a descriptive and retrospective bibliometric study. We identified all the articles from PEDro published in a peer-review journal in the period 1986–2017, which also have undergone the PEDro inclusion process. To be able to identify producers and to calculate bibliometric indicators, we matched these articles with the Web of Science database through Digital Object Identifier (DOI) and PubMed Identification Number (PMID). Authors used the Leiden Ranking Database to identify institutions and countries which the selected articles were affiliated to. We calculated bibliometric indicators of production and citation impact (normalized indicators), based on the in-house version of the Web of Science database, available at the Center for Science and Technology Studies (Leiden University).
Results
We have identified 29,090 articles suitable for the analysis, produced by 108 countries and 2,590 institutions. The most productive countries are (descending order): United States, United Kingdom, Australia, Canada and The Netherlands. The five most productive institutions are (descending order): the University of Sydney, VU University of Amsterdam, University of Queensland, University of Toronto, and University of Maastricht. The most productive countries and institutions do not always have the highest impact. The temporal evolution shows changes both in productivity and impact of the main countries and institutions.
Discussion (Include Limitations)
The methodology used for the identification of actors and the calculation of the indicators allow us to compare countries and institutions reliably, but it does not allow us to include all the publications indexed in PEDro.
Conclusion
The most productive countries and institutions are not always related to high average citation impact, which suggests that the mere measurement of production is not enough to identify high scientific impact in research.
Keywords: research production and impact, physiotherapy, bibliometrics
TRACK 4: COVID-19
ID 287 – Evaluation of satisfaction of sport physiotherapy students with distance learning of orthopedic practical skills during COVID19 pandemic
Sebastian Martín-Pérez
Faculty of Health Sciences, Universidad Europea de Canarias, Tenerife, Canary Islands, Spain
Background
The emerging COVID19 pandemic has forced us to move from a face-to-face model toward a distance learning education in Physiotherapy. Although the acceptance of students of practical orthopedic learning in classroom has been previously studied, we still do not know their satisfaction about practical skills learning developed virtually at home.
Objective
To evaluate the satisfaction of sport physiotherapy students with practical orthopedic skills carried out through distance learning Method: A descriptive cross-sectional study was done with a total of 20 students from second (n = 8) and fourth year (n = 12) randomly selected (GraphPad®). Free online videos from Youtube, presentations from Slideshare and open research papers were used to elaborate the practical virtual sessions. Students enrolled in six synchronous virtual sessions of two hours of duration about orthopedic assessment and management of sport injuries (BlackBoard®). At the end of every session, a clinical case discussion was carried out. They were evaluated with a 10-minute live interview in which they had to solve a clinical case and simulate an evaluation and treatment technique. Finally, the Student Outcome Survey (Socrative®) was sent by e-mail to know their satisfaction with this novel methodology.
Results
Overall satisfaction was high (M = 7,9/10, SD = 1.3). They reported as advantages saving of mobility expenses (n = 4) and the possibility of reviewing the recording of the virtual session (n = 16). In contrast, the majority indicated as disadvantages the lack of active participation (n = 12) and manual contact and technical procedures learning (n = 18). Regarding the practical evaluation, a half of the participants were satisfied with the method used specifically with the adequacy of the content and the given time (n = 10). Moreover, all of them agreed to be asked to have a companion to take the virtual practical exam (n = 20).
Conclusion
The adaptation of practical knowledge learning through synchronous virtual distance sessions is globally satisfactory for sports physiotherapy students. However, more research is needed because the absence of face-to-face practice and the lack of active participation during virtual sessions seem to notably affect student opinion about distance learning education.
Keywords: practice, education, COVID-19
ID 288 – Course changes due to COVID bring about stronger relationship with physiotherapy society
Abigail Grover Snook
University of Iceland, Iceland
Problem statement
Normally, 25% of the final grade in the Therapeutic Modalities course at the University of Iceland physiotherapy program is based on an oral presentation at a seminar of a recent (since 2017) evidence-based research article involving a therapeutic modality. Most articles presented are randomized controlled trials or systematic reviews. The seminar was open for others to attend but was rarely attended by anyone outside the course. This course was disrupted by COVID, requiring all teaching for the last third of the course to be online as well as this research article presentation.
Objectives
For students to benefit from the learning experience of reading and presenting a therapeutic research article and to share this information with others who could benefit from the information.
Methods
Instructions for the presentation were amended so that students recorded their presentation in the Studio function of CANVAS. Students were given instructions in Studio and examples of good presentations. After grading and student consent, mp4 recordings were made available to the Icelandic Physiotherapy Society to be displayed on their inner web as a form of educational material.
Outcomes
Students gained experience reading and presenting therapeutic modality research as per course outcomes and learned how to use Studio. The quality of the presentations was good to excellent and was approved by the Icelandic Physiotherapy Society to be published on their inner web. The Society indicated a desire to continue this sharing of information in future years and indicated interest in other similar cooperation between students, the university, and the Society.
Reflection
The changes to this seminar due to COVID caused reflection on how these presentations could be useful to others besides the students. Most students were happy to contribute and share their presentations with other physiotherapists in Iceland. The sharing of the presentations with the Society was welcomed and more cooperation was encouraged, indicating the growth of a stronger relationship with the society of physiotherapists here in Iceland. We hope this type of cooperation will continue.
Keywords: online presentation, cooperation
ID 290 – Coping with COIVD-19 – Keeping students on track
Beate Salchinger, Sabine Eichler
FH JOANNEUM Graz, Austria
Problem Statement
Communication with students can be applied as an effective tool for detecting problems, and for solving these problems in a clear and structured way. A structured approach is a prerequisite to come to an agreement, especially in demanding situations. Face to face communication, both formal and informal, was interrupted during the period of the overall lock-down with the accompanying change to only online classes and communication.
Aims and objectives
To implement a clear and structured way of online communication with 190 students of all three cohorts, to ensure ongoing information about and ownership of processes, to allow possibilities to ask questions and express worries, to assure early error detection and correction, to generate a positive spirit when dealing with challenges, with the overall aim to finish the study year without delays for students resulting from the adjustments to COVID-19.
