Kadija Perreault

Interprofessional collaboration: One or multiple realities?

Searching through the literature in the interprofessional field can be a daunting experience. In doing so, the reader is exposed to multiple terms and definitions. “Multidisciplinary,” “interdisciplinary,” “teamwork,” “interprofessional practice,” “collaborative relationships,” “coordination,” “integration,” etc., such terms differentiate and coincide, are used in all kinds of contexts and are often employed interchangeably (Schofield & Amodeo 1999). Petri (2010) recently conducted a concept analysis in which she noted at least six surrogate concepts and related terms associated with the concept of “interdisciplinary collaboration,” including interprofessional collaboration (IPC). Definitions, when provided by the authors (Petri, 2010; Schofield & Amodeo, 1999), often mix and diverge meanings. In this editorial, we explore various approaches to defining “IPC” and discuss some of the underlying epistemological and ontological challenges.

Physiotherapy practice in the private sector: organizational characteristics and models

BackgroundEven if a large proportion of physiotherapists work in the private sector worldwide, very little is known of the organizations within which they practice. Such knowledge is important to help understand contexts of practice and how they influence the quality of services and patient outcomes. The purpose of this study was to: 1) describe characteristics of organizations where physiotherapists practice in the private sector, and 2) explore the existence of a taxonomy of organizational models.MethodsThis was a cross-sectional quantitative survey of 236 randomly-selected physiotherapists. Participants completed a purpose-designed questionnaire online or by telephone, covering organizational vision, resources, structures and practices. Organizational characteristics were analyzed descriptively, while organizational models were identified by multiple correspondence analyses.ResultsMost organizations were for-profit (93.2%), located in urban areas (91.5%), and within buildings containing multiple businesses/organizations (76.7%). The majority included multiple providers (89.8%) from diverse professions, mainly physiotherapy assistants (68.7%), massage therapists (67.3%) and osteopaths (50.2%). Four organizational models were identified: 1) solo practice, 2) middle-scale multiprovider, 3) large-scale multiprovider and 4) mixed.ConclusionsThe results of this study provide a detailed description of the organizations where physiotherapists practice, and highlight the importance of human resources in differentiating organizational models. Further research examining the influences of these organizational characteristics and models on outcomes such as physiotherapists’ professional practices and patient outcomes are needed.

Interdisciplinary primary health care research training through TUTOR-PHC: the insiders' view.

Recent policy initiatives in Canada have highlighted the lack of research capacity among most disciplines involved in primary health care, resulting in a majority of clinical and health services research being conducted in secondary and tertiary care centers (Russell et al., 2007). At the same time, interprofessional care is increasingly being seen as a preferred approach to address the complex and wide-ranging clinical problems evident in primary health care. Interdisciplinary research training has therefore been proposed as a way to ensure that research evidence can address the complex interplay between biomedical, psychosocial and organizational dimensions of primary health care. The design of interdisciplinary research training programs requires close attention to the individual components and process factors that explain their long-term effectiveness (or lack of effectiveness) (Campbell et al., 2000). However, little has been reported on the process and influence of such programs. The goals of this paper are threefold: (i) to describe the Transdisciplinary Understanding and Training on Research in Primary Health Care (TUTOR-PHC) program, an interdisciplinary research training program; (ii) to identify content and process elements that were seen as key to its success; and (iii) to outline its influence on participants. As a cohort of trainees and mentor (with backgrounds in health administration, education, epidemiology, family medicine, nursing, physical therapy and psychology), we report on our experience of working together as an ‘‘interdisciplinary research team’’ throughout the program. We hope this paper will contribute to the knowledge base and design of effective interdisciplinary research training programs in the future, by providing participants’ views.

Ethics teaching in rehabilitation: results of a pan-Canadian workshop with occupational and physical therapy educators

Abstract Purpose: Ethical practice is an essential competency for occupational and physical therapists. However, rehabilitation educators have few points of reference for choosing appropriate pedagogical and evaluation methods related to ethics. The objectives of this study were to: (1) identify priority content to cover in ethics teaching in occupational therapy (OT) and physical therapy (PT) programmes and (2) explore useful and innovative teaching and evaluation methods. Method: Data for this qualitative descriptive study were collected during a 1-d knowledge exchange workshop focused on ethics teaching in rehabilitation. Results: Twenty-three educators from 11 OT and 11 PT Canadian programmes participated in the workshop. They highlighted the importance of teaching foundational theoretical/philosophical approaches and grounding this teaching in concrete examples drawn from rehabilitation practice. A wide range of teaching methods was identified, such as videos, blogs, game-based simulations and role-play. For evaluation, participants used written assignments, exams, objective structured clinical examinations and reflective journals. The inclusion of opportunities for student self-evaluation was viewed as important. Conclusion: The CREW Day provided ethics educators the opportunity to share knowledge and begin creating a community of practice. This space for dialogue could be expanded to international rehabilitation ethics educators, to facilitate a broader network for sharing of tacit and experiential knowledge. Implications for Rehabilitation According to the study participants, rehabilitation ethics education should include learning about foundational knowledge related to ethical theory; be grounded in examples and cases drawn from clinical rehabilitation practice; and contribute to building professional competencies such as self-knowledge and critical thinking in students. Regardless of the methods used by occupational therapy (OT) and physical therapy (PT) educators for teaching and evaluation, the value of creating spaces that support open discussion for students (e.g. protected discussion time in class, peer-discussions with the help of a facilitator, use of a web discussion forum) was consistently identified as an important facet. Educators from OT and PT programmes should work with various professionals involved in OT and PT student training across the curricula (e.g. clinical preceptors, other educators) to extend discussions of how ethics can be better integrated into the curriculum outside of sessions specifically focused on ethics. The CREW Day workshop was the first opportunity for Canadian rehabilitation ethics educators to meet and discuss their approaches to teaching and evaluating ethics for OT and PT students. Including international rehabilitation ethics educators in this dialogue could positively expand on this initial dialogue by facilitating the sharing of tacit and experiential knowledge amongst a larger and more diverse group of ethics educators.

