Physiotherapists are known to be prone to Work- related musculoskeletal disorders (WRMDs) but its prevalence among physiotherapists in Nigeria has not been reported. This study investigated the prevalence and work factors of WRMDs among physiotherapists in Nigeria.
A cross- sectional survey was administered to physiotherapists in different parts of Nigeria using a 2- part questionnaire with items adopted from questionnaires used for similar studies around the world. Two hundred and seventeen copies of the questionnaire were distributed for self administration but 126 physiotherapists returned completed surveys for a 58.1% response. The data were analyzed using SPPS version 10 at alpha level of 0.05. Descriptive statistics of frequency and percentages and inferential statistics of x2 were used as appropriate for data analysis.
Reported 12- month prevalence of WRMDs among Nigerian physiotherapists was 91.3%. Prevalence of WRMDs was significantly higher in female physiotherapists (p = 0.007) and those with lower body mass index (p = 0.045). The low back (69.8%) was the most commonly affected body part, followed by the neck (34.1%). Fifty percent of the physiotherapists first experienced their WRMDs within five years of graduation and the highest prevalence (61.7%) was found among physiotherapists younger than 30 years. Treating large number of patients in a day was cited by most (83.5%) of the respondents as the most important work factor for their WRMDs. The most commonly adopted coping strategy identified was for the therapists to modify their position and/or the patient's position (64.3%). Majority of the respondents (87.0%) did not leave the profession but 62.6% changed and/or modified their treatment because of their WRMDs.
The prevalence of WRMDs among physiotherapists in Nigeria is higher than most values reported for their counterparts around the world. The coping strategies and work factors of WRMDs among Nigerian physiotherapists are mostly similar to those of their counterparts elsewhere.
Problems associated with pain in several body regions due to work-related musculoskeletal disorders (WRMDs), repetitive movement and negative stress at work are quite common in many manufacturing industries of Latvia, int.al. clothing industry. The aim of this study was to evaluate efficiency of the psychotherapeutic intervention using medical hypnotherapy (MH) program for mind-body relaxation with pain-blocking imagery, cognitive restructuring of unpleasant physical and emotional experience.
300 sewers and 50 cutters with chronic pain were involved in the study. Self-rated WRMDs symptoms, pain intensity and interference were assessed using the extended version of Nordic Musculoskeletal Questionnaire and Brief Pain Inventory Scale. Assessment of the functional state of muscles was carried out using myotonometric (MYO) measurements. Work heaviness degree was estimated via heart rate monitoring (HRM). The MH program was composed of cognitive hypnotherapy and self-hypnosis training. Sunnen Trance Scale was used to determine person’s hypnotic susceptibility. Life quality assessment before and after MH program was carried out using Quality of Life Scale.
At the beginning of MH program sessions both sewers and cutters reported on pain interference with general activities, mood, sleep, normal work, etc., but after MH the interference of pain significantly decreased. HRM data confirmed that work heaviness degree of sewers and cutters can be referred to as light and moderate work (energy expenditure for their tasks varies from 3.4 till 4.7 kcal/min). Using MYO measurements it was stated that before MH 22% of workers involved in the study fell under III MYO category indices, consequently, their muscle tone was increased, which is associated with muscular fatigue. After MH muscle tone remained within the normal range meaning that they were able to adapt to the existing workload (II MYO category) or fully relax (I MYO category).
MH program including exercises-workouts, cognitive hypnotherapy and self-hypnosis training sessions is an effective method to decrease composite chronic pain intensity for sewers and cutters, as well as to decrease psychogenic tension and muscle fatigue (proved by objective measurements of muscles tone) and to increase the life quality.
Muscle fatigue; Work heaviness; Psychotherapeutic intervention; Quality of life
Despite the high frequency of work-related musculoskeletal disorders (WRMD), the relations between working conditions and ulnar nerve entrapment at the elbow (UNEE) has not been the object of much study. We studied the predictive factors for UNEE in a three-year prospective survey of upper-limb WRMD in repetitive work.
In 1993–1994 and three years later, 598 workers whose jobs involve repetitive work were examined by their occupational health physicians and completed a self-administered questionnaire. Predictive factors associated with the onset of UNEE were studied with bivariate and multivariate analysis.
Annual incidence was estimated at 0.8% per person year, based on 15 new cases during this three-year period. Holding a tool in position was the only predictive biomechanical factor (OR = 4.1, CI 1.4–12.0). Obesity increased the risk of UNEE (OR = 4.3, CI 1.2–16.2), as did presence of medial epicondylitis, carpal tunnel syndrome, radial tunnel syndrome, and cervicobrachial neuralgia. The associations with “holding a tool in position” and obesity were unchanged when the presence of other diagnoses was taken into account.