Methods
A weekly compulsory update session was introduced beginning with the first week of the lock-down. Using management tools for virtual leadership, these sessions focused on establishing trust, providing assurance and positive spirit, exchanging transparent information, enabling communication and connecting relevant players, i.e. students, degree program management, and administration. The sessions began with information provided by the head of the degree program, which was followed by a questions and answers session for students, thus ensuring all topics were covered and information was understood.
Outcomes
Specific rules for the communication process during the update sessions were implemented ensuring a clear structure within sessions. As a result of these sessions, the number of additional questions posed to the administration and management was limited. Students’ feedback was very positive about the weekly update sessions. There is a clear request from students to implement these sessions in the next study year, too.
Reflection
In times of uncertainty, it is the management’s responsibility to give guidance and provide for process security to support students in their learning process. Ongoing information and feedback about success, errors and the reactions to errors help students to understand the challenges and processes implemented to overcome them. Creating ownership facilitates a motivating environment to deal with new situations.
Keywords: COVID-19, communication, virtual leadership
ID 295 – Evaluating a new online program to support physiotherapy clinical educators
Alice Toepritz, Jacqueline Shanley
Coventry University, United Kingdom
Problem statement
COVID-19 has caused high levels of disruption to physiotherapy education, including severe restriction of face to face teaching. However, clinical educators who supervise physiotherapy students on practice placements still require access to educational support from academic partners
Objectives
To create an online program to support clinical educators
To evaluate the experiences of clinical educators’ engaging with the online program
To evaluate the value of specific online activities
To highlight priorities for further development
Methods
A clinical education website was developed by academic staff aimed at supporting clinical educators, providing access to a range of videos and guidelines on topics including assessment, models of supervision and supporting mental health and well-being on placement, as well as a discussion forum. Educators were sent a link to the website, with instructions and invited to engage with the material.
An online questionnaire was developed for completion by clinical educators after accessing the program. Ethical approval was sought from Coventry University. To gain an insight into educators’ experiences, qualitative feedback has been sought (Creswell 2013). In addition, Likert scales are included to evaluate the value of specific resources. Qualitative data will be analyzed through thematic analysis (Braun & Clarke 2006) and quantitative data will be analyzed using descriptive statistics.
Outcomes
Changes were made in response to feedback to enhance usability. Activities perceived as useful expanded and those seen as less helpful replaced with more appropriate material. Attention was paid not only to the content of resources but the delivery format to identify the best platforms for future development. An action plan was created for further data gathering and analysis to gain feedback on proposed improvements.
Reflection
Online resources were created quickly, in response to a crisis. However, the new innovative program provided an opportunity for educators to access up to date information in a flexible manner whilst having students working with them on placement. Having benefitted from timely feedback, this new resource represents a responsive platform which will allow future developments to be implemented rapidly.
(References will be added to presentation/poster; not included here due to word limitation)
Keywords: clinical education, online
ID 299 – Exploring Physiotherapy Student’s Perspective of the Educational Environment in the Era of COVID-19
Brad W. Willis1,2
1Department of Physical Therapy, School of Health Professions, University of Missouri, Columbia, MO. USA; 2American Council of Academic Physical Therapy, USA
Problem statement
Student’s educational environment (EE) perception is a crucial pedagogical domain associated with well-being, academic achievement, and program completion. COVID-19 has required physiotherapy educators to rapidly pivot to online platforms to safely deliver educational strategies. Unfortunately, few investigations have examined differences in physiotherapy student’s EE perception during the COVID-19 era as compared to traditional teaching and learning approaches.
Aims/Objectives
To enhance program delivery, this study aims to explore physiotherapy student’s EE perception of online learning during COVID-19 compared to traditional teaching strategies. Objectives included (1) measure physiotherapy student’s EE perception using the Dundee Ready Educational Environment Measure(DREEM) and (2) compare DREEM scores between two-consecutive first-year physiotherapy student cohorts, one receiving instruction during the COVID-19 era and one receiving traditional teaching strategies.
Methods
This cross-sectional survey design study included two consecutive physiotherapy first-year cohorts in the Midwestern United States, one receiving two months of asynchronous and synchronous online learning strategies amid COVID-19 (INT = 33, response rate 55%) and one receiving traditional in-class didactics with an integrated clinical experience (CON = 56, response rate 93%). The DREEM, a reliable and valid, 50 item Likert-type inventory measured the EE via overall score (151–200 = an excellent environment) and five subdomains including perception of atmosphere, teachers, learning, as well as academic and social self-perceptions. Both groups completed the DREEM at the end of program year-one, CON via paper and INT online via QualtricsTM. Differences in overall and subdomains were examined using independent t-tests, with the Mann–Whitney U test used for non-parametric findings. Significance accepted at p < .008 following a Bonferroni correction.
Outcomes
Results reported as mean±SD, with only social self-perceptions demonstrating non-parametric findings. No differences observed in overall score, with both reporting an excellent EE (INT = 161.3 ± 14.6; CON = 167.3 ± 18.0,p = .11). Similarly, no differences seen in perception of learning (INT = 39.8 ± 3.7; CON = 40.8 ± 5.3,p = .36), teachers (INT = 38.7 ± 3.6; CON = 39.0 ± 4.0,p = .72), atmosphere (INT = 38.5 ± 4.0; CON = 40.3 ± 4.5,p = .62), and social self-perception (INT = 21.5 ± 2.7; CON = 21.7 ± 3.8,p = .76). Conversely, INT reported decreased academic self-perceptions (INT = 22.7 ± 2.8; CON = 25.4 ± 3.1,p < .001), centered on workload management concerns, inability to use prior learning strategies, and a desire for more active learning.
Reflection
Underscoring programmatic strengths and opportunities for improvements amid COVID-19, although EE perception overall remained excellent with no change in four of five subdomains, academic self-perception decreased. Consequently, additional strategies to enhance workload management and clinically driven active learning strategies are warranted.
