Cathy Evans

Pulling Together and Pushing Apart: Tides of Tension in the ICU Team

Balancing interdisciplinary differences and coping with the strain of limited resources, intensive care unit (ICU) teams face the physical and psychological stress of caring for the critically ill. Differences in knowledge and skill, gender, and care models are organized by a complex hierarchical structure that does not always adequately account for these differences. Thus, ICU teams not only face the challenge of working efficiently in a highly stressful acute care environment, they also confront the complexities of interprofessional communication and collaboration. Multifaceted interprofessional relationships must be established and re-established as individual providers continuously rotate to and from the unit. These characteristics provide the context for potentially divisive team communication and pose significant challenges to team collaboration. Problems in team communication and collaboration may have significant impact on administrative, social, clinical, and educational outcomes in the ICU. Previous studies have highlighted the importance of collaboration in improving patient outcomes, in decision making around ethical issues and in improving the team’s morale. Other studies have focused on physician–nurse interactions and describe inadequate communication of treatment goals and a lack of collaboration, as well as a lack of understanding and frank disputes over roles and responsibilities. This study examines communication patterns in the context of this continuously shifting interprofessional team. Further, it explores the implications of these patterns for the education and socialization of critical care trainees as they negotiate professional roles and relationships within the hidden curriculum of critical care medicine.

An Online Community of Practice to Support Evidence-Based Physiotherapy Practice in Manual Therapy

Introduction: The purpose of this study was to explore how a community of practice promoted the creation and sharing of new knowledge in evidence‐based manual therapy using Wengers constructs of mutual engagement, joint enterprise, and shared repertoire as a theoretical framework. Methods: We used a qualitative approach to analyze the discussion board contributions of the 19 physiotherapists who participated in the 10‐week online continuing education course in evidence‐based practice (EBP) in manual therapy. The course was founded on community of practice, constructivism, social, and situated learning principles. Results: The 1436 postings on 9 active discussion boards revealed that the community of practice was a social learning environment that supported strong participation and mutual engagement. Design features such as consistent facilitation, weekly guiding questions, and collaborative assignments promoted the creation and sharing of knowledge. Participants applied research evidence to the contexts in which they worked through reflective comparison of what they were reading to its applicability in their everyday practice. Participants’ shared goals contributed to the common ground established in developing collective knowledge about different study designs, how to answer research questions, and the difficulties of conducting sound research. Discussion: An online longitudinal community of practice utilized as a continuing education approach to deliver an online course based on constructivist and social learning principles allowed geographically dispersed physiotherapists to be mutually engaged in a joint enterprise in evidence‐based manual therapy. Advantages included opportunity for reflection, modeling, and collaboration. Future studies should examine the impact of participation on clinical practice.

Dissemination of Student Research in a Canadian Master of Science in Physical Therapy Programme

PURPOSE To determine the extent of presentation and publication, as well as time to publication, of student research completed as a component of a Master of Science in Physical Therapy (MScPT) degree at a Canadian university. METHOD The authors conducted a retrospective cross-sectional study of MScPT research projects completed between 2003 and 2009, each undertaken by a group of MScPT students who carried out protocol development, ethics submission, data collection, analysis, and manuscript and poster preparation under the supervision of research advisors. Research advisors were e-mailed a request for citations of presentations and publications. RESULTS Advisors from 102 of 113 research projects completed from 2003 through 2009 provided information, for a response rate of 90.3%. Of the 102 groups, 53.9% disseminated findings through publication or presentation, 33.3% presented at one or more conferences, and 30.4% published at least one peer-reviewed journal article. Median time to publication was 21 months. Almost half the journal articles (47%) were published in Physiotherapy Canada. CONCLUSIONS MScPT student research groups are disseminating their findings through publication or presentation at a moderate rate. Investigation of factors influencing dissemination is needed to develop strategies to facilitate knowledge transfer.

