Gisela van Kessel

The ability of older people to overcome adversity: A review of the resilience concept

Resilience has been recognized as the ability to bounce back from adversity and regain health. This review seeks to explore the validity of the current understanding of resilience as it applies to older people and its application as guide for interventions. One mixed method, 19 qualitative and 22 quantitative papers were located through a systematic search of nine databases. Results confirmed a number of themes of personal resources. Older people who have the ability to use personal resources and see the world beyond their own concerns are more likely to be resilient. In addition a number of environmental factors were identified including social support from community, family and professionals as well as access to care, availability of resources and the influence of social policy and societal responses. Nurses can facilitate resilience of older people by maintaining or enhancing social support and facilitating access to care and resources.

Evaluating moral reasoning outcomes in physical therapy ethics education: stage, schema, phase, and type

Abstract Background: Physical therapists must have skills in moral reasoning (the ability to analyze ethical situations in order to determine a right action). The cognitive developmental perspective initiated by Kohlberg and developed by James Rest and associates proposes that moral reasoning progresses in stages or schemas (default frameworks for determining a right course of action) with periods of transition or consolidation between schemas. The purpose of this research was to evaluate changes among physical therapy students in moral reasoning and organization of ethical knowledge following an intensive 6-week ethics course focused on transformative learning, self-knowledge/reflection, relationships between ethical and clinical knowledge, and responding to ethical disequilibrium. This paper focuses on evaluating changes in moral reasoning from the cognitive developmental perspective using the Defining Issue Test (DIT2). The DIT2 evaluates the proportion of moral reasoning that an individual uses in three schemas (personal interest, maintaining norms, post-conventional) with a focus on the shift to post-conventional reasoning. Methods: A pre-test–post-test design was used to evaluate changes in moral reasoning schema. Results: Of the 54 final year physiotherapy students invited to participate, 37 students completed all portions of the research, a usable response rate of 68·5%. The resulting sample was predominantly female (59·5%, n = 22) with a mean age of 24·2 years. Paired t-tests were not significant for changes in personal interest or maintaining norms, but were significant for changes in post-conventional reasoning. Discussion: Results indicate that an intensive ethics course can be successful in producing changes in post-conventional moral reasoning among physical therapy students.

Does antenatal physical therapy for pregnant women with low back pain or pelvic pain improve functional outcomes? A systematic review

Objective. A systematic review was undertaken to update the understanding of the available evidence for antenatal physical therapy interventions for low back or pelvic pain in pregnant women to improve functional outcomes when compared with other treatments or no treatment. Data Sources. Seven electronic databases were systematically searched and supplemented by hand searching through reference lists. Methods of study selection. Two reviewers independently selected trials for inclusion and independently assessed the internal validity of the included trials using the Clinical Appraisal Skills Program tool. Results. Four trials with 566 participants were identified that met the inclusion criteria. The validity of the trials was moderate. Exercise, pelvic support garments and acupuncture were found to improve functional outcomes in pregnant women with low back or pelvic pain. No meta‐analysis was performed because of the heterogeneity of functional outcome measures. Conclusions. While there is some evidence that physical therapy using exercise, acupuncture and pelvic supports may be useful, further research needs to consider other treatment modalities used by physical therapists and establish an appropriate, reliable and valid functional outcome measure to assess low back and pelvic pain in pregnancy.

The development of moral judgment and organization of ethical knowledge in final year physical therapy students