Keywords: COVID-19, educational environment, physiotherapy
ID 302 – A National Approach to delivering Physiotherapy Practice Placement during COVID-19: The Irish Context
Marie O’Donnell1, Lucy Alpine2, Helen Heery3, Sinead McMahon4, Denise O’Callaghan4, Aidan O’Shea5
1University of Limerick, Ireland; 2Trinity College Dublin, Ireland; 3Royal College of Surgeons, Ireland; 4University College Dublin, Ireland; 5University College Cork, Ireland
Practice placements are an integral part of physiotherapy professional education. Placement provision requires engagement with multiple agencies and needs to be tailored to individual services. On March 12, 2020, following the announcement of a national lockdown due to COVID-19 in Ireland, all ongoing and planned physiotherapy student placements were suspended with immediate effect. Five Higher Education Institutes (HEIs) delivering seven pre-registration programs were affected. The HEI’s sought an agreed understanding as to how placements would be delivered nationally.
The aims of the project were to agree a national framework for physiotherapy placements during COVID-19.
Practice education co-ordinators formed a working group with representation from each of the HEIs. A mapping process was conducted to determine the impact of the suspension of placements nationally. Directives from professional regulators, professional bodies and employer groups were considered. The framework considered models of blended teaching and learning and an assessment approach that reflected the adaptability required to deliver healthcare during a global pandemic. The process ensured alternative placement models that met the standards of proficiency for physiotherapy practice.
A framework document entitled “Physiotherapy placements during COVID-19 in Ireland (V1)” was created. The key points in the document were: a mixed model of placements with onsite and offsite teaching and learning activities, additional pre-placement training to prepare students for the specific demands of the current clinical environment, telehealth as a service delivery model, acceptance of extended working hours and days for students as part of normal practice and the continued use of the national Common Placement Assessment Form (CAF) as the standard for placement competencies, with a collaborative grading approach. This document was used as a reference point to allow changes in placement delivery models.
Practice Education Co-ordinators in Ireland adopted a partnership approach to overcome a significant difficulty facing Irish HEIs and to provide leadership in a time of crisis with the formulation of a common placement roadmap. This project fostered a solution-oriented approach, with shared learning, understanding and a pooling of resources and intellectual capital that resulted in a partnership that will serve to improve practice education for all stakeholders.
Keywords: practice education, collaboration, framework
ID 303 – Delivering physiotherapy practice placements during the COVID-19 pandemic
Marie O’Donnell, Jimmy Burke, Andrea Dunne, Alison Holmes, Jane Kavanagh, Lexi Keating, Elaine Kelly, Sarah Kennedy, Scott Murphy
University of Limerick, Ireland
Problem statement
Ireland announced a national lockdown due to COVID-19 on March 12, 2020. All ongoing and planned physiotherapy student placements were canceled with immediate effect. At the University of Limerick, final year student placements, from both the MSc and BSc programs, were effected. Concurrently there was a national recruitment campaign for healthcare professionals and workforce capacity issues were identified. A pathway to graduation was necessary.
Objectives
The aims of the project were to
Design a new model of placement delivery that ensured access and equity for students and complied with the accreditation standards.
Implement a blended teaching learning and assessment approach that could be adopted by all.
Methods
A project team was established. Required learning outcomes were mapped to the achievable teaching and learning activities. Engagement with external stakeholders in the community, including health services and voluntary bodies was necessary. The team followed a framework to identify telehealth as a service delivery option and establishing governance pathways for implementing these projects. Project review and modifications were necessary and facilitated by a weekly meeting. Stakeholder feedback was considered using online questionnaires for students and clients.
Outcomes
Forty-four final year placements were delivered. The placement design used a blended teaching and learning approach with onsite and offsite opportunities. Student-led telehealth clinics were established in partner sites and remotely. Policy, guideline documents and standard operating procedures were created. Stakeholder feedback from students and service users was vital in ensuring a quality experience was created.
A reflection
At all levels of society, adaptability was required. The framework for these placements evolved in response to the situation in real-time. The rhetoric from the WHO of “speed trumps perfection” was also true in this case. Pilot projects proved that student competencies could be met, but further development is needed. Feedback from the students allowed adjustments to circumstances as they evolved.
Keywords: placement design, telehealth, adaptability
ID 304 – Pilot Study: Learning skills questionnaire of Sports physiotherapy module during the COVID-19 pandemic
Eleftherios Paraskevopoulos, Maria Papandreou
University of West Attica, Greece
Problem statement
The ongoing coronavirus led Universities around the world to progressively impose social distancing measures. Mass closure of universities, including physiotherapy departments, was one of the necessary measures that aimed to slow down the spread of the virus with great impact on students’ learning skills. Physiotherapy departments in Greece moved, to a greater extent, theoretical and lab-based modules online.
Objectives
The aims and objectives in seeking to solve the problem: The aim of this pilot study survey was to examine undergraduate physiotherapy students’ learning skills to online delivery of the Sports Physiotherapy Module (SPM), in order to provide organization and processing information of this recommended COVID-19-time management strategies.
Methods
Our data derived from 45 undergraduate students of the Physiotherapy department of the University of West Attica in Greece. The students were at the 3rd year of their study and between a total of the 9th of the 13th courses (June semester 2020). This protocol was the adaptation of a theoretical and practical background, utilized in previous studies (1,2,3,4) and it was divided into 4 factors (time management, organizing and processing information, study aids and noting information, motivation and attitude) of 12 items scaled in highest and lowest scores. The questionnaire included 12 questions using Likert-type scales (1 = None at all; 6 = Too much). Cronbach’s coefficient-α was used to calculate the internal consistency coefficients of the items included in the questionnaire for each factor.
Outcomes
The results showed a good level of internal consistency for the three factors with a Cronbach’s alpha analysis of 0.75 on organizing and processing information, 0.76 on study aids and noting information and 0.73 on motivation and attitude (5). However, internal consistency was not acceptable for time management (Cronbach’s alpha 0.57).
Reflection
The results of this pilot study indicate that the online education in SPM is suggested as a learning facilitator during the pandemic. Distance learning approaches should be employed in similar circumstances in order to enhance our academic work. This new scale may be used to explore differences in students’ perception and attitudes toward their multi‐professional learning skills. Further work is necessary to validate the scale amongst a larger population.