Despite the limitations of the study, the results suggest that UNEE incidence is associated with one biomechanical risk factor (holding a tool in position, repetitively), with overweight, and with other upper-limb WRMD, especially medial epicondylitis and other nerve entrapment disorders (cervicobrachial neuralgia, carpal and radial tunnel syndromes).
Adult; Comorbidity; Cubital Tunnel Syndrome; epidemiology; etiology; Cumulative Trauma Disorders; complications; epidemiology; Female; France; epidemiology; Humans; Incidence; Logistic Models; Male; Middle Aged; Musculoskeletal Diseases; classification; epidemiology; Obesity; complications; Occupational Diseases; complications; epidemiology; Occupations; classification; Posture; physiology; Prospective Studies; Questionnaires; Risk Factors; Workplace; psychology; elbow; repetitive work; ulnar nerve entrapment; work-related musculoskeletal disorder
The objective of this study is to analyze the commitment to a more health-promoting health service and to illuminate important barriers for having a health-promoting role in daily practice, among Swedish health care professionals.
Material and method:
Out of a total of 3751 health professionals who are working daytime in clinical practice in the province of Västerbotten, 1810 were invited to participate in a survey. The health professionals represented eight different occupational groups: counselors, dieticians, midwives, nurses, occupational therapists, physical therapists, psychologists, and physicians. A questionnaire that operationalized perceptions found in a previous qualitative study was mailed to residential addresses of the participants.
The majority believed that health services play a major role in long-term health development in the population and saw a need for health orientation as a strategy to provide more effective health care. Willingness to work more in health promotion and disease prevention was reported significantly more often by women than men, and by primary health care personnel compared to hospital personnel. Among the professional groups, psychologists, occupational therapists, and physiotherapists most frequently reported willingness. The most common barriers to health promotion roles in daily practice were reported to be heavy workload, lack of guidelines, and unclear objectives.
This study found strong support for reorientation of health services in the incorporation of a greater health promotion. A number of professions that are not usually associated with health promotion practices are knowledgeable and wish to focus more on health promotion and disease prevention. Management has a major role in creating opportunities for these professionals to participate in health promotion practices. Men and physicians reported less positive attitudes to a more health-promoting health service and often possess high positions of power. Therefore, they may play an important role in the process of change toward more health promotion in health services.
health promotion; health care professionals; health service; attitudes; barriers
Adolescents and young adults frequently experience mental disorders, yet tend not to seek help. This systematic review aims to summarise reported barriers and facilitators of help-seeking in young people using both qualitative research from surveys, focus groups, and interviews and quantitative data from published surveys. It extends previous reviews through its systematic research methodology and by the inclusion of published studies describing what young people themselves perceive are the barriers and facilitators to help-seeking for common mental health problems.
Twenty two published studies of perceived barriers or facilitators in adolescents or young adults were identified through searches of PubMed, PsycInfo, and the Cochrane database. A thematic analysis was undertaken on the results reported in the qualitative literature and quantitative literature.
Fifteen qualitative and seven quantitative studies were identified. Young people perceived stigma and embarrassment, problems recognising symptoms (poor mental health literacy), and a preference for self-reliance as the most important barriers to help-seeking. Facilitators were comparatively under-researched. However, there was evidence that young people perceived positive past experiences, and social support and encouragement from others as aids to the help-seeking process.
Strategies for improving help-seeking by adolescents and young adults should focus on improving mental health literacy, reducing stigma, and taking into account the desire of young people for self-reliance.
In the course of the last four decades, the profession of physiotherapy has progressively expanded its scope of responsibility and its focus on professional autonomy and evidence-based clinical practice. To preserve professional autonomy, it is crucial for the physiotherapy profession to meet society's expectations and demands of professional competence as well as ethical competence. Since it is becoming increasingly popular to choose a carrier in private practice in Denmark this context constitutes the frame of this study. Physiotherapy in private practice involves mainly a meeting between two partners: the physiotherapist and the patient. In the meeting, power asymmetry between the two partners is a condition that the physiotherapist has to handle. The aim of this study was to explore whether ethical issues rise during the first physiotherapy session discussed from the perspective of the physiotherapists in private practice.
A qualitative approach was chosen and semi-structured interviews with 21 physiotherapists were carried out twice and analysed by using a phenomenological framework.
Four descriptive themes emerged: general reflections on ethics in physiotherapy; the importance of the first physiotherapy session; the influence of the clinical environment on the first session and; reflections and actions upon beneficence towards the patient within the first session. The results show that the first session and the clinical context in private practice are essential from an ethical perspective.
