Joy Higgs

Portrait of the physiotherapy profession

As a profession integral to health promotion, prevention, acute care and rehabilitation physiotherapy plays an essential role in the health care system. This paper explores the nature of physiotherapy, the role of physiotherapy in health care, the practice of physiotherapy internationally, the education of physiotherapists, the regulation of physiotherapy practice and the maintenance of practice standards.As a profession integral to health promotion, prevention, acute care and rehabilitation physiotherapy plays an essential role in the health care system. This paper explores the nature of physiotherapy, the role of physiotherapy in health care, the practice of physiotherapy internationally, the education of physiotherapists, the regulation of physiotherapy practice and the maintenance of practice standards.

The Nature, Generation and Verification of Knowledge

Summary Summary In this paper the critical question of knowledge as the underpinning of clinical practice is examined. The nature of knowledge is explored in this paper, with support being given to the constructivist perspective. Types of knowledge include propositional, professional craft and personal knowledge. The importance and validity of each of these forms of knowledge is argued. Knowledge construction is a task which requires much attention from students, teachers and researchers. Approaches to generating knowledge include: working through research paradigms (such as the empirico-analytical, critical and interpretive paradigms) and also utilising different ‘ways of knowing’. Physiotherapists need to gain a deep understanding of the nature of knowledge and of how to generate knowledge in order to enrich their own knowledge bases and to contribute to the knowledge of the field of physiotherapy.

Seeking the optimal posture of the seated lumbar spine

Prolonged sitting with poor posture is associated with the development of lower back pain. Ergonomic texts for physiotherapists contain diverging and confusing views on recommended postures for the lumbar spine when seated that will promote postural health and optimal functioning of the lumbar spine. A review of the literature reveals that proponents of both the lordosed and kyphosed lumbar seated position use similar arguments with contradictory conclusions. The arguments of those advocating the kyphosed lumbar seated posture are, however, often anecdotal and unsubstantiated by research. This paper evaluates the confl icting views and concludes that the lordosed seated posture, regularly interspersed with movement, is the optimal sitting posture and assists in maintaining lumbar postural health and preventing low back pain.

Integrating clinical reasoning and evidence-based practice.

Evidence-based practice involves basing clinical decisions and practice on the best available evidence. What do nurses need to think about when seeking to pursue evidence-based practice? What challenges do practitioners face in blending clinical reasoning with evidence-based practice? In this article, the authors argue against basing clinical practice on narrow definitions of evidence, relying solely on experimental findings or, even more exclusively, on randomized controlled trials. Instead of defining best practice narrowly by the strength of the current empirical evidence used to guide clinical decisions, it should be defined broadly by what is the best information to use to make decisions for a given patient in a particular setting. Credible and accountable clinical decisions rely on a number of forms of knowledge and evidence. This evidence includes findings from across the range of research methods, including experimental, interpretive, and action research. In nursing, it also includes evidence that has arisen from the depth of practice knowledge of expert clinical nurses. Professionals, particularly advanced and expert clinicians such as critical care nurses, use clinical reasoning to guide their practice in the uncertainty of clinical practice contexts. This reasoning helps the nurse make judgments about the relevance of particular research and clinical evidence for a specific patient and setting.

University Education and the Physiotherapy Professional

Summary The growth and development of physiotherapy is influenced significantly by the professional abilities and potential of its new graduates. Physiotherapy graduates need to have skills and attributes relevant to their day-to-day practice to enable them to be confident and competent. They also need skills and attributes that will enable them to adapt to changes and develop professionally. It could be assumed that physiotherapists are well equipped for their future role, because, as well as gaining discipline-specific technical competence, as university graduates they are expected to have generic skills and attributes in such areas as communication, thinking, learning, teamwork, research, evaluation and problem solving. However, possession of these generic university-education skills does not, alone, provide a guarantee of competence in the workplace. The education process must equip graduate physiotherapists for professional survival in a health care environment in which the funding and organisation of health care are changing. This paper examines the need for the profession and its educators to review current teaching in physiotherapy. It explores curriculum and teaching strategies that could be implemented to foster required skills and attributes in its newest graduates to ensure that they meet the needs of the community, thereby facilitating the ongoing development of the profession.

Developing Clinical Reasoning Competencies

Summary Effective clinical practice requires the ability to develop a sound Knowledge base and clinical reasoning skills. The purpose of this paper is to examine the nature of clinical reasoning and knowledge and ways of fostering the development of knowledge and reasoning competence in physiotherapists. Strategies are discussed for developing clinical reasoning skills and knowledge. These include planning appropriate curricula and learning activities, developing and exploring knowledge through cognitive mapping, and promoting learning through evaluation and feedback.

