scholarly journals Parental self-medication with antibiotics for children promotes antibiotic over-prescribing in clinical settings in China

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Jiayao Xu ◽  
Xiaomin Wang ◽  
Kai Sing Sun ◽  
Leesa Lin ◽  
Xudong Zhou
Keyword(s):  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Clinical Settings ◽  
Cross Sectional Survey ◽  
Self Medication ◽  
Cross Sectional ◽  
Prescribing Behavior ◽  
The Past ◽  
Outpatient Settings ◽  
The Impact

Abstract Background Self-medication with antibiotics (SMA) is one of the most dangerous inappropriate antibiotic use behaviors. This study aims to investigate the impact of parental SMA for children before a consultation on their doctor’s subsequent antibiotic prescribing behavior, including intravenous (IV) antibiotic use in the clinical setting of China. Methods A cross-sectional survey was conducted between June 2017 and April 2018 in three provinces of China. A total of 9526 parents with children aged 0–13 years were investigated. Data from 1275 parents who had self-medicated their children and then visited a doctor in the past month were extracted and analyzed. Results One-third (410) of the studied children had parental SMA before the consultation and 83.9% of them were subsequently prescribed antibiotics by doctors. Children with parental SMA were more likely to be prescribed antibiotics (aOR = 7.79, 95% CI [5.74–10.58]), including IV antibiotics (aOR = 3.05, 95% CI [2.27–4.11]), and both oral and IV antibiotics (aOR = 3.42, 95% CI [2.42–4.84]), than children without parental SMA. Parents with SMA behaviors were more likely to request antibiotics (aOR = 4.05, 95% CI [2.59–6.31]) including IV antibiotics (aOR = 2.58, 95% CI [1.40–4.76]), and be fulfilled by doctors (aOR = 3.22, 95% CI [1.20–8.63]). Conclusions Tailored health education for parents is required in both community and clinical settings to discourage parental SMA for children. The doctors should not prescribe unnecessary antibiotics to reinforce parents’ SMA behaviors. We recommend expanding the current IV antibiotics ban in outpatient settings of China to cover outpatient pediatrics.

scholarly journals Knowledge of antibiotics and antibiotic usage behavior among the people of Dhaka, Bangladesh

2020 ◽  
Vol 6 (3) ◽  
pp. 519-524
Author(s):  
Iftekhar Ahmed ◽  
Md Bodiuzzaman Rabbi ◽  
Marufa Rahman ◽  
Rehnuma Tanjin ◽  
Sharmin Jahan ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Antibiotic Use ◽  
Antibiotic Usage ◽  
Cross Sectional Survey ◽  
Self Medication ◽  
Cross Sectional ◽  
The People ◽  
Usage Behavior ◽  
Educational Campaigns ◽  
Adherence To Therapy

Bangladesh is a developing country with a very high prevalence of antibiotic resistance where irrational use of antibiotics is very common. This cross-sectional survey was conducted to assess the knowledge of antibiotics and antibiotic usage behavior (Antibiotic use, self-medication, adherence to therapy) among the people of Bangladesh. The association between participants’ knowledge of antibiotics and their antibiotic usage behavior was also analyzed. A cross-sectional survey based on a structured questionnaire was conducted in the Dhaka district. The questionnaire included questions about demographic information, participants’ knowledge of antibiotics, and their recent antibiotic usage. The data analysis involved the use of descriptive statistics and multivariable logistic regression. Very few participants knew that antibiotics are not effective against most common colds (16.8%), viruses (22.5%), and pains (41.7%). Most respondents (>75%) knew that excessive use of antibiotics and failing to complete a course may render antibiotics less effective in the future. However, only 56.1% were aware of antibiotic resistance. About half (46.6%) of the participants took antibiotics in the last six months, 20.5% of whom resorted to self-medication and 23.1% reported non-adherence to therapy. Greater knowledge of antibiotics was significantly associated with lower rates of self-medication (p=0.037). Misconceptions about antibiotics and antibiotic misuse are very common in Bangladesh. The findings suggest that misconceptions about antibiotics and antibiotic misuse are very common in Bangladesh. To mitigate these problems, interventions comprised of educational campaigns and redesigning of the healthcare system and policies should be undertaken. Asian J. Med. Biol. Res. September 2020, 6(3): 519-524