Ethical issues do occur within the first session, the consciousness about ethical issues differs in Danish physiotherapy private practice, and reflections and acts are to a lesser extent based on awareness of ethical theories, principles and ethical guidelines. Beneficence towards the patient is a fundamental aspect of the physiotherapists' understanding of the first session. However, if the physiotherapist lacks a deeper ethical awareness, the physiotherapist may reason and/or act ethically to a varying extent: only an ethically conscious physiotherapist will know when he or she reflects and acts ethically. Further exploration of ethical issues in private practice is recommendable, and as management policy is deeply embedded within the Danish public sector there are reasons to explore public contexts of physiotherapy as well.
This study was planned to collect data about causes, prevalence and responses to work-related musculoskeletal disorders reported by physiotherapists employed in Izmir, Turkey.
A two-page survey with closed ended questions was used as the data collected method. This survey was distributed to 205 physiotherapists working in Izmir, Turkey, and 120 physiotherapists answered. Questions included occupational history of physiotherapists and musculoskeletal symptoms, special areas, tasks, job-related risk factors, injury prevention strategies, and responses to injury.
Eighty-five percent of the physiotherapists have had a musculoskeletal injury once or more in their lifetime. Injuries have been occurred mostly in low back (26 %), hand-wrist (18 %), shoulders (14 %) and neck (12 %). The highest risk factor in causing the injury was transferring the patient at 15%. Sixty-nine percent of physiotherapists visited a physician for their injury and sixty-seven percent of the respondents indicated that they had not limited their patient contact time as a result to their injury
According to the results of this study, the rate of musculoskeletal disorders in physiotherapists in Izmir-Turkey has been found to be high due to their profession. Respondents felt that a change in work habits was required in order to decrease the risk of another injury.
Introduction. Contemporary health policy promotes delivery of community-based health services to people with musculoskeletal conditions, including rheumatoid arthritis (RA). This emphasis requires a skilled workforce to deliver safe, effective care. We aimed to explore physiotherapy workforce readiness to co-manage consumers with RA by determining the RA-specific professional development (PD) needs in relation to work and educational characteristics of physiotherapists in Western Australia (WA). Methods. An e-survey was sent to physiotherapists regarding their confidence in co-managing people with RA and their PD needs. Data including years of clinical experience, current RA clinical caseload, professional qualifications, and primary clinical area of practice were collected. Results. 273 physiotherapists completed the survey. Overall confidence in managing people with RA was low (22.7–58.2%) and need for PD was high (45.1–95.2%). Physiotherapists with greater years of clinical experience, a caseload of consumers with RA, postgraduate qualifications in musculoskeletal physiotherapy, or who worked in the musculoskeletal area were more confident in managing people with RA and less likely to need PD. Online and face-to-face formats were preferred modes of PD delivery. Discussion. To enable community-based RA service delivery to be effectively established, subgroups within the current physiotherapy workforce require upskilling in the evidence-based management of consumers with RA.
The physiotherapy profession has undergone a paradigmatic shift in recent years, where a ‘biopsychosocial’ model of care has acquired popularity in response to mounting research evidence indicating better patient outcomes when used alongside traditional physiotherapy. However, research has not examined how this new dimension to traditional physical therapy is implemented within the therapeutic consultation.
The study aimed to investigate physiotherapists’ reported approaches to back pain care in the context of increasing pressure to address patients’ psychosocial concerns. A secondary analysis of semi-structured qualitative interviews with 12 UK physiotherapists was conducted. Respondents were sampled from a national survey, to include a broad mix of physiotherapists. Data were analysed thematically, adopting the constant comparative methodology.
The combination of traditional physical therapy with a broader biopsychosocial approach presented significant challenges. Physiotherapists responded by attempting to navigate patients’ biopsychosocial problems through use of various strategies, such as setting boundaries around their clinical role and addressing lay health beliefs of patients through the provision of reassurance and lifestyle advice.
As psychosocial issues, alongside biomechanical factors, command a prominent place within the back pain consultation, physiotherapists may benefit from further specific training and mentoring support in identifying specific strategies for combining the best of traditional physiotherapy approaches with greater focus on patients’ beliefs, fears and social context.
Physiotherapy; Back pain; Biopsychosocial; Clinician-patient communication
A cross-sectional study was conducted to measure the prevalence of work-related
injuries among physiotherapists in Malaysia and to explore the influence of factors such
as gender, body mass index, years of work experience and clinical placement areas on the
occurrence of work-related musculoskeletal disorders.