Keywords: sports physiotherapy module, COVID-19, learning skills
ID 307 – Remote, not distant: creating quiet writing groups via Microsoft Teams
Charlotte Pereira, Harriet Shannon
UCL Great Ormond Street Institute of Child Health, United Kingdom
The COVID-19 pandemic saw universities move from face-to-face teaching to distance learning. Seminars that traditionally took place in large lecture theaters were adapted for the online classroom. Whilst these were successful, it was acknowledged that the full university experience extended beyond classroom teaching. Students missed the opportunity to form study groups, as they normally would in the university library. We aimed to facilitate an online writing group that would enhance the students’ learning.
We invited postgraduate physiotherapy students to join us on Microsoft Teams for a weekly writing session, lasting a total of 90 minutes. The first 10 minutes involved a welcome from a lecturer and informal conversation between students. Students were then encouraged to keep their cameras on and undertake 2 × 30 minute sittings of quiet writing, with a 10 minute break in between. The lecturer acted as timekeeper. Although there was no prescription as to the nature of the writing, students were generally working on the same summative assessments at the same time. During the break, students could go off camera or stay for casual discussions with their peers. The lecturer was available to answer questions, but generally encouraged peer-to-peer communication. At the end of the second sitting, students were invited to stay on-line for a further 10 minutes for further discussion.
Students were positive about the opportunity to write alongside their peers. One said, ‘it is so hard to motivate myself when it’s just me and my laptop. These sessions really helped,’ and another, ‘I enjoyed looking up from my writing and seeing the faces of my friends hard at work. It spurred me on.’ Students reflected on the benefits of relatively short bursts of writing, and some adopted a similar approach for their own studies going forward.
Most of our full-time overseas students returned to their home countries at the beginning of the COVID-19 pandemic. During this period of upheaval, many felt isolated from their peers and demotivated. Quiet writing groups facilitated a sense of community beyond the classroom, providing teaching staff the space and time to support students whilst they completed assignments alongside their peers.
Keywords: distance learning, postgraduate education, writing groups
ID 308 – A massive open online course (MOOC) as an educational response to the coronavirus disease 2019
Nicole Beamish1,2, Rachael Lowe2
1Canadian Physiotherapy Association, Canada; 2Physiopedia, United Kingdom
Problem statement
On March 11, 2020, the World Health Organization (WHO) declared the coronavirus disease 2019 (COVID-19) a pandemic with over 123 countries around the world being affected by the disease. Physiotherapists have a vital role in managing the impact of this disease but needed access to the knowledge and resources that would allow them to play a proactive role in global and local efforts to reduce the impact of the pandemic.
Objectives
To create a massive open online course (MOOC) relevant to all rehabilitation professionals, which aimed to assist in the understanding, identification, containment, mitigation and treatment of COVID-19.
Methods
On March 16, 2020, Physioplus responded to the global need for information by creating and hosting a MOOC. The coronavirus disease program is a free, online program that contains approximately 10 hours of learning over four modules: (1) understanding coronavirus disease, (2) infection prevention and control, (3) role of physiotherapy in COVID-19, and (4) respiratory management of people with COVID-19 Participants perform learning activities, which include online reading activities, videos, quizzes and optional participation in reflective writing using online discussion boards.
Outcomes
Between March 16 and May 10, 2020, 166,870 participants from 214 countries engaged with the program. Ten thousand one hundred and two individuals completed the first module; 5,813 completed the second module, 6,525 completed the 3rd module and, 4,540 completed the final module. Over 170,000 learning activities were logged over eight weeks.
Reflection
During the COVID-19 pandemic, free access to accurate and up-to-date information is imperative. A MOOC targeted at rehabilitation professionals can be an effective strategy to reach a large number of individuals from across the world during a pandemic.
Keywords: e-learning, rehabilitation
ID 309 – Student-generated video creation for the assessment of communication skills
Claire Stapleton
Chartered Society of Physiotherapy, United Kingdom
Problem statement
The pressures placed on Practice Educators during the COVID-19 pandemic resulted in the cancellation of many practice-based placements for pre-registration physiotherapy students and the need to devise alternative means of meeting the intended learning outcomes.
Objectives
A number of online assessments were designed; the aim of one was to provide the students with the opportunity to critically reflect and compare aspects of effective communication and interactions with patients.
Methods
Students were required to create a video of themselves providing guidance for a simulated patient on one aspect of their physiotherapy management plan. The task was to create two videos (2–5 minutes duration) to highlight any differing communication strategies that would be employed to effectively convey the same aspect of the management plan for (1) an anxious 8 year old girl and (2) an 80 year old male who is hard of hearing.
Outcomes
The explicit intended benefit of the task was to induce critical thinking and consideration of communication strategies for patients with differing characteristics. However, the implicit intended benefits of video creation are related to digital literacy. A key aspect of the Digital Literacy Capability Framework (2018) is promoting a positive attitude toward change, technology and innovation. Evaluation of the task demonstrated a shift in how comfortable students felt when working with new technology; prior to the task, 26% reported feeling ‘uncomfortable’ compared to 8.6% after the task. In addition, after the task students reported higher levels of confidence in all technical aspects of video creation as well as communication as a health professional.
Reflection
The assessment was successful in promoting skills in both communication and digital literacy. The ability to communicate effectively using digital media is increasingly critical for the current generation of healthcare students. The processes involved in video creation (preparing a script, consideration of body language, voice tone, pitch and pace, facial expression, language used) and review/editing of material involve several stages of repetition and reflection that met the aims of the task.
Keywords: communication, digital literacy, technology-enhanced learning
ID 310 – Adaptation of a Service-Learning Program of Final Physiotherapy Degree Project to COVID-19 pandemic
Sara Pérez-Palomares, Carolina Jiménez-Sánchez, Mª Pilar López-Royo, Almudena Buesa Estéllez, Rocío Fortún Rabadán, Patricia Jovellar Isiegas, Marina Francín Gallego, Raquel Lafuente Ureta, Sandra Calvo
Universidad San Jorge, Zaragoza, Spain
Problem statement
The Final Degree Project in Physiotherapy Degree must focus on key content of physiotherapy theory and practice and also has to demonstrate competencies in research, development and professional communication skills. To achieve this, students can develop their Final Degree Project carrying out a Service-Learning program (SL) named “Beyond Physiotherapy: Active Teaching through the Development of Service-Learning Projects” with patient associations. Because of COVID-19 situation, the contact between people has been disrupted for several months, unabling the normal implementation of these projects.