More than just dancing: experiences of people with Parkinson’s disease in a therapeutic dance program

Abstract Purpose: To understand why individuals with Parkinson’s disease (PD) participate in a community-based therapeutic dance program and to explore its influence on perceived physical, social and emotional well-being of participants. Methods: A qualitative descriptive design was employed using one-on-one semi-structured interviews. Individuals with PD who participated in the Dancing with Parkinson’s program were recruited from two locations. Interviews were audio-recorded, transcribed, de-identified and then placed into NVivo 10 software for analysis. A content analysis approach was used with an inductive analysis method to generate a coding scheme. Group discussion facilitated development of overarching themes. Results: Ten participants’ responses revealed that the dance program allows for self-improvement and regaining identity through disease self-management. Positive influences of socialization arose through the class, decreasing isolation and improving quality of life. Participants communicate through music and dance to enhance connection with others. Conclusions: Dancing with Parkinson’s classes allow for re-development of the social self, which can increase sense of enjoyment in life. Dance programs provide opportunities for social interaction, non-verbal communication and self-improvement, reestablishing self-identity and a sense of usefulness. This study provides unique insight into the experience of participating in a dance program from the perspective of individuals with PD. Implications for rehabilitation Dance is emerging as a strategy to address the physical and psychosocial effects of Parkinson’s disease (PD), but little is known regarding participants’ perceptions of community-based therapeutic dance programs for PD. This study found that Dancing with Parkinson’s (DWP) facilitated an improvement in social participation, resulting in decreased isolation and improved quality of life. Participation in the DWP program can facilitate a positive change in perspective and attitude toward a PD diagnosis, thereby increasing feelings of self-efficacy and improving self-management of the disease. Participants of this study emphasized the multifaceted benefits of DWP, suggesting that it has great potential for addressing not only the physical challenges, but also the cognitive and emotional challenges associated with PD.

Comparison of Physical Therapy Anatomy Performance and Anxiety Scores in Timed and Untimed Practical Tests.

Students in health care professional programs face many stressful tests that determine successful completion of their program. Test anxiety during these high stakes examinations can affect working memory and lead to poor outcomes. Methods of decreasing test anxiety include lengthening the time available to complete examinations or evaluating students using untimed examinations. There is currently no consensus in the literature regarding whether untimed examinations provide a benefit to test performance in clinical anatomy. This study aimed to determine the impact of timed versus untimed practical tests on Master of Physical Therapy student anatomy performance and test anxiety. Test anxiety was measured using the State‐Trait Anxiety Inventory (STAI). Differences in performance, anxiety scores, and time taken were compared using paired sample Students t‐tests. Eighty‐one of the 84 students completed the study and provided feedback. Students performed significantly higher on the untimed test (P = 0.005), with a significant reduction in test anxiety (P < 0.001). Students who were unsuccessful on the timed test showed the greatest improvement on the untimed test ( x¯  = 20.4 ±10%). Eighty‐three percent (n = 69) of students preferred the untimed test, 8.4% (n = 7) the timed test, and 8.4% (n = 7) had no preference. Students took on average eight minutes longer on the untimed test. This study found that physical therapy students perform better on untimed tests, which may be related to a reduction in test anxiety. If the intended goal of evaluating health care professional students is to determine fundamental competencies, these factors should be considered when designing future curricula. Anat Sci Educ 8: 518–524.

It just feels weird!: a qualitative study of how children aged 10–18 years describe neuropathic pain

Abstract Purpose: The aim of this study was to explore how children aged 10–18 years describe their neuropathic pain (NP). Method: This is a qualitative descriptive study using inductive content analysis. Semi-structured interviews were conducted with eight children, aged 10–18 years with varying diagnoses, who were experiencing NP. Results: All children were able to describe their NP using a variety of strategies, including use of literal and figurative language. While some sensory descriptors commonly reported by adults were used, descriptions of NP pattern and impact were also integral to their narratives. Children were able to differentiate NP from nociceptive pain. Parents clarified and gave context to pain reports. Conclusions: NP is a complex experience necessitating consideration of the different ways that children describe their symptoms. Involvement of parents is invaluable to the process of taking a pain history with a child who is being screened for NP. Implications for Rehabilitation The findings of the study may inform the screening process for NP in children to facilitate earlier identification. Clinicians should consider the variety of ways that children may express their NP symptoms and the resulting impact. Clinicians should probe further when children report that symptoms are hard to describe or “weird”. Presence of a parent during the child’s pain assessment may assist with gathering a more complete picture.