Self-administered questionnaires adapted from the Nordic Musculoskeletal Questionnaire
were sent to 105 physiotherapists at three main public hospitals in Kuala Lumpur,
Malaysia. The questionnaire had 12 items that covered demographic information, areas of
musculoskeletal problems and physiotherapy techniques that could contribute to
work-related musculoskeletal disorders. The data obtained were analyzed using the
Statistical Package for Social Science version 14 software.
The overall prevalence of work-related injuries during the past 12 months was 71.6%.
Female therapists reported a significantly higher prevalence of work-related
musculoskeletal disorders than the male therapists (73.0%, p<0.001). Significant
differences were observed between the proportion of therapists who had work-related
musculoskeletal disorders and those who did not for the group with a body mass index
(BMI) >25 (χ2 = 9.0,
p = 0.003) and the group with a BMI of 18–25
(χ2 = 7.8, p = 0.006). Manual
therapy (58.6%) and lifting/transfer tasks (41.3%) were the two physiotherapy techniques
that most often contributed to work-related musculoskeletal disorders.
Work-related injuries are significantly higher among the physiotherapists in Malaysia
compared with many other countries. Female therapists reported a higher incidence of
work-related musculoskeletal disorders in this study, and work-related musculoskeletal
disorders were more common among therapists working in the pediatric specialty. This
study contributes to the understanding of work-related disorders among physiotherapists
from a southeast Asian perspective where the profession is in its development stage.
Occupation; Manpower; Standards; Injuries, Epidemiology
Significant efforts have been made to address the shortage of health professionals in rural communities. In the face of increasing demand for rehabilitation services, strategies for recruiting and retaining occupational therapists (OTs) and physiotherapists (PTs) have yielded limited success. This study aims to broaden the understanding of factors associated with recruitment and retention of OTs and PTs in rural regions, through a synthesis of evidence from qualitative studies found in the literature.
A systematic search of three databases was conducted for studies published between 1980 - 2009 specific to the recruitment and retention of OTs and PTs to rural areas. Studies deemed eligible were appraised using the McMaster Critical Review Form. Employing an iterative process, we conducted a thematic analysis of studies and developed second order interpretations to gain new insight into factors that influence rural recruitment and retention.
Of the 615 articles retrieved, 12 qualitative studies met the eligibility criteria. Our synthesis revealed that therapists’ decision to locate, stay or leave rural communities was influenced to a greater degree by the availability of and access to practice supports, opportunities for professional growth and understanding the context of rural practice, than by location. The second-order analysis revealed the benefits of a strength-based inquiry in determining recruitment and retention factors. The themes that emerged were 1) support from the organization influences retention, 2) with support, challenges can become rewards and assets, and 3) an understanding of the challenges associated with rural practice prior to arrival influences retention.
This meta-synthesis illustrates how universally important practice supports are in the recruitment and retention of rehabilitation professionals in rural practice. While not unique to rural practice, the findings of this synthesis provide employers and health service planners with information necessary to make evidence-informed decisions regarding recruitment and retention to improve availability of health services for rural residents.
Recruitment; Retention; Workforce; Physical therapy; Occupational therapy; Continuing professional development
Health care workers have high physical work demands, involving patient handling and manual work tasks. A strategy for prevention of work-related musculoskeletal disorders can enhance the physical capacity of the health care worker. The aim of this study is to evaluate the efficacy of 'Tailored Physical Activity’ for health care workers in the Sonderborg Municipality.
This protocol describes the design of a randomised controlled trial to assess the efficacy of 'Tailored Physical Activity’ versus a reference group for health care workers in the Sonderborg Municipality. Inclusion criteria to be fulfilled: health care workers with daily work that includes manual work and with the experience of work-related musculoskeletal pain in the back or upper body.
All participants will receive 'Health Guidance’, a (90-minute) individualised dialogue focusing on improving life style, based on assessments of risk behaviour, on motivation for change and on personal resources. In addition, the experimental groups will receive 'Tailored Physical Activity’ (three 50-minute sessions per week over 10 weeks). The reference group will receive only 'Health Guidance’.
The primary outcome measure is the participants’ self-reported sickness absence during the last three months due to musculoskeletal troubles, measured 3 and 12 months after baseline.
In addition, secondary outcomes include anthropometric measurements, functional capacity and self-reported number of sick days, musculoskeletal symptoms, self-reported health, work ability, work productivity, physical capacity, kinesiophobia and physical functional status.
The results from this study will contribute to the knowledge about evidence-based interventions for prevention of sickness absence among health care workers.