Objectives
On-site health education conferences could not be conducted, and it was proposed to do them online, in order to generate or increase knowledge on physiotherapeutic treatment in some pathologies.
Methods
Due to the COVID-19 pandemic, some SL programs through awareness educational campaigns were adapted to an online platform. A qualitative approach (descriptive phenomenology) was used to describe the perspectives of the participants. Student reflections on their SL experiences were identified through a student reflection journal. In addition, a virtual focus group and semi-structured interviews were implemented to collect opinions of associations’ members about the SL program. Data were analyzed using thematic analysis through Systematic Text Condensation.
Outcomes
Students answered questions related to the selection of the project, the service they had to do, why it was necessary and if new perspectives had been generated. They concluded that they had learned so much about the experience and reported a change after their informative sessions.
The questions of the focus group and the patient’s interviews asked about the general opinion of the development of the online interventions. The results were composed of three subthemes: increasing knowledge, close and accessible communication and thanks and congratulations.
Reflection
According to our results, carrying out a health promotion SL program through an online educational theoretical conference allows students to serve to the community, as well as it enables patients to acquire new knowledge related to the treatment of their pathology.
Keywords: service-learning, higher education
ID 313 – Innovation in clinical placement – Design Implementation and evaluation of an ehealth/telehealth placement at University College Dublin during COVID-19
Sinead McMahon, Frank Kenny, Ciaran Purcell, Caitriona Cunningham
University College Dublin, Ireland
Problem statement
Across the world, the outbreak of COVID-19 has changed the way that healthcare services operate. For student physiotherapists in Ireland, the COVID-19 outbreak resulted in all traditional face to face clinical placements being canceled. In response to this challenge, the practice education team developed an eHealth/telehealth alternative allowing their students to continue their learning to achieve their placement outcomes in line with statutory and professional body requirements.
Objectives
The aims and objectives of this study were to design, implement an ehealth/telehealth module and to evaluate students’ confidence in their knowledge, skills and attitudes required for telehealth.
Methods
The module design was informed by the framework for ehealth capabilities for health science students (Bruner et al. 2018). The learning outcomes and competencies were developed using guidelines from the WCPT (2020) and van Houwelingen (2019). The module consists of 10 weeks; this study reports the outcomes from weeks 1–5. All sessions were delivered online to 91 students in 4 different countries.
Outcomes
An adapted version of the KSA survey instrument developed by van Houwelingen et al. 2016 was used to measure students’ self-confidence in their knowledge skills and attitudes required for telehealth pre and post.
Results
Significant differences were found from week 1 to week 5 scores. All students demonstrated that confidence in their knowledge skills and attitudes required for telehealth improved. Overall students were very satisfied with the eHealth/Telehealth module.
Conclusion
The importance of including eHealth/telehealth in the undergraduate curriculum has been widely accepted. The impact of COVID-19 demonstrates the urgent need for graduates to be equipped with the relevant knowledge skills and attitudes needed. Not only has this the potential to help with the future demands on placement capacity but it provides purposeful and valuable learning for students.
Reflection
Development of this module was made possible because of the existing University College Dublin (UCD) Physiotherapy hub at UCD Sport. Students experienced academic staff in collaboration with clinical staff from partner sites, responding in real time to their current and future educational needs as healthcare professionals.
Keywords: Ehealth, telehealth, placement
ID 314 – COVID-19: the opportunities for innovations in Higher Education
Glykeria Skamagki, Timothy Ishaku, Cassie Hayes
School of Nursing, Midwifery and Health, Coventry University, Coventry, United Kingdom
Problem statement
Higher Education providers have faced unique set of challenges from the coronavirus pandemic. Given the new rules on social distancing, traditional face-to-face teaching was impossible for the physiotherapy courses. As teaching and learning needed to evolve with future real-world skills, COVID-19 presented a unique opportunity to engage with technology. A practical exercise module ‘Movement analysis and exercise’ was flipped online to actively engage a large cohort providing a holistic approach to the theory and online practice relating to exercise prescription.
Objectives
To address the challenge of remote teaching and assessing exercise prescription online using software technology and to provide an inclusive learning environment to all students.
Methods
Each week’s learning materials were uploaded online in advance. An interactive webpage (Adobe Spark) was used to provide a narrative to allow students with learning difficulties to engage with the relevant topics. The pre-learning session consisted of 30–45 min video resources and/or use of other digital tools such as HP5, Screencastomatic, Tophat and Kahoot. Exercise prescription was delivered with the use of clinical cases and the Physiotec Software. Students were provided with images, and videos which were linked to exercises. The software included an editable step-by-step instruction approach allowing students to adapt each exercise. Feedback was given each week and an asynchronous chat room was provided for peer support. The assignment reflected authentic clinical problems and required critical thinking and reasoning in combination to the software use.
Outcomes: Students reported over 90% satisfaction rate with the module and highlighted their preference into new technology and online learning. Interaction with peers and tutors, and flexibility, were the most positive factors. Self-perceived learning outcomes and students’ experiences were also collected in informal discussions and the module evaluation questionnaire.
Reflection/Recommendation
Students responded positively to the collaborative learning environment, especially with respect to the associated autonomy and flexibility. We found this new way of assessing exercise prescription effective, as it mimics the real-life practice. Moving into telehealth, the use of digital software can enhance the IT literacy of students and prepare them for the new practice environment.
Keywords: exercise prescription, online learning, digital practitioner
ID 322 – Using video analysis to assess the feasibility of physiotherapy clinical interview evaluation
Raquel Irina Medina Ramírez, Irene García-Rodríguez, Marlene García-Quintana, Martin Vilchez-Barrera, David Álamo-Arce
Physiotherapy, University of Las Palmas de Gran Canaria, Spain
Problem statement
Technologies make it possible to remove spatial and temporal barriers, they also permit more people to access training and education. In addition, it allows the use of multimedia and internet technologies in different settings for university teachers, in the same way, it approaches traditional educational settings to incorporate ICT into university education. The usefulness for teachers and students can be applied in the competence-based teaching and learning clinical tasks in order to improved physiotherapy skills through online learning in case of lockdown period.
