Group Physiotherapy for Treatment of Pelvic Floor Dysfunction: A Consumer’s Perspective

Introduction: Level 1 grade A evidence exists to support physiotherapy as a first line treatment of women with stress urinary incontinence and pelvic organ prolapse (POP). A novel way to provide care for women with pelvic floor dysfunction in a tertiary hospital setting is to mandate attendance at an introductory group education session prior to offering an individual physiotherapy consultation. There is minimal research to date examining the consumer perspective of group physiotherapy for treatment of pelvic floor dysfunction. This study aims to evaluate the consumer experience with a view to determining if this model of care meets the needs and expectations of the consumer. Objective: To evaluate the consumer perspective of an educational and practical pelvic floor class prior to offering an individual physiotherapy appointment for women with pelvic floor dysfunction. Method: Over a 6-month period, 39 women completed a voluntary, anonymous survey to evaluate their experience of attending a physiotherapy pelvic floor class. Results: Respondents reported that the information delivered was appropriate, relevant, and engaging and felt more informed and less alone in their symptoms after attending the pelvic floor class. Women reported that they had received the necessary education and practical skills required to begin implementing practical changes that addressed their pelvic floor dysfunction. Conclusion: By providing a consistent, informative, and practical group session for women referred with pelvic floor dysfunction as a baseline entry point to individual care, treatment can be commenced that is acceptable to the consumer. The acceptability of this method of service delivery serves as a basis for further important research evaluating the efficiency and effectiveness of group physiotherapy treatment.

Increasing Physical Activity In Older Australians to Reduce Falls: A Program Evaluation

Purpose: As people age, they are at greater risk of injurious falls. Falling has a significant impact not only on the individual but also the wider community. Undertaking physical activity is effective in reducing the rate of falls in this population. Therefore, providing targeted education during group-based falls prevention programs may increase the awareness and amount of physical activity older people undertake to assist in reducing their risk of falling. Methods: A longitudinal cohort design involving a pre-post intervention survey was conducted over an eight-month period with community-dwelling older adults who participated in a fall-prevention program. Participants were N = 161 (123 female and 38 male), aged 65 years and over, with the most common age bracket being 75 to 84 years. Demographic information was collected at baseline. It included falls history and self-reported physical activity levels. Immediately post-intervention, self-reported changes in the awareness of the role of physical activity and awareness of falls risks were measured. Six months post-intervention, participants self-reported their physical activity levels and post-program fall history. Results: An increase in awareness of the role of physical activity in reducing falls risk as well as falls risk factors was reported in most participants after completing the program. Despite this, only around a third of participants increased their physical activity levels during the six months after the program even though a decrease in falls rates was noted. Conclusions: The targeted education within the falls prevention program demonstrated an increase in awareness of falls risk factors and the importance of regular physical activity to minimise the risk of falling. However, this awareness did not seem to result in an increase in the amount of physical activity participants undertook after the program, even though falls rates across the participants reduced. Further research is needed to explore why older people who understand the benefits of undertaking regular physical activity did not increase their activity levels.

Addressing Health-Related Myths in the Culturally Diverse African American Population: A Call to Action

African Americans (AAs) experience numerous challenges that socially, economically, and physically affect their communities. Recent studies have found that a diverse array AAs encounter many struggles as they navigate the United States (U.S.) healthcare system to access care and receive healthcare services. AA communities are significantly affected by the burden of chronic diseases. They face considerable barriers to healthcare services that contribute to adverse health outcomes. This paper explains the daily struggles many AAs face within their communities to access and navigate the healthcare system due to culturally held myths and barriers. This paper discusses commonly held myths among Afro-Caribbean and West Indies populations living within the state of Georgia to suggest a call to action to address health disparities in this population.

Therapeutic Management of a Patient with Necrotizing Fasciitis Resulting in Quadrilateral Amputation and Critical Illness Myopathy in the Intensive Care Setting: A Case Report.

Purpose: The purpose of this case is to illustrate the best available evidence to provide early therapeutic intervention for a critically ill patient presenting with cardiovascular and pulmonary complications due to multi-system compromise. Case Description: A 19-year-old male was admitted to the hospital with the diagnosis of necrotizing fasciitis and necrotizing pneumonia. He experienced numerous additional medical complications ultimately leading to tracheostomy, delirium, critical illness myopathy, and quadrilateral amputation secondary to necrotizing fasciitis and critical limb ischemia following prolonged veno-venous extracorporeal membrane oxygenation (VV-ECMO). Outcomes: Patient was discharged to an outside rehabilitation hospital after 103 days in the acute setting (56 days in the ICU) and was able to tolerate 40 minutes sitting edge of bed with supervision, perform bed mobility with supervision, and propel a standard wheelchair up to 50 feet independently. At 10 months’ post-discharge from the acute setting, the patient was ambulating independently up to 150 feet without assistive device using bilateral lower extremity prosthetics, able to propel a lightweight wheelchair community distances, independent in all transfers, and returned to school and work. Discussion: These findings suggest that clinicians may want to consider examining and combining the best available evidence of multiple medical conditions to provide a well-rounded therapeutic approach including but not limited to, close monitoring of vitals and early mobilization, to managing complex patients in the intensive care setting.