'Tailored Physical Activity’; Health care workers; Musculoskeletal disorders; Prevention; Sickness absence
A mismatch between individual physical capacities and physical work demands enhance the risk for musculoskeletal disorders, poor work ability and sickness absence, termed physical deterioration. However, effective intervention strategies for preventing physical deterioration in job groups with high physical demands remains to be established. This paper describes the background, design and conceptual model of the FINALE programme, a framework for health promoting interventions at 4 Danish job groups (i.e. cleaners, health-care workers, construction workers and industrial workers) characterized by high physical work demands, musculoskeletal disorders, poor work ability and sickness absence.
A novel approach of the FINALE programme is that the interventions, i.e. 3 randomized controlled trials (RCT) and 1 exploratory case-control study are tailored to the physical work demands, physical capacities and health profile of workers in each job-group. The RCT among cleaners, characterized by repetitive work tasks and musculoskeletal disorders, aims at making the cleaners less susceptible to musculoskeletal disorders by physical coordination training or cognitive behavioral theory based training (CBTr). Because health-care workers are reported to have high prevalence of overweight and heavy lifts, the aim of the RCT is long-term weight-loss by combined physical exercise training, CBTr and diet. Construction work, characterized by heavy lifting, pushing and pulling, the RCT aims at improving physical capacity and promoting musculoskeletal and cardiovascular health. At the industrial work-place characterized by repetitive work tasks, the intervention aims at reducing physical exertion and musculoskeletal disorders by combined physical exercise training, CBTr and participatory ergonomics. The overall aim of the FINALE programme is to improve the safety margin between individual resources (i.e. physical capacities, and cognitive and behavioral skills) and physical work demands, and thereby reduce the physical deterioration in a long term perspective by interventions tailored for each respective job-group.
The FINALE programme has the potential to provide evidence-based knowledge of significant importance for public health policy and health promotion strategies for employees at high risk for physical deterioration.
ISRCTN96241850, NCT01015716 and NCT01007669
The use of social networking software has become ubiquitous in our society. The aim of this study was to explore the attitudes and experiences of healthcare professional students using Facebook at our school, to determine if there is a need for development of policy to assist students in this area.
A mixed-methods approach was employed, using semistructured interviews to identify themes which were explored using an online survey. A combination of descriptive statistics and thematic analysis was used for analysis.
Healthcare professions education programmes at a large Canadian university.
Students of medicine, nursing, pharmacy, speech and language pathology, occupational therapy, physical therapy, dentistry, dental hygiene and medical laboratory Science were invited to participate. 14 participants were interviewed, and 682 participants responded to an online survey; the female:male balance was 3 : 1.
14 interviews were analysed in-depth, and 682 students responded to the survey (17% response rate). 93% reported current Facebook use. Themes identified included patterns of use and attitudes to friendship, attitudes to online privacy, breaches of professional behaviour on Facebook and attitudes to guidelines relating to Facebook use. A majority considered posting of the following material unprofessional: use of alcohol/drugs, crime, obscenity/nudity/sexual content, patient/client information, criticism of others. 44% reported seeing such material posted by a colleague, and 27% reported posting such material themselves. A majority of participants agreed that guidelines for Facebook use would be beneficial.
Social networking software use, specifically Facebook use, was widespread among healthcare students at our school who responded to our survey. Our results highlight some of the challenges which can accompany the use of this new technology and offer potential insights to help understand the pedagogy and practices of Facebook use in this population, and to help students navigate the dilemmas associated with becoming 21st century healthcare professionals.
OBJECTIVE: To evaluate the effectiveness and cost effectiveness of specially trained physiotherapists in the assessment and management of defined referrals to hospital orthopaedic departments. DESIGN: Randomised controlled trial. SETTING: Orthopaedic outpatient departments in two hospitals. SUBJECTS: 481 patients with musculoskeletal problems referred for specialist orthopaedic opinion. INTERVENTIONS: Initial assessment and management undertaken by post- Fellowship junior orthopaedic surgeons, or by specially trained physiotherapists working in an extended role (orthopaedic physiotherapy specialists). MAIN OUTCOME MEASURES: Patient centred measures of pain, functional disability and perceived handicap. RESULTS: A total of 654 patients were eligible to join the trial, 481 (73.6%) gave their consent to be randomised. The two arms (doctor n = 244, physiotherapist n = 237) were similar at baseline. Baseline and follow up questionnaires were completed by 383 patients (79.6%). The mean time to follow up was 5.6 months after randomisation, with similar distributions of intervals to follow up in both arms. The only outcome for which there was a statistically or clinically important difference between arms was in a measure of patient satisfaction, which favoured the physiotherapist arm. A cost minimisation analysis showed no significant differences in direct costs to the patient or NHS primary care costs. Direct hospital costs were lower (p < 0.00001) in the physiotherapist arm (mean cost per patient = 256 Pounds, n = 232), as they were less likely to order radiographs and to refer patients for orthopaedic surgery than were the junior doctors (mean cost per patient in arm = 498 Pounds, n = 238). CONCLUSIONS: On the basis of the patient centred outcomes measured in this randomised trial, orthopaedic physiotherapy specialists are as effective as post-Fellowship junior staff and clinical assistant orthopaedic surgeons in the initial assessment and management of new referrals to outpatient orthopaedic departments, and generate lower initial direct hospital costs.