Patient Knowledge and Experiences With Antibiotic Use and Delayed Antibiotic Prescribing in the Outpatient Setting

2019 ◽  
pp. 089719001988942 ◽  
Author(s):  
Mary Beth A. Seipel ◽  
Emily S. Prohaska ◽  
Janelle F. Ruisinger ◽  
Brittany L. Melton
Keyword(s):  
Antibiotic Stewardship ◽  
General Public ◽  
Community Pharmacists ◽  
Antibiotic Use ◽  
Outpatient Setting ◽  
Antibiotic Prescribing ◽  
Patient Knowledge ◽  
Cross Sectional Survey ◽  
Chi Square ◽  
Cross Sectional

Background: Most antibiotic prescriptions originate in the outpatient setting and an estimated 30% are unnecessary. Pharmacists are well positioned to positively impact antibiotic prescribing habits; the role of the community pharmacist in outpatient antibiotic stewardship programs is not well defined. Objectives: The objectives of this study were to (1) assess the knowledge of the general public regarding appropriate antibiotic use, and (2) assess the experiences of the general public regarding delayed antibiotic prescriptions. Methods: A cross-sectional survey was administered at community pharmacies in Kansas from September 2018 to January 2019. Eligible individuals were older than 18 years and self-reported their ability to speak and read English. The 22-item survey collected demographics, knowledge regarding appropriate antibiotic use, and participant understanding and experiences of delayed antibiotic prescribing. Descriptive statistics assessed demographics and chi-square compared responses between demographics. Results: Of 347 surveys completed, respondents were mainly Caucasian (91.6%), female (58.2%), and aged 60 years or older (59.1%). Those with high school education or below were more likely to believe antibiotics kill viruses (43.1% vs 20.9%, respectively; p < 0.01) and that antibiotics work on most coughs and colds (31.4% vs 16.2%, respectively; p = 0.01). Delayed antibiotic prescriptions were more frequently offered to those who had received an antibiotic prescription in the last year compared to those who had not (36.1% vs 15%, p < 0.001). Conclusion: Gaps in patient knowledge about appropriate antibiotic use and delayed prescribing present an opportunity for community pharmacists to educate patients and become involved in outpatient antibiotic stewardship.

scholarly journals PREPAREDNESS OF CANADIAN PHYSICIAN OFFICES FOR PAEDIATRIC EMERGENCIES

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e5-e5
Author(s):  
Anushka Weeraratne ◽  
Dayae Jeong ◽  
Suhrata Verma ◽  
Marina Atalla ◽  
Mohammed Hassan-Ali ◽  
...  
Keyword(s):  
Emergency Preparedness ◽  
Life Support ◽  
Advanced Life Support ◽  
Family Physicians ◽  
Care Staff ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
The Past ◽  
Paediatric Emergency ◽  
The Impact

