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Shaun Oleary - One of the best experts on this subject based on the ideXlab platform.
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agreement between a Physiotherapist and an orthopaedic surgeon regarding management and prescription of corticosteroid injection for patients with shoulder pain
Manual Therapy, 2016Co-Authors: Darryn Marks, Michael Thomas, Shaun Oleary, Tracy Comans, Philip G Conaghan, Paul Anthony Scuffham, Leanne Margaret BissetAbstract:Abstract Background Physiotherapists increasingly manage shoulder referrals in place of orthopaedic doctors. Better understanding the agreement between these professionals will help inform the safety, quality and potential costs of these care models. Objective To establish the level of agreement between a Physiotherapist and an orthopaedic surgeon regarding diagnosis, management and corticosteroid injection, in a representative sample of orthopaedic shoulder referrals. Design Blinded inter-rater agreement study. Method 274 public orthopaedic shoulder patients were independently assessed by a Physiotherapist and an orthopaedic surgeon. Management, subacromial corticosteroid injection, diagnosis and investigation decisions were compared using inter-rater reliability statistics. Results Agreement between the Physiotherapist and the orthopaedic surgeon was near perfect for surgical versus nonsurgical management (Gwets agreement coefficient AC1 = 0.93, 95%CI: 0.90-0.93), safety of injection (AC1 = 0.85, CI: 0.79-0.91) and investigations requested (AC1 = 0.87, CI: 0.83-0.91); substantial for the presence of subacromial pain (AC1 = 0.74, CI: 0.66-0.81) and diagnosis (AC1 = 0.72, CI: 0.66-0.78); and moderate regarding delivery of subacromial corticosteroid injection as an immediate treatment (AC1 = 0.48, CI 0.33-0.53), with the Physiotherapist less inclined to select corticosteroid injection as the first intervention. Conclusion In this study a Physiotherapist with prescribing and injection training made decisions analogous to those of an orthopaedic surgeon at initial consultation for orthopaedic shoulder pain, including the safe identification of patients for subacromial injection, without prior screening of referrals by orthopaedic doctors. Trial registration Australia and New Zealand Clinical Trials Registry, number 12612000532808.
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increasing capacity for the treatment of common musculoskeletal problems a non inferiority rct and economic analysis of corticosteroid injection for shoulder pain comparing a Physiotherapist and orthopaedic surgeon
PLOS ONE, 2016Co-Authors: Darryn Marks, Leanne Margaret Bisset, Shaun Oleary, Tracy Comans, Philip G Conaghan, Michael J Thomas, Paul Anthony ScuffhamAbstract:Background Role substitution is a strategy employed to assist health services manage the growing demand for musculoskeletal care. Corticosteroid injection is a common treatment in this population but the efficacy of its prescription and delivery by Physiotherapists has not been established against orthopaedic standards. This paper investigates whether corticosteroid injection given by a Physiotherapist for shoulder pain is as clinically and cost effective as that from an orthopaedic surgeon. Methods A double blind non-inferiority randomized controlled trial was conducted in an Australian public hospital orthopaedic outpatient service, from January 2013 to June 2014. Adults with a General Practitioner referral to Orthopaedics for shoulder pain received subacromial corticosteroid and local anaesthetic injection prescribed and delivered independently by a Physiotherapist or a consultant orthopaedic surgeon. The main outcome measure was total Shoulder Pain and Disability Index (SPADI) score at baseline, six and 12 weeks, applying a non-inferiority margin of 15 points. Secondary outcomes tested for superiority included pain, shoulder movement, perceived improvement, adverse events, satisfaction, quality of life and costs. Results 278 participants were independently assessed by the Physiotherapist and the orthopaedic surgeon, with 64 randomised (Physiotherapist 33, orthopaedic surgeon 31). There were no significant differences in baseline characteristics between groups. Non-inferiority of injection by the Physiotherapist was declared from total SPADI scores at 6 and 12 weeks (upper limit of the 95% one-sided confidence interval 13.34 and 7.17 at 6 and 12 weeks, respectively). There were no statistically significant differences between groups on any outcome measures at 6 or 12 weeks. From the perspective of the health funder, the Physiotherapist was less expensive. Conclusions Corticosteroid injection for shoulder pain, provided by a suitably qualified Physiotherapist is at least as clinically effective, and less expensive, compared with similar care delivered by an orthopaedic surgeon. Policy makers and service providers should consider implementing this model of care.