Objectives
The aim of this research is to study the feasibility of incorporating information and communication technologies (ICTs) based on the video-analysis of clinical interview skills in the clinical interview process in physiotherapy and the evaluation of the task through a checklist.
Methods
An evaluation of physiotherapy clinical interview was carried out through a checklist based on three-dimension; confident, suitable questions and active listening. We used video analysis to assess competency-based learning results. Inter-observer agreement and external validity of the checklist (12 items) used were also analyzed.
Outcomes
The confidence and active listening dimension were achieved by the 97% of the student. We also identified difficulties for suitable question dimension, only 45.7% of the student registered correctly, and for final summary to explain the patient (14% of the student developed this dimension). The video analysis allowed to obtain quick information about the learning results, and we demonstrated the external validity of the tool developed.
Reflection
The incorporation of video analysis for a physiotherapy task, sample collection as well as the use of the tool by several teachers (evaluators) was feasible. The video-recorded evaluations suppose a valid measurement tool of the chosen clinical ability identifying the deficiencies in the analyzed learning results. In addition, it could become an interesting tool to use for online learning (in a new pandemic situation) which the student can video-recorded their practice, send to teachers to be evaluated and offer a feedback of their skills and competences.
Keywords: video analysis, physiotherapy, clinical interview
ID 323 – How to adapt a one-week presential workshop in a European education project: the “PETRHA+” COVID-19 experience
Alejandro San Juan Ferrer1, Catherine Romanus2, Robert Michaël2, Tiina Pystynen3, Claudia Silva4, David García-González1, Olivier Vossen2, Maria Maljanen3, Severine Despons5, Emilia Fernandez5, Alan Le-Coniat5, Helene Pelegris5, Stephanie Saurois5, Hugo Couderc6, Sophie Alex-Bacquer5, Chloe Ducourneau5, Eric Ranvial5, Bruno Suárez-Luginick1, Enrique Navarro1, Txomin Pérez-Bilbao1, Rui Macedo4, Bruno Albouy5
1Universidad Politécnica de Madrid (UPM), Spain; 2Haute école libre de Bruxelles Ilya Prigogine (HELB), Belgium; 3Tampere University of Applied Sciences (TAMK), Finland; 4Instituto Politécnico do Porto (IPP), Portugal; 5Institut Régional de Formation Sanitaire et Sociale Nouvelle Aquitaine (Croix-Rouge Française), France; 6SimforHealth, France
Problem statement
PETRHA+ (Physiotherapy E-Training Re-Habilitation) is a European Erasmus+ project (2018-1-BE01-KA203-038581) focused on the development of three intellectual outputs for physiotherapy students: (1) Clinical simulation video game (i.e. based in real patients with specific pathological content and context); (2) Clinical reasoning massive online open course (MOOC); (3) Clinical reasoning evaluation tool. The main aim of PETRHA+ is to strengthen the training of clinical reasoning skills for all the European physiotherapy students. The project started in September 2018 and will end in August 2021. In PETRHA+ participate five universities and one informatic enterprise from five European countries (Belgium, Finland, France, Portugal, Spain). We have planned five days “Summer-class” exchange with students and teachers in Bordeaux (France) in May 2020. However, the COVID-19 pandemic made it impossible.
Objectives
The aim of the project team was to continue with the development and evaluation of PETRHA+ despite the cancellation of the “Summer-class” workshop due to COVID-19.
Methods
We decided to keep the initial meeting dates and implement an adapted on-line schedule with (1) Multiple rooms (i.e. 1 Student group and 1 teacher/room); (2) Sharing sessions (i.e. Various student’s groups and teachers/room); (3) Reflection sessions (i.e. All the teachers). At the end of the five days workshop, all the students filled a technical oriented satisfaction survey.
Outcomes
Thirty-one European physiotherapy students and 12 teachers participated in the adapted online workshop. The amount of work hours during the five days was 30 hours. The participation data were improved by ≈300% for students and 240% for teachers and the amount of work hours were equal compared to what was initially planned for the face-to-face meeting. We found in the satisfaction survey the students reported that distance learning was a good replacement for presential learning in this COVID-19 context (score ≈88/100).
Reflection
In PETRHA+ project the adapted on-line educational workshop due to COVID-19 has enhanced the students and teachers participation and has achieved the objectives and quality initially planned. Moreover, it has diminished the costs related to travel (e.g. Flight, accommodation, support, personal time, and ecological print).
Keywords: COVID-19, on-line education, physiotherapy
ID 331 – Delivering an In-House Physiotherapy Clinical Placement During Covid-19 – The Challenges, Innovations and Student Perceptions
Caroline Nichol, Helen Edwards, Victoria Pearsall
School of Allied Health Professions, Keele University, United Kingdom
Problem statement
During the COVID-19 pandemic, the Chartered Society of Physiotherapy advised that first year undergraduate students should continue their studies by distance and virtual learning, pausing clinical placements the academic year. Students due to undergo their first three-week placement were unable to gain valuable hours and experience in the usual clinical environment. The challenge was to design an innovative alternate method of online teaching and assessment providing students a simulated and comparable to the intended practice education.
Objectives
The aims were to design an in-house module that delivered teaching and assessment strategies that were constructively aligned to the intended learning outcomes of the first year clinical placement.
Methods
The clinical placement and opportunities this provides were replicated in the academic environment over the placement duration using innovation and technology to include simulation, video cases, synchronous and asynchronous online learning, role play and peer group working to emulate MDT working, communication, professionalism, patient assessment and management and record keeping.
An online questionnaire was designed and implemented evaluating anonymized student perceptions of the in-house placement. Seventy-nine students were invited to complete the questionnaire.