The purpose of this study is to examine current beliefs about the use, the clinical importance, the theoretical fundamentals and the utilization criteria of therapeutic ultrasound (TUS) among physical therapists on the clinical practice in orthopedic and sports physiotherapy in Brazil.
A brief survey was developed based on previous studies and was sent to 55 physical therapists with advanced competency in orthopedics and sports physiotherapy. The questions addressed general topics about the professional profile and ultrasound usage and dosage.
Our data show the wide availability and frequent use of TUS in this sample of physical therapists. TUS is used in distinct musculoskeletal injuries and/or disorders in both acute and chronic conditions. Muscles, tendons and ligaments represented the major structures where TUS is used. Questions on the basic theory of TUS demonstrated a lack of knowledge of the ultrasound physiological effects as well as its interaction with biological tissues and TUS absolute contraindication.
A Brazilian profile about the US usage and dosage in orthopedic and sports physiotherapy is presented and highlights the need for a continuous upgrading process and further research into its effects.
Ultrasound therapy; Electrophysical agent; Survey; Physical therapy; Orthopedic
A comparison of the job satisfaction of health care professionals has not been well studied in Malaysia. This study aimed to compare the job satisfaction level among 8 groups of health care professionals in private settings, using the Job Satisfaction Survey (JSS).
A total of 81 health care professionals, including nurses, physiotherapists, occupational therapists, medical laboratory technologists, dieticians, medical imaging practitioners, environmental health officers, and optometrists in private (non-government) settings in the Klang Valley, were interviewed using the Job Satisfaction Survey scale invented by Dr Paul E Spector. Their job satisfaction scores were calculated and determined.
In the demographic data, the majority of the subjects were 20–30 years old (81.5%), were female (72.8%), had a basic degree (98.8%), were single (64.2%), and had 1–5 years of working experience (83.9%). A Kruskal–Wallis analysis showed significant differences (P < 0.05) in promotion, supervision, operating conditions, co-workers, nature of the work, and communication, but there were no significant differences (P > 0.05) in pay, fringe benefits, and contingent rewards in JSS score among the 8 health care professions. The Friedman Test showed a significant difference of overall JSS scores (χ2 = 526.418, P < 0.001) among the 8 health care professions.
The overall job satisfaction levels are different among health care professionals in private settings, especially regarding promotion, supervision, operating conditions, co-workers, the nature of the work, and communication.
job satisfaction; health care; non-governmental organizations; private sector
Professional musicians may have high rates of musculoskeletal pain, but few studies have analysed risks by work activities or the psychosocial work environment.
To assess the prevalence and impact of musculoskeletal pain, and its relation to playing conditions, mental health and performance anxiety, in musicians from leading British symphony orchestras.
Musicians from six professional orchestras completed a questionnaire concerning their orchestral duties and physical activities at work; mental health (somatising tendency, mood, demand, support and control at work, performance anxiety); and regional pain in the past four weeks and past 12 months. Prevalence rates were estimated by anatomical site, and associations with risk factors assessed by logistic regression.
Responses were received from 243 musicians (51% of those approached), among whom 210 (86%) reported regional pain in the past 12 months, mainly affecting the neck, low-back, and shoulders. Risks tended to be higher in women, in those with low mood, and especially in those with high somatising scores. Only weak associations were found with psychosocial work stressors and performance anxiety. However, risks differed markedly by instrument category. Relative to string players, the odds of wrist/hand pain were raised 2.9-fold in wind players, but 60% lower in brass players, while the odds of elbow pain were 50% lower among wind and brass players.
Musculoskeletal pain is common in elite professional musicians. A major personal risk factor is somatising tendency, but performance anxiety has less impact. Risks differ substantially by instrument played, offering pointers towards prevention.
Purpose: Military physiotherapists in the Canadian Forces meet the unique rehabilitation needs of military personnel. Recently, the physiotherapy officer role has evolved in response to the Canadian Forces' involvement in the combat theatre of operations of Afghanistan, and this has created new and unique challenges and demands. The purpose of this study was to describe the experiences and challenges of military physiotherapists deployed to Afghanistan.
Methods: A qualitative research design guided by descriptive phenomenology involved recruitment of key informants and in-depth interviews as the data collection method. The interviews were transcribed verbatim and the data analyzed using a foundational thematic analysis approach. Strategies of peer review and member checking were incorporated into the study design.