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an experienced Physiotherapist prescribing and administering corticosteroid and local anaesthetic injections to the shoulder in an australian orthopaedic service a non inferiority randomised controlled trial and economic analysis study protocol for a
Trials, 2014Co-Authors: Darryn Marks, Leanne Margaret Bisset, Michael Thomas, Shaun Oleary, Tracy Comans, Philip G Conaghan, Paul Anthony ScuffhamAbstract:Background The early management of orthopaedic outpatients by Physiotherapists may be useful in reducing public hospital waiting lists. Physiotherapists in Australia are prevented by legislation and funding models from investigating, prescribing, injecting and referring autonomously. This gap in service is particularly noticeable in the management of shoulder pain in early-access physiotherapy services, as patients needing corticosteroid injection face delays or transfer to other services for this procedure. This trial will investigate the clinical (decision making and outcomes) and economic feasibility of a Physiotherapist prescribing and delivering corticosteroid and local anaesthetic injections for shoulder pain in an Australian public hospital setting.
Paul Anthony Scuffham - One of the best experts on this subject based on the ideXlab platform.
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agreement between a Physiotherapist and an orthopaedic surgeon regarding management and prescription of corticosteroid injection for patients with shoulder pain
Manual Therapy, 2016Co-Authors: Darryn Marks, Michael Thomas, Shaun Oleary, Tracy Comans, Philip G Conaghan, Paul Anthony Scuffham, Leanne Margaret BissetAbstract:Abstract Background Physiotherapists increasingly manage shoulder referrals in place of orthopaedic doctors. Better understanding the agreement between these professionals will help inform the safety, quality and potential costs of these care models. Objective To establish the level of agreement between a Physiotherapist and an orthopaedic surgeon regarding diagnosis, management and corticosteroid injection, in a representative sample of orthopaedic shoulder referrals. Design Blinded inter-rater agreement study. Method 274 public orthopaedic shoulder patients were independently assessed by a Physiotherapist and an orthopaedic surgeon. Management, subacromial corticosteroid injection, diagnosis and investigation decisions were compared using inter-rater reliability statistics. Results Agreement between the Physiotherapist and the orthopaedic surgeon was near perfect for surgical versus nonsurgical management (Gwets agreement coefficient AC1 = 0.93, 95%CI: 0.90-0.93), safety of injection (AC1 = 0.85, CI: 0.79-0.91) and investigations requested (AC1 = 0.87, CI: 0.83-0.91); substantial for the presence of subacromial pain (AC1 = 0.74, CI: 0.66-0.81) and diagnosis (AC1 = 0.72, CI: 0.66-0.78); and moderate regarding delivery of subacromial corticosteroid injection as an immediate treatment (AC1 = 0.48, CI 0.33-0.53), with the Physiotherapist less inclined to select corticosteroid injection as the first intervention. Conclusion In this study a Physiotherapist with prescribing and injection training made decisions analogous to those of an orthopaedic surgeon at initial consultation for orthopaedic shoulder pain, including the safe identification of patients for subacromial injection, without prior screening of referrals by orthopaedic doctors. Trial registration Australia and New Zealand Clinical Trials Registry, number 12612000532808.