Correlation between Global Rating Scale and Specific Checklist Scores for Professional Behaviour of Physical Therapy Students in Practical Examinations

The purpose of this study was to determine whether or not the specific item checklist (checklist) and global rating scale (GRS) scores are correlated in practical skills examinations (PSEs). Professional behaviour was evaluated using both the checklist and GRS scores for 183 students in three PSEs. Mean, standard deviation, and correlation for checklist and GRS scores were calculated for each station, within each PSE. Pass rate for checklist and GRS was determined for each PSE, as well as for each individual checklist item within each PSE. Overall, pass rate was high for both checklist and GRS evaluations of professional behaviour in all PSEs. Generally, mean scores for the checklist and GRS were high, with low standard deviations, resulting in low data variability. Spearman correlation between total checklist and GRS scores was statistically significant for two out of five stations in PSE 1, five out of six stations in PSE 2, and three out of four stations in PSE 3. The GRS is comparable to the checklist for evaluation of professional behaviour in physical therapy (PT) students. The correlation between the checklist and GRS appears to become stronger in the assessment of more advanced students.

Achieving Consensus on Recommendations for the Clinical Management of Overweight and Obese Adults for Canadian Physiotherapy Practice

PURPOSE The purpose of this study was to reach consensus on the importance and feasibility of clinical practice guideline (CPG) recommendations for physiotherapy practice for the prevention and management of overweight and obesity in Canadian adults. METHODS We used a modified Delphi method to achieve consensus. Participants rated the importance and feasibility of recommendations using a nine-point scale in two rounds of electronic surveys and a conference call. The mean and distribution of ratings were analyzed to determine consensus. RESULTS Twenty-one physiotherapists experienced in the management of patients with obesity and representing diverse regions of Canada and areas of practice participated. Seventeen (81.0%) completed survey 1. Ten (47.6%) participated in the conference call and survey 2. Eight of 34 strategies received mean ratings of 7.00 or more for both importance and feasibility from at least two-thirds of participants. These strategies were related to physical activity prescription and assessment. CONCLUSIONS A sample of physiotherapists in Canada agreed that obesity-related CPGs contain recommendations that are important to physiotherapy practice. These findings, along with the Canadian Physiotherapy Associations position statement on obesity, provide support for the argument that physiotherapists, as direct-access practitioners or members of multidisciplinary teams, should play a role in the health care of people with obesity and overweight.

Mobilization patterns of children on a hematology/oncology inpatient ward

Children being treated for cancer are admitted to the hospital for treatment of their disease or complications of therapy. Periods of bed rest during hospitalization can cause impairments detrimental to children with cancer who endure many side effects of therapy. Little is known about how these children mobilize while admitted to the hospital. The purpose of this study was to examine how children admitted to a hematology/oncology ward are mobilizing and analyze factors associated with delayed or infrequent mobility.

Reaching Consensus on Measuring Professional Behaviour in Physical Therapy Objective Structured Clinical Examinations

Purpose: We determined which professional behaviours (PBs) are important and feasible to measure in an objective structured clinical examination (OSCE) intended to assess the hands-on skills and knowledge of students in a Canadian physical therapy (PT) program. Methods: We used a modified Delphi technique to identify the criteria required to assess PBs in PT students during an OSCE. We conducted a focus group to better understand the results of the modified Delphi process. Results: Experienced local OSCE examiners participated in the modified Delphi panel, which consisted of two rounds of surveys: round 1 (n=12) and round 2 (n=10). A total of 31 PBs were reduced to 18 through the two rounds. Five of the panellists participated in the focus group, reduced the 18 PBs to 15, and then identified 4 as clinical skills. Participants categorized the remaining 11 as mixed PBs and clinical skills (1 item), PBs (4 items), or communication skills (6 items). Conclusion: This study provides preliminary evidence to support the feasibility and importance of evaluating 5 PB items in practical skills OSCEs for entry-to-practice PT students.