Abstract BACKGROUND Studies in the US have demonstrated that many primary care staff and offices are inadequately prepared for paediatric emergencies. Although the Canadian Paediatric Society (CPS) recently reaffirmed their “Guidelines for Paediatric Emergency Equipment and Supplies for a Physician’s Office”, no evaluation has been made regarding the impact of publishing these recommendations, or on the state of preparedness for paediatric emergencies in family physician offices. OBJECTIVES The aim of this study was to evaluate awareness of and adherence of family physicians in Ontario to the CPS guidelines on preparedness for paediatric emergencies. DESIGN/METHODS We conducted a province-wide, cross-sectional survey of 749 randomly selected family physicians. Participants were asked to complete a 14-question survey regarding clinic characteristics, incidence of paediatric emergencies, and preparedness of the clinic in the case of a paediatric emergency. Ethics approval was obtained from the regional Ethics Review Board. RESULTS 94 physicians responded to our survey (response rate of 13.1%). 68.1% of respondents reported seeing more than 10 children per week, and 59.6% and had experienced at least one paediatric emergency in the past year. The proportion of physicians reporting paediatric emergencies within the last year increased with the number of children seen - 37.9% of physicians who saw fewer than 10 children per week reported an emergency, compared to 100.0% of those who saw more than 40 children per week. Only 4.3% respondents reported that they were unaware of the CPS guidelines on paediatric emergency preparedness. Although 85.1% of respondents were aware of the guidelines, only 10.6% of respondents had read them. Of the physicians who were aware of but had not read the guidelines, 2.5% engaged in mock code sessions, 27.8% were up-to-date on Paediatric Advanced Life Support (PALS), 1.3% had written protocols outlining safe transport of children to hospitals, and 41.8% stocked half or more of the recommended supplies. In comparison, of the physicians who had read the guidelines, 20.0% engaged in mock code sessions, 50.0% were up-to-date on PALS, 10.0% had written protocols, and 70.0% stocked half or more of the recommended supplies. CONCLUSION A large proportion of respondents had experienced at least one paediatric emergency in the past year, but were overall underprepared. There was a discrepancy between physicians who were aware of the CPS guidelines on emergency preparedness (85.1%), and those who have actually read them (10.6%), though offices with the latter were more adherent to the guidelines’ recommendations. It will be important for CPS to consider how to further advocate for paediatric emergency preparedness in clinics that see children regularly.

scholarly journals Management of Common Infections in German Primary Care: A Cross-Sectional Survey of Knowledge and Confidence among General Practitioners and Outpatient Pediatricians

Antibiotics ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 1131
Author(s):  
Peter Konstantin Kurotschka ◽  
Elena Tiedemann ◽  
Dominik Wolf ◽  
Nicola Thier ◽  
Johannes Forster ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Primary Care Physicians ◽  
Antibiotic Use ◽  
Educational Interventions ◽  
Treatment Decisions ◽  
Antimicrobial Treatment ◽  
Antibiotic Prescribing ◽  
Cross Sectional Survey ◽  
Cross Sectional

Outpatient antibiotic use is closely related to antimicrobial resistance and in Germany, almost 70% of antibiotic prescriptions in human health are issued by primary care physicians (PCPs). The aim of this study was to explore PCPs, namely General Practitioners’ (GPs) and outpatient pediatricians’ (PDs) knowledge of guideline recommendations on rational antimicrobial treatment, the determinants of confidence in treatment decisions and the perceived need for training in this topic in a large sample of PCPs from southern Germany. Out of 3753 reachable PCPs, 1311 completed the survey (overall response rate = 34.9%). Knowledge of guideline recommendations and perceived confidence in making treatment decisions were high in both GPs and PDs. The two highest rated influencing factors on prescribing decisions were reported to be guideline recommendations and own clinical experiences, hence patients’ demands and expectations were judged as not influencing treatment decisions. The majority of physicians declared to have attended at least one specific training course on antibiotic use, yet almost all the participating PCPs declared to need more training on this topic. More studies are needed to explore how consultation-related and context-specific factors could influence antibiotic prescriptions in general and pediatric primary care in Germany beyond knowledge. Moreover, efforts should be undertaken to explore the training needs of PCPs in Germany, as this would serve the development of evidence-based educational interventions targeted to the improvement of antibiotic prescribing decisions rather than being focused solely on knowledge of guidelines.

scholarly journals Inappropriate habits of antibiotic use among medical specialists and students in Vilnius

2016 ◽  
Vol 23 (2) ◽  
pp. 135-141
Author(s):  
Artūras Barkus ◽  
Ingrida Lisauskienė
Keyword(s):  
Medical Care ◽  
Drug Prescription ◽  
Medical Personnel ◽  
Antibiotic Use ◽  
Cross Sectional Survey ◽  
Self Medication ◽  
Cross Sectional ◽  
Antibacterial Drugs ◽  
Medical Specialists ◽  
At Home