Upper Extremity Pain

Work-related upper extremity disorders (WRUEDs) are a major problem in modern society, and they represent the primary cause of absenteeism in North America and Western Europe (Health and Safety Executive (HSE), 2002; Punnett & Wegman, 2004). The impact of WRUEDs on workers themselves in terms of pain and disability is important, but these conditions, often chronic, also incur significant loss of quality of life and impact the workers’ families, co-workers, and employers (Huang, Feuerstein, & Sauter, 2002; Punnett & Wegman, 2004). The productivity loss and economic costs of WRUEDs for society are substantial, and the economic burden of WRUEDs is increasing, despite efforts in prevention and implementation of novel intervention strategies for sustainable return to work (RTW) (Fabrizio, 2002; Feuerstein et al., 1993; Katz et al., 2000). At the outset, it should also be noted that WRUED is an “umbrella term” used to describe a wide range of disorders of the muscles, tendons, bursae, nerves, or blood vessels, potentially caused or aggravated by work, that may affect the neck/shoulder region, the shoulder itself, the elbow, the wrist, or the hand (Burton, Kendall, Pearce, Birrell, & Bainbridge, 2009; Zakaria, Robertson, MacDermid, Hartford, & Koval, 2002). These disorders range from those that are relatively well defined and specific (disorders with a well-defined set of diagnostic criteria established from evidence-based approaches) to those that are considered nonspecific (ill-defined disorders for which signs and symptoms may be present without a clear pattern allowing for a specific diagnosis) (Van Eerd et al., 2003). Numerous other terms have also been used to describe WRUED, such as cumulative trauma disorders, repetitive physical overuse, or repetitive strain injuries, but this lack of consensus on the definition of WRUED has led to confusion (Burton et al., 2009; Katz et al., 2000).

Access to publicly funded outpatient physiotherapy services in Quebec: waiting lists and management strategies

Abstract Purpose: Problems with access to outpatient physiotherapy services have been reported in publicly funded healthcare systems worldwide. A few studies have reported management strategies aimed at reducing extensive waiting lists, but their association with waiting times is not fully understood. The purpose of this study was to document access to public outpatient physiotherapy services for persons with musculoskeletal disorders in hospitals and explore organizational factors associated with waiting time. Methods: We surveyed outpatient physiotherapy services in publicly funded hospitals in the province of Quebec (Canada). Results: A total of 97 sites responded (99%) to the survey. The median waiting time was more than six months for 41% of outpatient physiotherapy services. The waiting time management strategies most frequently used were attendance and cancelation policies (99.0%) and referral prioritization (95.9%). Based on multivariate analyses, the use of a prioritization process with an initial evaluation and intervention was associated with shorter waiting times (p = 0.008). Conclusions: Our findings provide evidence that a large number of persons wait a long time for publicly funded physiotherapy services in Quebec. Based on our results, implementation of a prioritization process with an initial evaluation and intervention could help improve timely access to outpatient physiotherapy services. Implications for Rehabilitation Access to publicly funded outpatient physiotherapy services is limited by long waiting times in a great proportion of Quebec’s hospitals. The use of a specific prioritization process that combines an evaluation and an intervention could possibly help improve timely access to services. Policy-makers, managers, and other stakeholders should work together to address the issue of limited access to publicly funded outpatient physiotherapy services.

Evaluation of the acceptability, feasibility and effectiveness of two methods of involving patients with disability in developing clinical guidelines: study protocol of a randomized pragmatic pilot trial

BackgroundDespite growing interest in the importance of, and challenges associated with the involvement of patient and population (IPP) in the process of developing and adapting clinical practice guidelines (CPGs), there is a lack of knowledge about the best method to use. This is especially problematic in the field of rehabilitation, where individuals with disabilities might face many barriers to their involvement in the guideline development and adaptation process. The goal of this pilot trial is to document the acceptability, feasibility and effectiveness of two methods of involving patients with a disability (traumatic brain injury) in CPG development.Methods/DesignA single-blind, randomized, crossover pragmatic trial will be performed with 20 patients with traumatic brain injury (TBI). They will be randomized into two groups, and each will try two alternative methods of producing recommendations; a discussion group (control intervention) and a Wiki, a webpage that can be modified by those who have access to it (experimental intervention). The participants will rate the acceptability of the two methods, and feasibility will be assessed using indicators such as the number of participants who accessed and completed the two methods, and the number of support interventions required. Twenty experts, blinded to the method of producing the recommendations, will independently rate the recommendations produced by the participants for clarity, accuracy, appropriateness and usefulness.DiscussionOur trial will allow for the use of optimal IPP methods in a larger project of adapting guidelines for the rehabilitation of individuals with TBI. Ultimately the results will inform the science of CPG development and contribute to the growing knowledge about IPP in rehabilitation settings.Trial registrationClinical trial KT Canada 87776.