Results: Six military physiotherapists were interviewed. They described rewarding experiences that were stressful yet highly career-satisfying. Main challenges revolved around heavy workloads, an expanded scope of practice as sole-charge practitioners, and the consequences and criticality of their clinical decisions.
Conclusions: Our findings suggest that enhanced pre-deployment training and the implementation of a stronger support network will improve the capabilities of military physiotherapists deployed to difficult theatres of operations. This type of systematic and comprehensive research is needed to assist the Canadian Forces in proactively preparing and supporting physiotherapists deployed on future missions.
Afghanistan; military medicine; stress, psychological; workload; Afghanistan; exigences de charge de travail; fatigue psychologique; physiothérapie militaire; recherche qualitative
With the overall objective to develop future strategies for a more health-promoting health service in Sweden, the aim of this paper was to describe how health personnel view barriers and possibilities for having a health-promoting role in practice.
Materials and methods:
Seven focus group discussions were carried out with a total of 34 informants from both hospital and primary health care settings in Sweden. The informants represented seven professional groups; counselors, occupational therapists, assistant nurses, midwives, nurses, physicians, and physiotherapists. The data were analyzed using qualitative content analysis.
The analysis resulted in one major theme “If we only got a chance”. The theme captures the health professionals’ positive view about, and their willingness to, develop a health-promoting and/or preventive role, while at the same time feeling limited by existing values, structures, and resources. The four categories, “organizational commitment to a paradigm shift”, “recognition of staff as health-promoting instruments”, “a balance between resources and tasks”, and “freedom of action” capture what is needed for implementing and increasing health promotion and preventive efforts in the health services.
The study indicates that an organizational setting that support health promotion is still to be developed. There is a need for a more explicit leadership with a clear direction towards the goal of “a more health–promoting health service” and with enough resources for achieving this goal.
qualitative methods; health promotion; health care professionals; health service; perceptions
In Australia, physiotherapy is a primary contact profession when practiced in private ambulatory settings. Primary contact means that physiotherapists take responsibility for diagnosis, decisions on interventions, appropriate ongoing management, and costs related to benefits. For most physiotherapists, the most common clinical presentations relate to symptoms from musculoskeletal conditions. There is considerable research evidence for many “physiotherapy” techniques in the management of musculoskeletal symptoms. As part of these management strategies, some physiotherapists may use nonsteroidal antiinflammatory drugs (NSAIDs) as an adjunct to treatment. Physiotherapists do not have the training or the legislative powers to prescribe NSAIDs. However, they can recommend that patients seek advice about appropriate adjunct NSAIDs from pharmacists and/or medical practitioners. The roles and responsibilities of key health providers in this area appear to be well defined in terms of minimizing medication misadventure and optimizing patient health outcomes. A recent survey of physiotherapist behaviors and practices, however, identified a number of “gray” areas that could confront unwary physiotherapists, or pose dilemmas for those without the support of medical/pharmacist colleagues. These gray areas relate to the adjunct use of topical NSAIDs in physiotherapy management and making recommendations for the use of oral NSAIDs. This paper reports on qualitative data that highlights the dilemmas confronting physiotherapists.
physiotherapy; antiinflammatory agents; legal and ethical issues
Purpose: To describe barriers to charting identified by physiotherapists working in private practice in New Brunswick.
Method: Physiotherapists were invited to focus-group interviews to discuss the results of a comprehensive chart audit. Sixty-nine physiotherapists who responded were assigned to nine focus groups. Seven of nine audiotaped interviews (49 participants) were of sufficient quality to be transcribed and imported into qualitative data analysis software for thematic analysis.
Results: Participants described the challenges of including charting in their routine client care. Barriers included the disjuncture between charting and thinking, the translation of impairment goals to functional goals, the time it takes to chart, fear of failure, and the difficulty of predicting length of treatment. Strategies to facilitate charting were suggested by participants.
Conclusion: Understanding barriers to charting in private practice is necessary to improve the quality of documentation. Barriers described are related to the fast-moving nonverbal, kinaesthetic, and cognitive process that is clinical reasoning in physiotherapy. This tacit, implicit process is mismatched with the charting task, which requires that the implicit become explicit in written form. Strategies to facilitate charting noted by participants address some of these issues; however, a broader, profession-wide discussion is necessary.
barriers; charting; focus-group interviews; qualitative research; subacute low back pain; groupes de discussion; lombalgie subaiguë; obstacles; recherche qualitative; tenue de dossiers
To reports a study in which action research approach was utilised to introduce a new system of risk
assessment, based on traffic lights, into a community mental health team.
