Michel D. Landry

Prevalence and risk factors associated with low back pain among health care providers in a Kuwait hospital.

Study Design. A cross-sectional survey among health professionals working in a Kuwait hospital. Objective. To investigate the prevalence and factors associated with low back pain (LBP). Summary of Background Data. The literature suggests that health professionals are exposed to occupational risk factors that predispose them to developing LBP. These rates are not well established in Middle Eastern countries such as Kuwait. Methods. A self-administered survey was conducted with health professionals in an urban orthopedic hospital. Results. The response rate to the survey was 60% (n = 344). Lifetime prevalence of LBP in the sample was 70.9%, and point prevalence of LBP was 21.5%. Factors associated with acute LBP included direct patient contact (P = 0.015), performing patient lifts and/or transfers (P = 0.016), low job satisfaction (P = 0.039), and poor self-reported health status (P = 0.019). The prevalence ratio (PR) of reporting acute LBP was also found to increase as a function of the number of daily lifts/transfers performed (PR: 1.4; 95% CI: 1.27 to 1.70). Other factors generally associated with LBP, such as age, sex, professional experience, smoking and exercise, were not found to be significantly associated with LBP in this study. Conclusion. No causal relationships can be inferred using these cross-sectional data. However, results suggest that direct patient contact that includes lifting and/or transferring patients may be an important risk factor. Further research is warranted to evaluate effectiveness of back education and prevention programs among hospital staff in Kuwait.

Health-related rehabilitation services: assessing the global supply of and need for human resources

BackgroundHuman resources for rehabilitation are often a neglected component of health services strengthening and health workforce development. This may be partly related to weaknesses in the available research and evidence to inform advocacy and programmatic strategies. The objective of this study was to quantitatively describe the global situation in terms of supply of and need for human resources for health-related rehabilitation services, as a basis for strategy development of the workforce in physical and rehabilitation medicine.MethodsData for assessing supply of and need for rehabilitative personnel were extracted and analyzed from statistical databases maintained by the World Health Organization and other national and international health information sources. Standardized classifications were used to enhance cross-national comparability of findings.ResultsLarge differences were found across countries and regions between assessed need for services requiring health workers associated to physical and rehabilitation medicine against estimated supply of health personnel skilled in rehabilitation services. Despite greater need, low- and middle-income countries tended to report less availability of skilled health personnel, although the strength of the supply-need relationship varied across geographical and economic country groupings.ConclusionThe evidence base on human resources for health-related rehabilitation services remains fragmented, the result of limited availability and use of quality, comparable data and information within and across countries. This assessment offered the first global baseline, intended to catalyze further research that can be translated into evidence to support human resources for rehabilitation policy and practice.

Post-earthquake Haiti: the critical role for rehabilitation services following a humanitarian crisis

The earthquake that occurred in Haiti on 12 January 2010 resulted in massive infrastructure damage, and created one of the largest single-day loss of life events in modern history. Despite the tragic mortality rates, many people with catastrophic injuries including spinal cord injuries and amputations survived due to swift emergency responses by local and international non-governmental organisations (NGOs). The outcome however is that Haiti now has a considerable cohort of people who live with important disabilities. In this ‘perspectives in rehabilitation’ we share our experiences of working in post-earthquake Haiti, and highlight that this event has raised awareness of the critical importance of providing rehabilitation services during and after a humanitarian crisis of this magnitude.

Analysis of factors affecting demand for rehabilitation services in Ontario, Canada: A health-policy perspective

Demand for health services tends to outstrip supply in an environment of economic scarcity. Purpose. In this research, we first explore factors affecting demand for rehabilitation services in Canadas most populous province of Ontario; we then interpret these findings and discuss their implications for future demand. Methods. Consistent with health-policy case-study methodology, we triangulated primary and secondary data sources (42 key-informant interviews and review of publicly available documents, respectively). Results. Demand for rehabilitation seems to be rising quickly across Ontarios continuum of care, and informants identified four primary factors: (1) overall population growth along with an increasingly large cohort aged 65 years or older; (2) increasing rates of chronic and complex conditions, along with changes in hospital discharge patterns; (3) increasing public expectations; and (4) advances in treatment and management of diseases and condition. Conclusions. Although demand may be rising, access to rehabilitation is now based more on eligibility than on demand alone. The presence of increasing demand does not ensure that there is, or will be, sufficient financial or human resources to meet such demand. This study signals the need to reflect on current policies regarding access, and highlights the need to consider the benefits of health-promotion and injury-prevention strategies in mediating demand.