What are private sector physiotherapists’ perceptions regarding interprofessional and intraprofessional work for managing low back pain?

ABSTRACT In the last decades, interactions between health professionals have mostly been discussed in the context of interprofessional teamwork where professionals work closely together and share a team identity. Comparatively, little work has been done to explore interactions that occur between professionals in contexts where traditionally formal structures have been less supporting the implementation of interprofessional teamwork, such as in the private healthcare sector. The objective of this study was to identify private sector physiotherapists’ perceptions of interprofessional and intraprofessional work regarding interventions for adults with low back pain. This was a cross-sectional survey of 327 randomly-selected physiotherapists. Data were analysed using descriptive statistics. A majority of physiotherapists reported positive effects of interprofessional work for their clients, themselves and their workplaces. Proximity of physiotherapists with other professionals, clinical workloads, and client’s financial situation were perceived as important factors influencing the implementation of interprofessional work. Low back pain is a highly prevalent and disabling condition. The results of this study indicate that integrating interprofessional work in the management of low back pain in the private sector is warranted. Furthermore, the implementation of interprofessional work is viewed by practicing physiotherapists as dependent upon certain client-, professional- and organizational-level factors.

Supporting ethics educators in Canadian occupational therapy and physical therapy programs: A national interprofessional knowledge exchange project

ABSTRACT Ethics education is the cornerstone of professional practice, fostering knowledge and respect for core ethical values among healthcare professionals. Ethics is also a subject well-suited for interprofessional education and collaboration. However, there are few initiatives to gather experiences and share resources among ethics educators in rehabilitation. We thus undertook a knowledge exchange project to: 1) share knowledge about ethics training across Canadian occupational and physical therapy programs, and 2) build a community of educators dedicated to improving ethics education. The objectives of this paper are to describe this interprofessional knowledge exchange project involving ethics educators (with a diversity of professional and disciplinary backgrounds) from Canadian occupational and physical therapy programs as well as analyze its outcomes based on participants’ experiences/perceptions. Two knowledge exchange strategies were employed: an interactive one-day workshop and a wiki platform. An immediate post-workshop questionnaire evaluated the degree to which participants’ expectations were met. Structured telephone interviews 9–10 months after the workshop collected participants’ perceptions on whether (and if so, how) the project influenced their teaching or led to further interprofessional collaborations. Open-ended questions from the post-workshop questionnaires and individual interviews were analyzed using qualitative methods. Of 40 ethics educators contacted, 23 participated in the workshop and 17 in the follow-up interview. Only 6 participants logged into the wiki from its launch to the end of data collection. Five themes emerged from the qualitative analysis: 1) belonging and networking; 2) sharing and collaborating; 3) changing (or not) ways of teaching ethics; 4) sustaining the network; and 5) envisioning the future of ethics education. The project attained many of its goals, despite encountering some challenges. While the wiki platform proved to be of limited benefit in advancing the project goals, the interactive format and collaborative nature of the one-day workshop were described as rewarding and effective in bringing together occupational therapy and physical therapy educators to meet, network, and share knowledge.

Variations in demand and provision for publicly funded outpatient musculoskeletal physiotherapy services across Quebec, Canada

RATIONALE The prevalence of musculoskeletal disorders is high and expected to increase in the next decade. Persons suffering from musculoskeletal disorders benefit from early physiotherapy services. However, access to publicly funded physiotherapy services has been shown to be compromised by long waiting times and limited availability of resources in many countries around the world. Decisions on resource allocation may create geographic disparities in provision and access to services, which may result in inequity in access. AIMS AND OBJECTIVES This study aimed to assess variations in demand and provision of publicly funded outpatient physiotherapy services across the province of Quebec, Canada, as well as to assess the demand to provision relationship. METHODS We conducted a secondary analysis of data retrieved from the 2008 Quebec Health Survey and data obtained from a survey of hospitals in the province of Quebec in 2015. We used geographic information systems analyses and descriptive analyses to assess geographic variations and the relationship between demand and provision. RESULTS Our results indicate substantial variations in the provision and demand for physiotherapy services in the province of Quebec. The variations in service provision did not follow the variations in demand. Long waiting times and insufficient provision of services were found in many regions. CONCLUSIONS The variations in provision of physiotherapy services between regions reported in our study did not correspond to the variations in demand. Such geographic variations and demand to provision mismatches may create inequity in access to services, especially for those unable to afford private services.