Abstract Background and purpose: It is well recognized that physical therapy practitioners need to go beyond adherence to professional codes of conduct and have skills of ethical reasoning in order to address the ethical issues which arise in clinical practice. There is little consensus in physical therapy regarding approaches to teaching ethical reasoning. The purpose of this research was to study changes in the moral reasoning schema and organization of ethical reasoning knowledge of final year physical therapy students following a 6 week intensive ethics course with a teaching focus on two particular ethical reasoning models: the Four Component Model and the Ethical Reasoning Bridge. Methods: A pre-test post-test design was used to evaluate changes in moral reasoning schema (using the Defining Issues Test version two (DIT2)) and changes in the organization of students’ ethical reasoning knowledge using concept maps. Results: Thirty-seven students completed all four portions of the research, a response rate of 68·5%. There was a significant increase in post-conventional reasoning (so called N2) scores (35·2 to 39·7, P = 0·006). Concept maps post-test displayed a shift from a pre-test quantitatively oriented and organised set of ethical knowledge concepts to a more integrated and qualitatively oriented new knowledge framework. Conclusion: This study has demonstrated that a 6 week course using curricular strategies involving the interpretation of experience and perspective transformation can facilitate in a cohort of final year physical therapy students both the development of ethical reasoning ability (moral judgment) and a richer organization of the types of knowledge required for ethical decision making.

Cognitive maps and the structure of observed learning outcome assessment of physiotherapy students’ ethical reasoning knowledge

Assessment of student learning in complex areas is challenging, particularly when there is interest in students’ deeper understanding and connectivity of concepts. Assessment of ethics learning has been limited by lack of consensus regarding what is effective and an overfocus on quantification at the expense of clinical or ethical relevance. Cognitive maps provide one means to evaluate depth and personal meaning of students’ ethics knowledge. A pre-/post-test design using cognitive maps and the structure of observed learning outcome (SOLO) taxonomy was used to assess student learning on completion of a six-week intensive ethics course. Thirty-seven students completed the research. Student learning was supported by significant changes in component (content, labelling, relationships and structure/visual message), and total pre- and post-test cognitive map scores, and significant change in pre- and post-test SOLO scores. A strong relationship was found between cognitive map improvement and SOLO improvement. Student written commentaries describing their post-test cognitive map provided a richer, more elaborated account of their understanding that qualitatively enhanced their cognitive maps. Cognitive maps offer an alternative to traditional ethics assessment strategies.

Strategies to enhance resilience post-natural disaster: a qualitative study of experiences with Australian floods and fires

BACKGROUND Disasters have a significant impact on mental health that may be mitigated by promoting resilience. This study explores the lay perspective on public health interventions that have the potential to facilitate resilience of adults who experience a natural disaster. METHODS Semi-structured interviews were conducted 6 months post-disaster between June 2011 and January 2012 with 19 people who experienced the 2010/11 Victorian floods. Twenty lay witness statements from people who presented to the 2009 Victorian Bushfires Royal Commission were also selected for analysis. Transcripts were analysed using an interpretive and comparative content analysis to develop an understanding of disaster resilience interventions in an ecological framework. RESULTS The participants identified resilience focused interventions such as information that help individuals manage emotions and make effective decisions and plans, or enable access to resources; face-to-face communication strategies such as public events that restore or create new social connections; rebuilding of community capacity through coordination of volunteers and donations and policies that manage disaster risk. CONCLUSIONS Disaster recovery interventions designed within an ecological model can promote a comprehensive integrated systems approach to support resilience in affected populations.

Immediate Blood Pressure Changes and Aquatic Physiotherapy

Objective. No studies to date have examined the effect on Blood pressure (BP) when pregnant women participate in aquatic physiotherapy (AP) classes; although, previous studies have indicated that there may be a detrimental outcome to the pregnant mother and fetus when there is a significant rise in the maternal BP. At least three components may contribute to BP changes: temperature, exercise, and immersion. This study examines BP changes in pregnant women attending AP classes. Method. An experimental same-subject, repeated measures design was employed. Forty-five sets of data were collected from pregnant women attending routine, existing, nonaerobic AP classes. Blood pressure measurements were taken preimmersion, 2–5 minutes after entering the pool, immediately following the 50 minute AP class (while immersed), and 8–12 minutes after exiting the water. Results. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) data were analyzed using a repeated measures analysis of variance (ANOVA). For all sets of data a highly significant difference was observed (p = 0.0000). Post-hoc Tukey test results showed BP to decrease significantly on entering the water (MAP mean difference of 10.52 mm Hg, 95% CI 8.75 to12.29), to remain at this low level postexercise while still immersed, and then return to preimmersion values 8–12 minutes after exiting the water. Conclusion. These results indicate that AP classes are safe for nonhypertensive pregnant women in their third trimester. The use of AP in the antenatal care of women with unstable BP or who are hypertensive needs further research.