Introduction. The resistance to antibacterial drugs is an emerging worldwide problem. Numbers of inappropriate ways to use antibiotics contribute to this issue. Self-medication is one of them. This study seeks to find out how prevalent the  self-medication with antibiotics, their storage at home and the inappropriate acquisition of antibacterial drugs are among medical specialists in Vilnius, Lithuania. Methods. A cross-sectional survey was conducted. To better identify the potential target groups, the respondents were classified according to their relation to medical care: physicians, other medical personnel, medical students and people, directly not related to medical care. Results. The overall actual self-medication with antibiotics rate was 4.0%. And, although the  actual self-medication rate might seem rather low, the intended self-medication rate was 51.4%. Also, a prevalent antibacterial drugs storage at home (45.8%) with a wide variety of preparations was reported. Only 61.9% respondents received prescriptions for antibiotics from their treating physician. 7.6% used the non-prescribed medicines and 22.0% received a prescription from a physician, who was either their colleague or a familiar person. Conclusions. Inappropriate habits of antibiotic use are prevalent. While there were some differences between the research groups, most of them were not statistically significant. It means that measures should be taken targeting health care givers as well as the general population. Educational programs about the rational use of antibiotics may help reducing the  improper habits of antibacterial drugs usage, including self-medication. Encouraging the  electronic drug prescription may be beneficial while reducing the prevalent inappropriate acquisition of antibiotics.

scholarly journals N01 Factors related to self-medication with corticosteroids, aminosalicylates or analgesics and reasons given by patients with ulcerative colitis from Spain

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S657-S657
Author(s):  
M Cañas ◽  
F Mesonero ◽  
I Rodriguez-Lago ◽  
C Savini ◽  
R Saldaña ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Emergency Room ◽  
Working Group ◽  
Associated Factors ◽  
Self Care ◽  
Female Gender ◽  
Cross Sectional Survey ◽  
Self Medication ◽  
Cross Sectional ◽  
The Past

Abstract Background Self-medication, when agreed with the treating physician, is an essential component of self-care. We describe the associated factors and the reasons related to the practice of self-medication with steroids, aminosalcylates (AS) or analgesics in patients with ulcerative colitis (UC) in Spain. Methods Information was anonymoulsy provided by patients through a web-based cross-sectional survey developed by 3 inflammatory bowel disease (IBD) experts from the Spanish working group on IBD (GETECCU), one nurse from the Spanish nursing working group on IBD (GETEII) and two patients from the Spanish confederation of associations of patients with IBD (ACCU). Participants voluntarily answered to the survey based on their own experiences from February to April 2019. Reasons for self-medication are described as frequencies and associated factors through logistic regression models. Results A total of 546 patients (61% women, mean age 40 years old) responded. Of these, 36 (7%) patients self-medicated with corticosteroids, and was associated with higher number of UC self-reported flares during the past year [OR 7 (95% CI: 1–32), p &lt; 0.001] and follow-up by a general gastroenterologist instead of in an IBD unit [OR 0.08 (0.01–0.5), p = 0.007]. Self-medication with AS was reported by 90 patients (16%) [oral 20 (22%) and topic 70 (78%)], and was associated with treatment with topical AS [OR 3 (95% CI: 2–4), p &lt; 0.001]. Finally, 320 patients (59%) self-medicated with analgesics and this was associated with female gender [OR 2 (95% CI: 1–3), p &lt; 0.001], need of intravenous (IV) biological therapy [OR 3 (95% CI: 2–5) p &lt; 0.001] and emergency room visits within the past year [OR 3 (95% CI: 2–4), p &lt; 0.001]. The main reasons for self-medication were ‘need for quick relief of symptoms’, ‘fear of worsening’ and, for AS, ‘agreed with the doctor’ (Table 1). Conclusion Self-medication in UC is not a common practice, but most of the times it is not agreed with the treating physician. Self-medication with analgesics was more frequent, probably reflecting a need of self-care. Female sex, number of flares, IV treatment, and need of emergency room care were factors associated to self-medication. This project was endorsed by GETECCU, GETEII, ACCU and funded by MSD Spain.

scholarly journals 1302. Antibiotic Prescribing Knowledge: A Brief Survey of Providers and Staff at an Ambulatory Cancer Center During Antibiotic Awareness Week 2017