Identification of recruitment and retention strategies for rehabilitation professionals in Ontario, Canada: results from expert panels

BackgroundDemand for rehabilitation services is expected to increase due to factors such as an aging population, workforce pressures, rise in chronic and complex multi-system disorders, advances in technology, and changes in interprofessional health service delivery models. However, health human resource (HHR) strategies for Canadian rehabilitation professionals are lagging behind other professional groups such as physicians and nurses. The objectives of this study were: 1) to identify recruitment and retention strategies of rehabilitation professionals including occupational therapists, physical therapists and speech language pathologists from the literature; and 2) to investigate both the importance and feasibility of the identified strategies using expert panels amongst HHR and education experts.MethodsA review of the literature was conducted to identify recruitment and retention strategies for rehabilitation professionals. Two expert panels, one on Recruitment and Retention and the other on Education were convened to determine the importance and feasibility of the identified strategies. A modified-delphi process was used to gain consensus and to rate the identified strategies along these two dimensions.ResultsA total of 34 strategies were identified by the Recruitment and Retention and Education expert panels as being important and feasible for the development of a HHR plan for recruitment and retention of rehabilitation professionals. Seven were categorized under the Quality of Worklife and Work Environment theme, another seven in Financial Incentives and Marketing, two in Workload and Skill Mix, thirteen in Professional Development and five in Education and Training.ConclusionBased on the results from the expert panels, the three major areas of focus for HHR planning in the rehabilitation sector should include strategies addressing Quality of Worklife and Work Environment, Financial Incentives and Marketing and Professional Development.

Examining International Clinical Internships for Canadian Physical Therapy Students from 1997 to 2007

PURPOSE To describe international clinical internships (ICIs) for Canadian physical therapy (PT) students, explore the experiences of individuals involved in ICIs, and develop recommendations for future ICIs based on these findings. METHODS This study employed a mixed-methods approach. An online questionnaire surveyed academic coordinators of clinical education (ACCEs, n=14) on the availability, destinations, and number of ICIs from 1997 to 2007. Semi-structured telephone interviews were then conducted with eight PT students, seven ACCEs, and three supervising clinicians to investigate their ICI experiences. Interview transcripts were coded descriptively and thematically using NVivo. RESULTS ICIs are currently available at 12 of 14 Canadian PT schools. A total of 313 students participated in ICIs in 51 different destination countries from 1997 to 2007. Over this period, increasing numbers of students participated in ICIs and developing countries represented an increasing proportion of ICI destinations. Key themes identified in the interviews were opportunities, challenges, and facilitating factors. CONCLUSIONS ICIs present unique opportunities for Canadian PT students. Recommendations to enhance the quality of future ICIs are (1) clearly defined objectives for ICIs, (2) additional follow-up post-ICI, and (3) improved record keeping and sharing of information on ICI destination countries and host sites.

Wait Times for Publicly Funded Outpatient and Community Physiotherapy and Occupational Therapy Services: Implications for the Increasing Number of Persons with Chronic Conditions in Ontario, Canada

BACKGROUND Timely access to publicly funded health services has emerged as a priority policy issue across the continuum of care from hospitals to the home and community sector. The purpose of this study was to examine wait lists and wait times for publicly funded outpatient and community occupational therapy (OT) and physical therapy (PT) services. METHODS A mailed self-administered questionnaire was sent in December 2005 to all publicly funded sites across Ontario that deliver outpatient or community OT or PT services (N = 374). Descriptive statistics were used to describe the study sample and to examine wait lists and wait times by setting and client condition. RESULTS Overall response rate was 57.2% (n = 214). More than 10,000 people were reported to be waiting for OT or PT services across Ontario. Of these, 16% (n = 1,664) were waiting for OT and 84% (n = 8,842) for PT. Of those waiting for OT, 59% had chronic conditions and half were waiting for home care rehabilitation services. Of those waiting for PT, 73% had chronic conditions and 81% were waiting at hospital outpatient departments. CONCLUSIONS Individuals with chronic conditions experience excessive wait times for outpatient and community OT and PT services in Ontario, particularly if they are waiting for services in hospital outpatient departments.