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increasing capacity for the treatment of common musculoskeletal problems a non inferiority rct and economic analysis of corticosteroid injection for shoulder pain comparing a Physiotherapist and orthopaedic surgeon
PLOS ONE, 2016Co-Authors: Darryn Marks, Leanne Margaret Bisset, Shaun Oleary, Tracy Comans, Philip G Conaghan, Michael J Thomas, Paul Anthony ScuffhamAbstract:Background Role substitution is a strategy employed to assist health services manage the growing demand for musculoskeletal care. Corticosteroid injection is a common treatment in this population but the efficacy of its prescription and delivery by Physiotherapists has not been established against orthopaedic standards. This paper investigates whether corticosteroid injection given by a Physiotherapist for shoulder pain is as clinically and cost effective as that from an orthopaedic surgeon. Methods A double blind non-inferiority randomized controlled trial was conducted in an Australian public hospital orthopaedic outpatient service, from January 2013 to June 2014. Adults with a General Practitioner referral to Orthopaedics for shoulder pain received subacromial corticosteroid and local anaesthetic injection prescribed and delivered independently by a Physiotherapist or a consultant orthopaedic surgeon. The main outcome measure was total Shoulder Pain and Disability Index (SPADI) score at baseline, six and 12 weeks, applying a non-inferiority margin of 15 points. Secondary outcomes tested for superiority included pain, shoulder movement, perceived improvement, adverse events, satisfaction, quality of life and costs. Results 278 participants were independently assessed by the Physiotherapist and the orthopaedic surgeon, with 64 randomised (Physiotherapist 33, orthopaedic surgeon 31). There were no significant differences in baseline characteristics between groups. Non-inferiority of injection by the Physiotherapist was declared from total SPADI scores at 6 and 12 weeks (upper limit of the 95% one-sided confidence interval 13.34 and 7.17 at 6 and 12 weeks, respectively). There were no statistically significant differences between groups on any outcome measures at 6 or 12 weeks. From the perspective of the health funder, the Physiotherapist was less expensive. Conclusions Corticosteroid injection for shoulder pain, provided by a suitably qualified Physiotherapist is at least as clinically effective, and less expensive, compared with similar care delivered by an orthopaedic surgeon. Policy makers and service providers should consider implementing this model of care.
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an experienced Physiotherapist prescribing and administering corticosteroid and local anaesthetic injections to the shoulder in an australian orthopaedic service a non inferiority randomised controlled trial and economic analysis study protocol for a
Trials, 2014Co-Authors: Darryn Marks, Leanne Margaret Bisset, Michael Thomas, Shaun Oleary, Tracy Comans, Philip G Conaghan, Paul Anthony ScuffhamAbstract:Background The early management of orthopaedic outpatients by Physiotherapists may be useful in reducing public hospital waiting lists. Physiotherapists in Australia are prevented by legislation and funding models from investigating, prescribing, injecting and referring autonomously. This gap in service is particularly noticeable in the management of shoulder pain in early-access physiotherapy services, as patients needing corticosteroid injection face delays or transfer to other services for this procedure. This trial will investigate the clinical (decision making and outcomes) and economic feasibility of a Physiotherapist prescribing and delivering corticosteroid and local anaesthetic injections for shoulder pain in an Australian public hospital setting.
Alison Rushton - One of the best experts on this subject based on the ideXlab platform.
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a delphi study to explore and gain consensus regarding the most important barriers and facilitators affecting Physiotherapist and pharmacist non medical prescribing
PLOS ONE, 2021Co-Authors: Emma Grahamclarke, Alison Rushton, John F. MarriottAbstract:Non-medical prescribing was introduced into the United Kingdom to improve patient care, but early research indicated a third of Allied Health Professionals may not use their prescribing qualification. A previous literature review, highlighting factors influencing prescribing, identified only papers with nursing and pharmacy participants. This investigation explored consensus on factors affecting Physiotherapist and pharmacist non-medical prescribers. A three round Delphi study was conducted with pharmacist and Physiotherapist prescribers. Round One comprised information gathering on facilitators and barriers to prescribing participants had experienced, and underwent content analysis. This was followed by two sequential consensus seeking rounds with participants asked to rate the importance of statements to themselves. Consensus criteria were determined a priori, including median, interquartile range, percentage agreement and Kendall's Coefficient of Concordance (W). Statements reaching consensus were ranked for importance in Round Three and analysed to produce top ten ranks for all participants and for each professional group. Participants, recruited October 2018, comprised 24 pharmacists and 18 Physiotherapists. In Round One, content analysis of 172 statements regarding prescribing influences revealed 24 themes. 127 statements were included in Round Two for importance rating (barriers = 68, facilitators = 59). After Round Two, 29 statements reached consensus (barriers = 1, facilitators = 28), with no further statements reaching consensus following Round Three. The highest ranked statement in Round Three overall was: "Being able to prescribe to patients is more effective and really useful working [in my area]". Medical support and improved patient care factors appeared the most important. Differences were noted between Physiotherapist and pharmacist prescribers regarding the top ten ranked statements, for example team working which pharmacists ranked higher than Physiotherapists. Differences may be explained by the variety of practice areas and relative newness of physiotherapy prescribing. Barriers appear to be post or person specific, whereas facilitators appear universal.