Outcomes
Overall students reported that it replicated placement experience and gave opportunity to progress skills for the future and aided in academic progression. Overall students agreed that it allowed them to develop skills and knowledge in professionalism, communication theories and application in the clinical setting, personal development, patient assessment and management and MDT working. Although student evaluation was positive overall, there were some challenges in fully replicating experience in practice such as record keeping.
Challenges for staff and students included timeframes for design and approval, students confidence and competency with technology and learning in a virtual environment and time zone differences for student engagement and group working.
Reflection
Whilst delivering an in-house placement does not replace experience clinically, students reported benefits to the innovative approach that will prepare them for future practice.
Keywords: practice education, innovation, technology
ID 338 – Evaluation of two models of remote physiotherapy placement in technology-enhanced care services
Laura Smith, Lorna Johnson, Kate Bazin
Kings’ College London, United Kingdom
Problem statement
As the UK went into lockdown in March 2020 140 Practice Education placements were required by the KCL Physiotherapy department for students to either graduate or progress into their final years of studies. Several students were not able to opt-in in the Health Education England face to face placement scheme; either for personal shielding reasons, shielding family, care responsibilities or because they had traveled internationally to return to their family homes.
Objectives
To explore Physiotherapy student and Practice Educator experiences and satisfaction rates of two novel remote placement models within Musculoskeletal technology-enabled care services (TECS).
Methods
Model A: ‘Traditional’ Remote placement, 4 students, 5-week placements. One hundred percent remote working using MS Teams and Attend Anywhere consultation software.
Model B: ‘Project-based’ Remote placement. Forty-five students, 170 hour flexible working placement, 100% remote working using MS Teams, Facebook live and teleconferencing platforms.
Phase 1: Students and educators surveyed pre and post placement exploring, satisfaction, preparedness and feedforward planning for subsequent student cohorts.
Phase 2: Focus groups
Outcomes:
Phase 1: Data collection ongoing
Model A Students:
100% felt prepared
outline concerns around ceiling limits if potential learning opportunities on the placement.
Model A Educators:
100% felt prepared
concern about the lack of opportunity to demonstrate practical skills
Model B Students:
83% of students felt prepared
outline learning opportunities around varied clinician exposure
gratitude for flexible working models
Model B Educators:
46% of educators felt prepared for the placement
outline concerns about students not getting a ‘true’ exposure to typical MSK practice.
Phase 2: Focus groups not yet commenced
Reflection
Gilbert et al. (2020) outline the rapid implementation of TECS NHS MSK services as a response to the Covid-19 outbreak. Our work explores the parallel implementation of Physiotherapy student practice-based learning placements in similar NHS settings. Initial concerns about loss of MSK skills in these settings have been outweighed by the depth of clinical reasoning required and the gains in listening, communication, safety netting skills and development of autonmous organizational skills. Both placement models provide opportunity for students who could not otherwise complete a placement gain valuable learning opportunities.
Keywords: practice-based learning, technology-enabled care services, physiotherapy education
ID 301 – Navigating COVID-19 with Digital Practice & Telehealth in Physiotherapy: Lessons from Academic and Clinical Settings in the United States
Alan C. Lee1, Emelia Exum2, Nupur Hajela3, Brian Hull2
1Mount Saint Mary’s University, Los Angeles, CA., United States of America; 2Baylor University Medical Center, Baylor Scott and White Institute for Rehabilitation, Dallas, TX, United States of America; 3California State University, Fresno, CA, United States of America
Problem statement
The COVID-19 continues to grow, with 19% of total confirmed patients classified as severe or critical experiencing complications such as dyspnea, hypoxia, acute respiratory distress syndrome, or multi-organ failure. These complications require essential care and innovative health models. Considering the contagious nature of COVID-19 and the necessity to decrease the volume of healthcare professionals entering confirmed COVID-19 patient rooms and becoming a potential disease vector, can digital health and telehealth physiotherapy help? In addition, how can students serve safely in a community clinic via telehealth?
Objectives
This health model presentation will focus on the COVID-19 acute care therapy team’s strategy to provide early rehabilitative intervention without increasing the odds of disease transmission harm at Baylor University Medical Center in Dallas, Texas and a physiotherapy gait and balance telehealth clinic in Fresno, California in the United States.
Methods
Health Model Demonstration including a telehealth usability questionnaire conducted.
Outcomes
Using rapid Change Management strategies, the COVID-19 therapy team created a safe process for identifying and triaging care for patients with possible or confirmed COVID-19. A structured risk-benefit analysis was used to determine when in-person care was necessary or a telehealth solution was indicated. In addition, academic telehealth clinic in Fresno, CA., completed a telehealth usability questionnaire.
Reflection
Rehabilitative team utilizing digital health and telehealth solutions can add value in mitigating COVID-19 related harm and influence recovery, while not unnecessarily becoming an additional disease vector. Telehealth strategies allowed rehabilitative therapists to intervene early, opening the possibility to maximize recovery and prevent harm or decompensation in patients while preserving valuable patient protective equipment in the hospital. In addition, student clinic utilizing telehealth was deemed as a viable solution.
Problem solving for the field of clinical education: Physiotherapy educators are navigating the COVID-19 pandemic. Telehealth and digital practice may provide additional solutions to patient management and clinical education in physiotherapy. However, there is limited education and practice engagement. Future research is necessary to identify entrustable professional activities in telehealth and best practices in digital practice for all stakeholders in physiotherapy.
Keywords: digital practice, telehealth, telerehabilitation
ID 316 – Recommendations for physiotherapy services in patients with COVID-19 after hospital discharge or patients who have been ill at home
Philip van der Wees1, Femke Driehuis2, Rob A. de Bie3, on behalf of the development group2
1Radboud University Medical Center, Nijmegen, The Netherlands; 2Royal Dutch Society for Physical Therapy (KNGF), The Netherlands; 3Maastricht university, Maastricht, The Netherlands
Problem statement
Many questions are still unanswered regarding COVID-19, including the impact on physical and daily functioning, the degree of physical exercise tolerance, and optimal physiotherapy care. Physiotherapists need guidance in making treatment decisions.