Physiotherapy decision making in acute cardiorespiratory care is influenced by factors related to the physiotherapist and the nature and context of the decision: a qualitative study

QUESTIONS What factors influence the decision making of cardiorespiratory physiotherapists in acute care? How do cardiorespiratory physiotherapists manage multiple factors in their decision making? DESIGN Qualitative study using observation and semi-structured interviews. PARTICIPANTS Fourteen physiotherapists working in acute cardiorespiratory care. RESULTS Cardiorespiratory physiotherapy decision making was affected by factors related to the nature of the decision itself (such as the complexity and difficulty of the decision), factors related to the context in which the decision occurred (such as physical, organisational and socio-professional factors), and factors related to the physiotherapists themselves (such as decision making capabilities, physiotherapy frames of reference, and level of clinical experience). CONCLUSION Optimising the quality of decision making in the context of health care today requires an awareness and consideration of a range of factors influencing decision making.

Managing Clinical Education: The Educator-manager and the Self-directed Learner

Summary Clinical educators and learners have important roles in managing clinical education programmes. This paper discusses the roles of clinical educators as facilitators and managers of student learning and the role of students as self-directed learners and co-managers of learning programmes in achieving effective learning in the clinical setting.

Integrative medicine: enhancing quality in primary health care

OBJECTIVES Integrative medicine (IM) is an emerging model of health care in Australia. However, little is known about the contribution that IM makes to the quality of health care. The aim of the research was to understand the contribution IM can make to the quality of primary care practices from the perspectives of consumers and providers of IM. DESIGN This interpretive research used hermeneutic phenomenology to understand meanings and significance that patients and practitioners attach to their experiences of IM. Various qualitative research techniques were used: case studies; focus groups; and key informant interviews. Data sets were generated from interview transcripts and field notes. Data analysis consisted of repeatedly reading and examining the data sets for what they revealed about experiences of health care and health outcomes, and constantly comparing these to allow themes and patterns to emerge. SETTING The setting for this research was Australian IM clinics where general medical practitioners and CAM practitioners were co-located. RESULTS From the perspective of patients and practitioners, IM: (1) provided authentically patient-centered care; (2) filled gaps in treatment effectiveness, particularly for certain patient populations (those with complex, chronic health conditions, those seeking an alternative to pharmaceutical health care, and those seeking health promotion and illness prevention); and (3) enhanced the safety of primary health care (because IM retained a general medical practitioner as the primary contact practitioner and because IM used strategies to increase disclosure of treatments between practitioners). CONCLUSIONS According to patients and practitioners, IM enhanced the quality of primary health care through its provision of health care that was patient-centered, effective (particularly for chronic health conditions, nonpharmaceutical treatments, and health promotion) and safe.

Kyphosed Seated Postures: Extending Concepts of Postural Health Beyond the Office

Introduction The harmful effects of sustained sitting and the health of the spine are well documented. The focus of much of this investigation has been sedentary occupations. However, how people sit during leisure hours can impact on the health of the spine both in and out of working hours. Methods A literature search was conducted using Amed, Cinahl and OVID Medline databases. Papers published between 1985 and 2007 were selected for review. These included epidemiological and experimental studies that explored the relationships between seated postures and health of the lumbar spine. Until recently there was confusion in the scientific literature as to which seated postures were least harmful: lordosed or kyphosed. This article reviews and analyses these conflicts in relation to leisure sitting. Results Analysis of the literature demonstrates that kyphosed seated postures when sustained are more harmful to the health of the lumbar spine than lordosed seated postures. There is a misconception amongst designers and users of leisure seating that kyphosed relaxed postures are comfortable and that comfort equates with health. It is argued that sustained kyphosed postures are insidiously harmful to the spine in that they may contribute to disc degeneration in the absence of pain. Sustained kyphosed postures also adversely affect spinal ligaments, muscles and joints and lead to neuromuscular and cumulative trauma disorders and loss of spinal stability. Conclusion Recent research demonstrates that postures popularly assumed in recreational or leisure seating lead to cumulative damage to soft tissues of the spine. These effects may still be present at the commencement of the following work day. In the prevention of work disability caused by sustained sitting, health professionals must consider the impact of leisure seating design and recreational sitting behaviour.