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evaluation of the clinical effectiveness of a work based mentoring programme to develop clinical reasoning on patient outcome a stepped wedge cluster randomised controlled trial
PLOS ONE, 2019Co-Authors: Aled Williams, Alison Rushton, James Lewis, Ceri PhillipsAbstract:Background Despite persistent calls to measure the effectiveness of educational interventions on patient outcomes, few studies have been conducted. Within musculoskeletal physiotherapy, the effects of clinical mentoring on postgraduate Physiotherapists have been explored, but its impact on patient outcomes is unknown. The objective of this trial was to assess the effectiveness of a work-based mentoring programme to facilitate Physiotherapist clinical reasoning on patient outcomes. Methods In a stepped-wedge cluster RCT in the musculoskeletal physiotherapy outpatient departments of a large NHS organisation, 16 Physiotherapists were randomised by cluster to receive the intervention—150 hours of mentored clinical practice—at one of 3 time periods; control was usual training. 441 patients submitted outcome measures: Patient-Specific Functional Scale (PSFS) (primary outcome measure), EQ-5D-5L, patient activation and patient satisfaction (secondary outcome measures). A further secondary outcome measure of Physiotherapist performance was collected by an independent assessor observing the Physiotherapists practice. Results 80.0% of intervention patients achieved clinically significant PSFS scores compared with 63.8% of control patients. Binary logistic regression analysis modelling for time, cluster and patient characteristics showed strong statistical evidence for this difference (p = 0.023; odds ratio 4.24, 95%CI 1.22, 14.79). Physiotherapist performance scores improved from a mean of 47.8% (SD 3.60) pre-intervention to a mean of 56.0% (SD 4.24) (p<0.001). There was no statistical evidence for differences between groups on other secondary outcomes. Conclusion This is the first study that we aware of that provides patient outcomes measurement of an established educational intervention in physiotherapy, providing evidence that this type of intervention positively impacts patient outcomes and Physiotherapist performance. This provides a basis for further research in education across other healthcare disciplines and outcome measures.
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Perceptions about the implementation of Physiotherapist prescribing in Australia: a national survey of Australian Physiotherapists.
BMJ open, 2019Co-Authors: Tim Noblet, John F. Marriott, Taryn Jones, Catherine M. Dean, Alison RushtonAbstract:Objectives To explore: (1) the views of Australian Physiotherapists regarding potential implementation of non-medical prescribing in Australia, (2) how the geographical location and health sector in which a clinician works may influence their perceptions and (3) the perceptions of Australian Physiotherapists about how Physiotherapist prescribing might impact the care that the profession can provide. Design A cross-sectional descriptive survey using open and closed questions. Setting Participants completed an online questionnaire. Participants 883 Australian Health Professionals Registration Authority (AHPRA)-registered Physiotherapists, working across all states and territories. Outcome measures An online questionnaire was developed by a panel of subject experts and pretested (n=10) for internal consistency. A hyperlink to the questionnaire was emailed to all members of the Australian Physiotherapy Association. A reminder email was sent 4 weeks later. Quantitative data were analysed descriptively, with use of absolute risk reductions (ARRs) and 95% CIs to determine the likelihood that health sector or geographical location were associated with specific views. Thematic analysis enabled synthesis of the qualitative data. Results 79.0% participants felt that Physiotherapist prescribing should be introduced in Australia, with 71.2% wanting to train as prescribers. Clinical governance, risk management, regulation of clinicians and the development of an education framework were identified as priorities for implementation. Participants working in the private sector were significantly more likely to train as prescribers than those in the public sector (ARR 9.9%; 95% CI 3.5 to 16.4) or educational/research institutions (ARR 23.3%; 95% CI 12.8 to 33.8), with city dwellers significantly more likely to train compared with Physiotherapists in remote regions (ARR 19.8%; 95% CI 0.8 to 39.2). Physiotherapist prescribing was predicted to improve efficiency of healthcare delivery, access to medicines and reductions in healthcare costs. Conclusions AHPRA-registered Physiotherapists perceive that the introduction of autonomous Physiotherapist prescribing would be beneficial for the Australian population and should be introduced. Decision makers should consider the results of this survey in conjunction with cost–benefit and risk analysis when planning the introduction of Physiotherapist prescribing.