Objectives
To support physiotherapists in clinical reasoning and decision-making, we have developed a position statement with recommendations for physiotherapy assessment, treatment and evaluation of patients with COVID-19 after hospital discharge or illness at home.
Methods
The position statement contains recommendations based on scientific evidence, expert opinion and clinical experiences at the time of publication. The recommendations will be refined and updated based on new scientific insights and clinical experiences. Various position statements and guidelines for patients with COVID-19 are currently being developed by other health disciplines. When making further iterations of this position statement we will look for (draft) versions of documents from other professions.
Outcomes
Our recommendations are published as position statement by the Royal Dutch Society for Physical Therapy (KNGF) in Dutch and English. The current version 2.0 was published on June 3, 2020.
The recommendations address initial treatment during the first six weeks after hospital discharge/illness at home, with evaluation after six weeks. Initial treatment includes gradually increasing the patient’s functioning in daily life and monitoring physical function and activity levels. After six weeks, potential further treatment goals are determined based on the patient’s needs and level of physical functioning, aimed at improving the performance of daily activities, and increasing physical activity levels and exercise capacity.
Reflection
- It is important to build a body of knowledge through prospective data collection and monitoring of recovery of patients with COVID-19 and to share knowledge and experience.
- To support physiotherapists in making treatment decisions based on the best available evidence and clinical expertise, it is important that they participate in activities for continuing education.
Keywords: clinical recommendations, clinical expertise, clinical guideline
ID 317 – Knowledge sharing and continuous learning on physiotherapy in patients with COVID-19: experiences from the Netherlands
Femke Driehuis1, Ton A.F. Lenssen2, on behalf of the development group2
1Royal Dutch Society for Physical Therapy (KNGF), The Netherlands; 2Maastricht University Medical Center, Maastricht, The Netherlands
Problem statement
After being infected with COVID-19, patients experience various complaints and problems in daily life and physical functioning. Physiotherapy plays an important role in the recovery of these patients. However, knowledge and clinical expertise regarding the treatment of this new patient group was lacking. An urgent need for guidance arose among physiotherapists. Therefore, clinical recommendations on physiotherapy treatment were developed based on available (indirect) evidence and clinical expertise.
Objectives
To inform physiotherapists on recommendations for treatment, share knowledge and facilitate continuous learning on physiotherapy after COVID-19.
Methods
Nationally, implementation consisted of publication of treatment recommendations, accompanied by patient instructions on video and paper on the online platform of the Royal Dutch Society for Physical Therapy (KNGF). These instructions were shared by physiotherapists from all around the country in order to share available material to stimulate optimal patient care.
To explain and interprofessionally discuss recommendations, various online webinars were organized for 500–3000 physiotherapists per webinar, and an informative clip explaining the recommendations was launched. Recommendations were translated into English to share our knowledge and experiences internationally.
Regionally webinars were organized giving information on the first impressions of healthcare professionals on the treatment of patients with COVID-19, advocating the use of the recommendations. Furthermore, the content of the recommendations was incorporated in multidisciplinary triage and treatment protocols for post-ICU patients, ex-hospitalized patients and patients that went through COVID-19 at home.
Outcomes
Due to various implementation strategies and tailored methods, Dutch physiotherapists were informed on physiotherapy treatment in patients with COVID-19. This enabled a quick start of rehabilitation processes and recovery of patients. With these methods, we stimulate continuous learning among physiotherapists, in the Netherlands and around the globe.
Reflection
- With various methods, we shared knowledge in a small-time frame to enable optimal delivery of physiotherapy services in patients affected by COVID-19
- With both national and regional implementation approaches, we facilitate and stimulate continuous learning among physiotherapists and optimize patient care
Keywords: implementation, continuous learning, recommendations for treatment
ID 318 – eHealth within physiotherapy for patients recovering from COVID-19: development and implementation
Mark van Tilburg1, Marjolein de Weerd1, Corelien Kloek1,2, Joost van der Heiden1, Cindy Veenhof1,2,3
1Expertise Center Healthy Urban Living, Research Group Innovation of Human Movement Care, University of Applied Sciences Utrecht, Utrecht, The Netherlands; 2Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands; 3Department of Rehabilitation, Physiotherapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, The Netherlands
Problem statement
Patients recovering from COVID-19 often experience limitations in their daily physical functioning, because of reduced functional capacity and reduced physical activity levels. To improve patients’ physical functioning, physiotherapists provide patients with advice, information and personalized exercise and physical activity recommendations. The Royal Dutch Society for Physiotherapy position statement (1.0 and 2.0) on physiotherapy recommendations in patients with COVID-19 states that remote communication should be used as much as possible and physical activity and exercise should be performed in the home situation. eHealth can be used to remotely monitor, treat and support patients’ recovery in the home situation. Specific content of eHealth modules for patients recovering from COVID-19 was not yet available.
Objective
To develop eHealth modules for patients recovering from COVID-19, which can be implemented by commercial eHealth providers in physiotherapy.
Methods
Based on the CeHRes Roadmap for development of effective eHealth, we started with a need assessment and contextual inquiry among patients, physiotherapists and experts. An interview, four focus groups and the Royal Dutch Society for Physiotherapy position statement (1.0 and 2.0) on physiotherapy recommendations in patients with COVID-19 provided input for the development of the eHealth modules. Patients, elderly, physiotherapists and experts were asked to provide feedback on the readiness, completeness, consistency and language usage.
Outcomes
Based on the needs of patients, physiotherapists and experts, eHealth modules were developed, consisting of recommendations on exercises and training principles, recommendations on outcome measures and 15 written information themes aimed to support self-management, including assignments. The modules were shared with three Dutch commercial eHealth providers in physiotherapy. These eHealth providers used the developed modules to implement eHealth for patients recovering from COVID-19 in commercially available eHealth platforms for Dutch physiotherapists.
Reflection
In co-creation with patients, physiotherapists and experts we managed to develop eHealth modules for patients recovering from COVID-19 within two months. By sharing these modules with various commercial eHealth providers, we aim to serve a large group of physiotherapists in The Netherlands. Continuous evaluation is needed to determine usability and applicability of the COVID-19 eHealth modules.
Keywords: eHealth, development, implementation