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S398-S398
Author(s):  
Erica Stohs ◽  
Elizabeth M Krantz ◽  
Ania Sweet ◽  
Jacqlynn Zier ◽  
Maria Paleologos ◽  
...  
Keyword(s):  
Hematopoietic Cell Transplantation ◽  
Antibiotic Use ◽  
Cancer Center ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Stewardship Program ◽  
Tract Infections

Abstract Background Antibiotics have contributed significantly to advances in cancer therapy and hematopoietic cell transplantation, but rising antibiotic resistance threatens this progress. Little is known about knowledge and perceptions surrounding antibiotic use and resistance among staff at cancer centers. Methods We conducted a brief cross-sectional survey of healthcare professionals (HCP) at a large ambulatory cancer center to assess knowledge of antibiotic prescribing and resistance during Antibiotic Awareness Week, November 13–19, 2017. A convenience sample of providers and staff who participated in one of two 2-hour Antimicrobial Stewardship Program “open house” events was used. Questions evaluated knowledge about antibiotic use for upper respiratory tract infections (URIs). Results There were 179 respondents. The proportion of correct responses to each question by employee type is displayed in Table 1. There was a statistically significant decreasing trend in the proportion correctly answering all four questions by employee type from providers, to pharmacists, to nurses, to others (P &lt;0.001) (Figure 1). Conclusion Providers were more likely to correctly answer questions pertaining to antibiotic use compared with other HCP. Due to the multidisciplinary nature of cancer care, patients often encounter a variety of HCP over the course of treatment. Opportunities exist to improve antibiotic stewardship education across the spectrum of HCP at our cancer center, including pharmacists, nurses, and other staff. Disclosures All authors: No reported disclosures.

scholarly journals Self-Medication Practices among the Adolescent Population of South Karnataka, India

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Edlin Glane Mathias ◽  
Anjalin D’souza ◽  
Savitha Prabhu
Keyword(s):  
Demographic Variables ◽  
Cross Sectional Survey ◽  
Self Medication ◽  
Cross Sectional ◽  
Adolescent Population ◽  
The Past ◽  
Health Area ◽  
Important Concern ◽  
Self Administered Questionnaire ◽  
Cluster Random Sampling

Introduction. Self-medication is used every day in the form of self-care of our health. Different studies in India have shown that more than 50% of the adolescent population takes self-medication every day for their health. Self-medication is an important concern at the global level, and it is an important issue in the health area. Aims. To determine the prevalence of self-medication among adolescents, identifying the commonly used drugs as self-medication and finding the association between self-medication and selected demographic variables are important. Materials and Methods. In a descriptive cross-sectional survey, 220 adolescents were enrolled through cluster random sampling. A self-administered questionnaire (developed by the researcher) along with a demographic profile sheet to assess the prevalence of self-medication and commonly used drugs was exercised. In the study, self-medication was defined as the consumption of medication without the prescription of the physician in the past year. Data analysis was performed by descriptive and inferential statistics using SPSS 16.0 software, and the significance of p value (<0.05) was considered. Results. Around 120 (54.5%) adolescents were in the age group of 17 years; among them, 123 (55.9%) were females. The prevalence of self-medication was found to be 173 (78.6%). Antipyretics were consumed by 147 (78.6%) adolescents and antitussives by 120 (54.5%). It was observed that 110 (50%) of the adolescents preferred allopathic system of medication. It was also reported that 52 (23.6%) adolescents self-medicated continuously (i.e., for a month). The results also showed that factors like the type of family (χ2 = 9.615, p<0.05), father’s education (χ2 = 13.791, p<0.05), mother’s education (χ2 = 14.633, p<0.05), and distance from a nearest medical store (χ2 = 17.290, p<0.05) were associated with self-medication. Conclusion. The present study has shown that the prevalence of self-medication is high among adolescents, and most of them had taken it without consulting a doctor. The study concludes that it is important to create awareness among adolescents regarding self-medication.