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perceptions of australian physiotherapy students about the potential implementation of Physiotherapist prescribing in australia a national survey
BMJ Open, 2019Co-Authors: John F. Marriott, Tim Noblet, Taryn Jones, Catherine M. Dean, Alison RushtonAbstract:Objectives To explore the perceptions of Australian physiotherapy students about (1) the potential implementation and use of non-medical prescribing by Physiotherapists in Australia and (2) how Physiotherapist prescribing might impact the care that the physiotherapy profession can provide in the future. Design A cross-sectional descriptive survey of physiotherapy students across Australia was completed using an online questionnaire developed by subject-experts and pretested (n=10) for internal consistency. A hyperlink to the questionnaire was emailed to all students enrolled in any accredited, entry-level Australian university physiotherapy programme. A reminder email was sent 4 weeks later. Setting Participants completed an online questionnaire. Participants 526 physiotherapy students from universities across all states with entry-level programmes. Outcome measures Quantitative data underwent primary descriptive analysis. Thematic analysis was used to synthesise qualitative data. Results 87% of participants supported the introduction of Physiotherapist prescribing in Australia. 91% of participants stated that they would train to prescribe following introduction. Participants identified improvements in clinical and cost effectiveness, timely access to appropriate prescription medicines and optimisation of quality healthcare as key drivers for the introduction. Conclusions Student Physiotherapists support the introduction of Physiotherapist prescribing in Australia, reporting potential benefits for patients, health services and the physiotherapy profession. Stakeholders should use the results of this study in conjunction with supporting literature to inform future decisions regarding Physiotherapist prescribing in Australia.
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views and perceptions of australian Physiotherapists and physiotherapy students about the potential implementation of Physiotherapist prescribing in australia a survey protocol
BMC Health Services Research, 2018Co-Authors: Taryn Jones, Tim Noblet, Catherine M. Dean, J Marriot, Alison RushtonAbstract:Non-medical prescribing (NMP) is acknowledged as an expanding area of clinical practice across the world. The physiotherapy profession is currently investigating the introduction of Physiotherapist prescribing in Australia, with the case for reform centred around meeting the healthcare needs of the current and future Australian population. Conflict within a profession has been identified as a barrier to implementation of new clinical innovations. An online survey has been developed with the aim to collect and synthesise the views and perceptions of Australian Physiotherapists and physiotherapy students about the potential use of NMP by Physiotherapists in Australia. A cross-sectional descriptive survey design, using a pre-tested online questionnaire, including quantitative and qualitative components, will be utilised to explore the views and perceptions of Australian Physiotherapists and physiotherapy students regarding NMP by Physiotherapists in Australia. Quantitative data will be analysed descriptively and regression analysis will be utilised to identify associations between the specific question outcomes and demographic data. A thematic analytical approach will be utilised to synthesise qualitative data from open-questions. The results from this survey will serve to inform decision-makers about the current views of the Australian physiotherapy profession with regards to the potential implementation of Physiotherapist prescribing in Australia. Data will be used in conjunction with cost-benefit analyses, risk analysis as well as assessment of the health-requirements and consultation with key stakeholders including the Australian health consumer when contemplating change.
Darryn Marks - One of the best experts on this subject based on the ideXlab platform.