The precarious supply of physical therapists across Canada: exploring national trends in health human resources (1991 to 2005)

BackgroundHealth Human Resource (HHR) ratios are one measure of workforce supply, and are often expressed as a ratio in the number of health professionals to a sub-set of the population. In this study, we explore national trends in HHR among physical therapists (PTs) across Canada.MethodsNational population data were combined with provincial databases of registered physical therapists in order to estimate the HHR ratio in 2005, and to establish trends between 1991 and 2005.ResultsThe national HHR ratio was 4.3 PTs per 10,000 population in 1991, which increased to 5.0 by 2000. In 2005, the HHR ratios varied widely across jurisdictions; however, we estimate that the national average dropped to 4.8 PTs per 10,000. Although the trend in HHR between 1991 and 2005 suggests positive growth of 11.6%, we have found negative growth of 4.0% in the latter 5-years of this study period.ConclusionDemand for rehabilitation services is projected to escalate in the next decade. Identifying benchmarks or targets regarding the optimal number of PTs, along with other health professionals working within inter professional teams, is necessary to establish a stable supply of health providers to meet the emerging rehabilitation and mobility needs of an aging and increasingly complex Canadian population.

Models of Integrating Physical Therapists into Family Health Teams in Ontario, Canada: Challenges and Opportunities

PURPOSE To explore the potential for different models of incorporating physical therapy (PT) services within the emerging network of family health teams (FHTs) in Ontario and to identify challenges and opportunities of each model. METHODS A two-phase mixed-methods qualitative descriptive approach was used. First, FHTs were mapped in relation to existing community-based PT practices. Second, semi-structured key-informant interviews were conducted with representatives from urban and rural FHTs and from a variety of community-based PT practices. Interviews were digitally recorded, transcribed verbatim, and analyzed using a categorizing/editing approach. RESULTS Most participants agreed that the ideal model involves embedding physical therapists directly into FHTs; in some situations, however, partnering with an existing external PT provider may be more feasible and sustainable. Access and funding remain the key issues, regardless of the model adopted. CONCLUSION Although there are differences across the urban/rural divide, there exist opportunities to enhance and optimize existing delivery models so as to improve client access and address emerging demand for community-based PT services.

Physical Therapy Health Human Resource Ratios: A Comparative Analysis of the United States and Canada

Background and Purpose: Health human resource (HHR) ratios are a measure of workforce supply and are expressed as a ratio of the number of health care practitioners to a subset of the population. Health human resource ratios for physical therapists have been described for Canada but have not been fully described for the United States. In this study, HHR ratios for physical therapists across the United States were estimated in order to conduct a comparative analysis of the United States and Canada. Methods: National US Census Bureau data were linked to jurisdictional estimates of registered physical therapists to create HHR ratios at 3 time points: 1995, 1999, and 2005. These results then were compared with the results of a similar study conducted by the same authors in Canada. Results: The national HHR ratio across the United States in 1995 was 3.8 per 10,000 people; the ratio increased to 4.3 in 1999 and then to 6.2 in 2005. The aggregated results indicated that HHR ratios across the United States increased by 61.3% between 1995 and 2005. In contrast, the rate of evolution of HHR ratios in Canada was lower, with an estimated growth of 11.6% between 1991 and 2005. Although there were wide variations across jurisdictions, the data indicated that HHR ratios across the United States increased more rapidly than overall population growth in 49 of 51 jurisdictions (96.1%). In contrast, in Canada, the increase in HHR ratios surpassed population growth in only 7 of 10 jurisdictions (70.0%). Discussion and Conclusion: Despite their close proximity, there are differences between the United States and Canada in overall population and HHR ratio growth rates. Possible reasons for these differences and the policy implications of the findings of this study are explored in the context of forecasted growth in demand for health care and rehabilitation services.