An ethical approach to health promotion in physiotherapy practice

ISSUE ADDRESSED With increased emphasis on reducing the global burden of non-communicable disease, health professionals who traditionally focused on the individual are being encouraged to address population-level health problems. While physiotherapists are broadening their clinical role to include health promotion strategies in their clinical practice, the ethical foundations of this practice focus have received less attention. METHODS We use a physiotherapy clinical scenario to highlight different physiotherapeutic approaches and to analyse underpinning ethical values and implications for practice. RESULTS We suggest there are potential harms of incorporating health promotion into physiotherapy management of individuals if the population-based research does not resonate with an individuals particular circumstances, capacity to change or view of what counts as important and meaningful. We propose that critical reasoning and ethical judgment by the physiotherapist is required to determine how health promotion messages applied in primary care settings might work to benefit and enhance a clients well being rather than impose burdens or cause harm. CONCLUSION We suggest four ethical reasoning strategies designed to assist physiotherapists to frame and understand fundamental ethical principles of beneficence, harm, autonomy and justice when implementing health promotion and self-management approaches in clinical practice.

A Qualitative Study to Examine Feasibility and Design of an Online Social Networking Intervention to Increase Physical Activity in Teenage Girls.

Background Online social networks present wide-reaching and flexible platforms through which to deliver health interventions to targeted populations. This study used a social marketing approach to explore teenage girls’ perceptions of physical activity and the potential use of online social networks to receive a physical activity intervention. Methods Six focus groups were conducted with 19 Australian teenage girls (ages 13 to 18 years) with varying levels of physical activity and socioeconomic status. A semi-structured format was used, with groups discussion transcribed verbatim. Content analysis identified emergent themes, with triangulation and memos used to ensure accuracy. Results Physical activity was most appealing when it emphasised sport, exercise and fitness, along with opportunities for socialisation with friends and self-improvement. Participants were receptive to delivery of a physical activity intervention via online social networks, with Facebook the most widely reported site. Participants commonly accessed online social networks via mobile devices and particularly smartphones. Undesirable features included promotion of physical activity in terms of walking; use of cartoon imagery; use of humour; and promotion of the intervention via schools, each of which were considered “uncool”. Participants noted that their parents were likely to be supportive of them using an online social networking physical activity intervention, particularly if not promoted as a weight loss intervention. Conclusion This study identified key features likely to increase the feasibility and retention of an online social networking physical activity intervention for teenage girls. Guidelines for the design of interventions for teenage girls are provided for future applications.

Physiotherapists’ attitudes toward circuit class therapy and 7 day per week therapy is influenced by normative beliefs, past experience, and perceived control: A qualitative study

ABSTRACT Introduction: Attitudes are recognized as influencing research implementation. However, little is known about the process by which physiotherapists’ attitudes and beliefs shape their use of 7-day per week therapy and circuit class therapy research findings. Understanding beliefs may assist in addressing barriers to research uptake. Methods: Fifteen physiotherapists from six rehabilitation centers who ranged in seniority, experience, and education levels consented to be interviewed. The transcribed interviews were analyzed using a qualitative content analysis drawing on the Theory of Planned Behavior. Findings: Participants felt that they had autonomy in adopting new approaches when the evidence was supported by social norms. Participants believed that 7-day per week therapy delivers a seamless service that increases physiotherapy time, which helps maintain patient improvement, but needs to accommodate patient choice and expectations. Circuit class therapy was viewed positively as it provides more physiotherapy time, increases patient social interaction, and motivation. However, this was qualified by a belief that patients would not receive individualized, quality of movement focused therapy, particularly for patients with limited capacities. Conclusion: Implementation of a new approach depends on the past experience, coherence with individual beliefs regarding important elements of therapy content, and opportunities to control barriers to implementation.