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agreement between a Physiotherapist and an orthopaedic surgeon regarding management and prescription of corticosteroid injection for patients with shoulder pain
Manual Therapy, 2016Co-Authors: Darryn Marks, Michael Thomas, Shaun Oleary, Tracy Comans, Philip G Conaghan, Paul Anthony Scuffham, Leanne Margaret BissetAbstract:Abstract Background Physiotherapists increasingly manage shoulder referrals in place of orthopaedic doctors. Better understanding the agreement between these professionals will help inform the safety, quality and potential costs of these care models. Objective To establish the level of agreement between a Physiotherapist and an orthopaedic surgeon regarding diagnosis, management and corticosteroid injection, in a representative sample of orthopaedic shoulder referrals. Design Blinded inter-rater agreement study. Method 274 public orthopaedic shoulder patients were independently assessed by a Physiotherapist and an orthopaedic surgeon. Management, subacromial corticosteroid injection, diagnosis and investigation decisions were compared using inter-rater reliability statistics. Results Agreement between the Physiotherapist and the orthopaedic surgeon was near perfect for surgical versus nonsurgical management (Gwets agreement coefficient AC1 = 0.93, 95%CI: 0.90-0.93), safety of injection (AC1 = 0.85, CI: 0.79-0.91) and investigations requested (AC1 = 0.87, CI: 0.83-0.91); substantial for the presence of subacromial pain (AC1 = 0.74, CI: 0.66-0.81) and diagnosis (AC1 = 0.72, CI: 0.66-0.78); and moderate regarding delivery of subacromial corticosteroid injection as an immediate treatment (AC1 = 0.48, CI 0.33-0.53), with the Physiotherapist less inclined to select corticosteroid injection as the first intervention. Conclusion In this study a Physiotherapist with prescribing and injection training made decisions analogous to those of an orthopaedic surgeon at initial consultation for orthopaedic shoulder pain, including the safe identification of patients for subacromial injection, without prior screening of referrals by orthopaedic doctors. Trial registration Australia and New Zealand Clinical Trials Registry, number 12612000532808.
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increasing capacity for the treatment of common musculoskeletal problems a non inferiority rct and economic analysis of corticosteroid injection for shoulder pain comparing a Physiotherapist and orthopaedic surgeon
PLOS ONE, 2016Co-Authors: Darryn Marks, Leanne Margaret Bisset, Shaun Oleary, Tracy Comans, Philip G Conaghan, Michael J Thomas, Paul Anthony ScuffhamAbstract:Background Role substitution is a strategy employed to assist health services manage the growing demand for musculoskeletal care. Corticosteroid injection is a common treatment in this population but the efficacy of its prescription and delivery by Physiotherapists has not been established against orthopaedic standards. This paper investigates whether corticosteroid injection given by a Physiotherapist for shoulder pain is as clinically and cost effective as that from an orthopaedic surgeon. Methods A double blind non-inferiority randomized controlled trial was conducted in an Australian public hospital orthopaedic outpatient service, from January 2013 to June 2014. Adults with a General Practitioner referral to Orthopaedics for shoulder pain received subacromial corticosteroid and local anaesthetic injection prescribed and delivered independently by a Physiotherapist or a consultant orthopaedic surgeon. The main outcome measure was total Shoulder Pain and Disability Index (SPADI) score at baseline, six and 12 weeks, applying a non-inferiority margin of 15 points. Secondary outcomes tested for superiority included pain, shoulder movement, perceived improvement, adverse events, satisfaction, quality of life and costs. Results 278 participants were independently assessed by the Physiotherapist and the orthopaedic surgeon, with 64 randomised (Physiotherapist 33, orthopaedic surgeon 31). There were no significant differences in baseline characteristics between groups. Non-inferiority of injection by the Physiotherapist was declared from total SPADI scores at 6 and 12 weeks (upper limit of the 95% one-sided confidence interval 13.34 and 7.17 at 6 and 12 weeks, respectively). There were no statistically significant differences between groups on any outcome measures at 6 or 12 weeks. From the perspective of the health funder, the Physiotherapist was less expensive. Conclusions Corticosteroid injection for shoulder pain, provided by a suitably qualified Physiotherapist is at least as clinically effective, and less expensive, compared with similar care delivered by an orthopaedic surgeon. Policy makers and service providers should consider implementing this model of care.
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an experienced Physiotherapist prescribing and administering corticosteroid and local anaesthetic injections to the shoulder in an australian orthopaedic service a non inferiority randomised controlled trial and economic analysis study protocol for a
Trials, 2014Co-Authors: Darryn Marks, Leanne Margaret Bisset, Michael Thomas, Shaun Oleary, Tracy Comans, Philip G Conaghan, Paul Anthony ScuffhamAbstract:Background The early management of orthopaedic outpatients by Physiotherapists may be useful in reducing public hospital waiting lists. Physiotherapists in Australia are prevented by legislation and funding models from investigating, prescribing, injecting and referring autonomously. This gap in service is particularly noticeable in the management of shoulder pain in early-access physiotherapy services, as patients needing corticosteroid injection face delays or transfer to other services for this procedure. This trial will investigate the clinical (decision making and outcomes) and economic feasibility of a Physiotherapist prescribing and delivering corticosteroid and local anaesthetic injections for shoulder pain in an Australian public hospital setting.