Risk management is a serious concern in community mental healthcare where there is less direct, real-time
supervision of clients than in other settings, and because inadequate management of risk can have fatal consequences
when service users are a risk to themselves and/or others.
An action research design was undertaken, using three phases of Look, Think and Act.
Data were collected between January and March of 2012. In the action research phases, qualitative data were
collected in focus groups with the team’s multi-disciplinary mental health professionals. Data were transcribed verbatim
and analysed thematically, which involved agreement of themes and interpretations by two researchers. The Look, Think
and Act phases guided the development of the project; team members worked collaboratively on the traffic light system,
implemented and evaluated it.
Themes were constructed that were discussed across the focus groups. These themes were: Ease of use; Risk
identification and management; Legal status; Different teams’ views of risk; Post-implementation evaluation.
Action research has been used to implement change in mental health risk management. Others internationally
would benefit from considering a Traffic Light System, and in using action research to implement it.
Risk management; risk assessment; community mental health; action research; traffic light system; qualitative
research, focus groups.
The prevalence of musculoskeletal complaints in dentists is high although relatively few studies had focus in this profession. The aim of this study was to investigate the relations between physical, psychosocial, and individual characteristics and different endpoints of musculoskeletal complaints of low back, neck, shoulders and hand/wrist.
A questionnaire survey was carried out among 430 dentists (response 88%) in Thessaloniki, Greece. Questions include data on physical and psychosocial workload, need for recovery, perceived general health and (i) the occurrence of musculoskeletal complaints in the past 12 months, (ii) chronic complaints during at least 1 month, complaints which led to (iii) sickness absence, and (iv) medical care seeking. In logistic regression analysis odds ratios were estimated for all relevant risk factors.
62% of dentists reported at least one musculoskeletal complaint, 30% chronic complaints, 16% had spells of absence and, 32% sought medical care. Self-reported factors of physical load were associated with the occurrence of back pain (OR = 1.59), shoulder pain (OR = 2.57) and, hand/wrist pain (OR = 3.46). With the exception of hand/wrist complaints, the physical factors were not associated with chronic complaints and musculoskeletal sickness absence. Physical load showed a trend with the number of musculoskeletal complaints with ORs of 2.50, 3.07 and 4.40 for two, three and four musculoskeletal complaints, respectively. No consistent influence of psychosocial factors on complaints, chronicity, sickness absence and medical care seeking was observed. A perceived moderate general health was a significant factor for chronic complaints, comorbidity and medical care seeking where high perceived exertion was significant for absenteeism. Living alone was also related with increased absenteeism due to shoulder pain (OR = 5.01) and hand/wrist (OR = 4.07).
The physical load among dentists seems to put them at risk for the occurrence of musculoskeletal disorders. More than one and severe complaints are related to perceived general health while high perceived exertion and social characteristics are associated with sickness absence. Chronic symptoms seem to determine medical care seeking. Ergonomic interventions may have a greater impact in prevention of hand/wrist complaints. When investigating the influence of work-related risk factors on musculoskeletal health, psychosocial and other personal characteristics should be taken into account.
Mental health professionals face unique demands and stressors in their work, resulting in high rates of burnout and distress. Clinical supervision is a widely adopted and valued mechanism of professional support, development, and accountability, despite the very limited evidence of specific impacts on therapist or client outcomes. The current study aims to address this by exploring how psychotherapists develop competence through clinical supervision and what impact this has on the supervisees’ practice and their clients’ outcomes. This paper provides a rationale for the study and describes the protocol for an in-depth qualitative study of supervisory dyads, highlighting how it addresses gaps in the literature.
The study of 16–20 supervisor-supervisee dyads uses a qualitative mixed method design, with two phases. In phase one, supervisors who are nominated as expert by their peers are interviewed about their supervision practice. In phase two, supervisors record a supervision session with a consenting supervisee; interpersonal process recall interviews are conducted separately with supervisor and supervisee to reflect in depth on the teaching and learning processes occurring. All interviews will be transcribed, coded and analysed to identify the processes that build competence, using a modified form of Consensual Qualitative Research (CQR) strategies. Using a theory-building case study method, data from both phases of the study will be integrated to develop a model describing the processes that build competence and support wellbeing in practising psychotherapists, reflecting the accumulated wisdom of the expert supervisors.
The study addresses past study limitations by examining expert supervisors and their supervisory interactions, by reflecting on actual supervision sessions, and by using dyadic analysis of the supervisory pairs. The study findings will inform the development of future supervision training and practice and identify fruitful avenues for future research.
Clinical supervision; Psychotherapy; Counselling; Mental health; Professional development; Professional wellbeing