scholarly journals Non-prescription antibiotic use for cough among Chinese children under 5 years of age: a community-based cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e051372
Author(s):  
Yao Zhu ◽  
Xuewen Tang ◽  
Rui Yan ◽  
Zhujun Shao ◽  
Yang Zhou ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Further Education ◽  
Annual Income ◽  
Cross Sectional Survey ◽  
Community Based ◽  
Cross Sectional ◽  
Runny Nose ◽  
The Past ◽  
Children's Caregivers ◽  
Children Under 5

ObjectiveThis study aimed to investigate the non-prescription use of antibiotics for cough among children under 5 years in China.DesignA community-based cross-sectional survey.SettingA face-to-face interview based on a standard questionnaire in the community from October to December 2019.ParticipantsA total of 3102 children under 5 years of age were enrolled with probability proportionate to size sampling method. The children’s caregivers provided the responses as their agents.Outcome measuresCough in the past month, non-prescription use of antibiotics after cough.Results1211 of 3102 children were reported to have a cough in the past month. Of these, 40.2% (487/1211) were medicated with antibiotics, and 18.7% (91/487) of these were not prescribed. Cephalosporins were the most frequently used antibiotic (52.8%), and community pharmacies were the main source (53.7%). Children who coughed for 1–2 weeks (OR 1.73, 95% CI 1.03 to 2.90) or 3–4 weeks (OR 2.39, 95% CI 1.08 to 4.97), with runny nose (OR 1.86, 95% CI 1.13 to 3.19) or those whose family annual income between ¥50 000 and ¥100 000 (OR 4.44, 95% CI 1.52 to 18.95) had a higher risk of non-prescription use of antibiotics than those coughing for <1 week, without runny nose or with family annual income <¥50 000.ConclusionsOur findings indicated that a high proportion of infants and young children had been treated with antibiotics for cough, and nearly one in five of them were used without prescription. More public health campaigns and further education on the appropriate use of antibiotics are needed to ensure the rational treatment of cough in children.

scholarly journals Physiotherapists perceived role in managing anxiety in patients with relapsing-remitting multiple sclerosis: a mixed-methods study

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Lauren Lucas ◽  
Jack Parker
Keyword(s):  
Multiple Sclerosis ◽  
Mixed Methods ◽  
Training Needs ◽  
Structured Interviews ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Rehabilitation Process ◽  
Relapsing Remitting ◽  
Outpatient Settings ◽  
The Impact

Abstract Background Anxiety is common for people with Multiple Sclerosis (PwMS) and is higher in those with relapsing-remitting MS (RRMS) and in community-based samples. Anxiety can impact self-efficacy, pain, fatigue, engagement in physical activity and treatment adherence, all of which influence the rehabilitation process. Little is known about how physiotherapists manage anxiety in PwMS and the challenges associated with anxiety throughout the rehabilitation process, in community and outpatient settings. Methods A mixed-methods design, combining a cross-sectional survey and semi-structured interviews with UK-physiotherapists, was used to answer the research question. To inform the qualitative study, a cross-sectional survey collected data from physiotherapists working in neurology to understand the impact and management of anxiety in people with MS (PwMS) during rehabilitation. Analysis used descriptive statistics and the findings formed the interview guide. Semi-structured interviews with specialist physiotherapists explored barriers and facilitators to managing anxiety in PwMS in community and outpatient settings, identified perceived physiotherapy training needs and offered suggestions to develop physiotherapy research and practice. Themes were derived inductively. Results The survey suggested how PwMS present with anxiety, its impact during rehabilitation, physiotherapy management practices, and physiotherapist skills and training needs. Five semi-structured interviews with specialist physiotherapists expanded on the survey findings and identified five main themes: Understanding the MS journey, modifying assessment and treatment, anxiety management toolbox, lagging behind Musculoskeletal Physiotherapy, and gaining knowledge and skills. Conclusion Physiotherapists encounter anxiety in PwMS in community and outpatient rehabilitation and perceive they have a role in managing it as it presents. Facilitators included communication, listening skills and opportunities to develop strong therapeutic relationships. Poor training and support, lack of clinical guidelines and limited research evidence were considered barriers. Clinically relevant learning opportunities, interprofessional working, and greater support through clinical supervision is recommended to better develop physiotherapy practice.

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