Barbro Krevers - One of the best experts on this subject based on the ideXlab platform.
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Important aspects in relation to patients’ attendance at exercise-based cardiac rehabilitation – facilitators, barriers and Physiotherapist’s role: a qualitative study
BMC cardiovascular disorders, 2017Co-Authors: Maria Bäck, Birgitta Öberg, Barbro KreversAbstract:In order to improve attendance at exercise-based cardiac rehabilitation (CR), a greater insight into patients’ perspectives is necessary. The aim of the study was to explore aspects that influence patients’ attendance at exercise-based CR after acute coronary artery disease (CAD) and the role of the Physiotherapist in patients’ attendance at exercise-based CR. A total of 16 informants, (5 women; median age 64.5, range 47-79 years), diagnosed with CAD, were included in the study at the Cardiology Department, Linkoping University Hospital, Sweden. Qualitative interviews were conducted and analysed according to inductive content analysis. Four main categories were identified: (i) previous experience of exercise, (ii) needs in the acute phase, (iii) important prerequisites for attending exercise-based CR and (iv) future ambitions. The categories demonstrate that there are connections between the past, the present and the future, in terms of attitudes to facilitators, barriers and the use of strategies for managing exercise. An overall theme, defined as existential thoughts, had a major impact on the patients’ attitudes to attending exercise-based CR. The interaction and meetings with the Physiotherapists in the acute phase were described as important factors for attending exercise-based CR. Moreover, informants could feel that the Physiotherapists supported them in learning the right level of effort during exercise and reducing the fear of exercise. This study adds to previous knowledge of barriers and facilitators for exercise-based CR that patients with CAD get existential thoughts both related to exercise during the rehabilitation process and for future attitudes to exercise. This knowledge might necessitate greater attention to the Physiotherapist-patient interaction. To be able to tailor exercise-based CR for patients, Physiotherapists need to be aware of patients' past experiences of exercise and previous phases of the rehabilitation process as these are important for how patients’ perceive their need and ability of exercise.
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important aspects in relation to patients attendance at exercise based cardiac rehabilitation facilitators barriers and Physiotherapist s role a qualitative study
BMC Cardiovascular Disorders, 2017Co-Authors: Maria Bäck, Birgitta Öberg, Barbro KreversAbstract:In order to improve attendance at exercise-based cardiac rehabilitation (CR), a greater insight into patients’ perspectives is necessary. The aim of the study was to explore aspects that influence patients’ attendance at exercise-based CR after acute coronary artery disease (CAD) and the role of the Physiotherapist in patients’ attendance at exercise-based CR. A total of 16 informants, (5 women; median age 64.5, range 47-79 years), diagnosed with CAD, were included in the study at the Cardiology Department, Linkoping University Hospital, Sweden. Qualitative interviews were conducted and analysed according to inductive content analysis. Four main categories were identified: (i) previous experience of exercise, (ii) needs in the acute phase, (iii) important prerequisites for attending exercise-based CR and (iv) future ambitions. The categories demonstrate that there are connections between the past, the present and the future, in terms of attitudes to facilitators, barriers and the use of strategies for managing exercise. An overall theme, defined as existential thoughts, had a major impact on the patients’ attitudes to attending exercise-based CR. The interaction and meetings with the Physiotherapists in the acute phase were described as important factors for attending exercise-based CR. Moreover, informants could feel that the Physiotherapists supported them in learning the right level of effort during exercise and reducing the fear of exercise. This study adds to previous knowledge of barriers and facilitators for exercise-based CR that patients with CAD get existential thoughts both related to exercise during the rehabilitation process and for future attitudes to exercise. This knowledge might necessitate greater attention to the Physiotherapist-patient interaction. To be able to tailor exercise-based CR for patients, Physiotherapists need to be aware of patients' past experiences of exercise and previous phases of the rehabilitation process as these are important for how patients’ perceive their need and ability of exercise.