Students’ Retention of Biophysical Agents Curriculum from First to Third Year of Study

Purpose: Biophysical agents (BPA) are widely used in physical therapy clinical practice and is a content area included in entry level physical therapist education programs. Retention of this content is critical for clinical practice. The purpose of this study was to measure to what extent 3rd year physical therapist students (PTS) were able to recall knowledge of BPA content after a 2 -year gap by repeating an examination that was given during the first year. Specifically, 1) Is there a significant difference in retention of BPA content/material between the 1st and 3rd year of curriculum, and 2) Does exposure/use of BPA during a clinical education experience (CEE) affect retention of material? Methods: A sample of convenience of 22 current 3rd year PTS who completed a BPA course during their 1st year participated. The comprehensive written examination for the BPA course served as the test instrument to determine knowledge retention. The PTS re-took this exam in their 3rd year of study, after completing their 2nd CEE. The PTS also completed a questionnaire soliciting information about demographics and degree of exposure to BPA during their CEE. A paired t-test was used to compare 1st year and 3rd year total test scores. The PTS were divided based on BPA exposure during their CEE, and test scores were compared using an independent samples t-test. Results: There was a significant decrease in test score from 1st to 3rd year (first year was 89.5% (range: 97.0% - 80.0%) while the 3rd year was 52.1% (range: 39.0% – 67.0%). There was no significant difference (p=0.561) in mean test scores on the 3rd year test for PTS with BPA exposure during CEEs (52.6%) vs those that did not (50.4%). Conclusions: Like other health professions, there was a decrement in knowledge retention. Results indicate a significant loss of retention of BPA knowledge when provided a 2-year gap, which was unaffected by exposure to BPA during CEEs. Exploring methods to improve knowledge retention in BPA curriculum may be needed. Future research should investigate retention with other methods of instruction including those that incorporate more active learning methods.

Relationship Among Emotional Intelligence and/or Extrovert Bias on Perceived Stress Levels in DPT Students

Purpose/Hypothesis: Students in graduate level DPT programs function at varying levels. Some students thrive and others struggle to maintain required minimum levels of academic performance. When considering admission of applicants, and when assisting enrolled students, consideration of factors contributing to academic success is of interest. Stress has been shown to be prevalent in a wide range of students and has many negative effects including poor life satisfaction, increased clinical burnout, and reduced academic performance. Research has shown a correlation between higher emotional intelligence (EI) and decreased stress levels in medical, nursing, and undergraduate students. The purpose of this study was to examine if emotional intelligence (EI) and/or extrovert bias correlates with perceived stress levels in Doctor of Physical Therapy (DPT) students. It was hypothesized that students with higher emotional intelligence and more extroverted personalities would experience lower levels of perceived stress. Participants: After providing consent, a convenience sample of 60 first and second year DPT students (33 female) with age range 23 to 38 participated in the current study. Participation was voluntary and 60 of a possible 72 students chose to participate. Materials/Methods: After obtaining informed consent, participants completed Goldberg’s IPIP-Neo questionnaire (extraversion), Perceived Stress Scale (PSS) and Assessing Emotions Scale (emotional intelligence). Each of these tools have demonstrated validity and reliability for the respective areas measured. Surveys were administered to students and results were analyzed for possible relationships between extraversion and stress levels as well as EI and stress levels using a Spearman Correlation test. Results: Spearman Correlation analyses were conducted with a significant negative correlation between EI and perceived stress rs = -0.291, p= 0.026 and a non-significant negative correlation between extraversion and perceived stress rs = -1.36, p= 0.305. Discussion: In the current sample, EI had a significant negative relationship with perceived stress levels, with higher EI scores correlating to lower levels of stress. The relationship between extraversion and perceived stress was non-significant. Clinical Relevance: Doctorate level graduate programs can be considered intense and very stressful. Admission of qualified students equipped to meet the demands of a DPT program has great importance. Establishing a correlation between EI, introversion/extraversion bias, and stress may help DPT programs further assess prospective students. Consideration of factors correlated with higher perceived stress may be useful when providing resources to admitted students to facilitate academic success.

Indoor Cooking Practices and Associated Health Factors Among Participants in the Dominican Republic and Nicaragua: A Collaborative Study Between Respiratory Therapy Students and Comunidad Connect

The purpose of this study is to determine factors associated with indoor cooking practices and specific vital signs across two middle-income countries, Dominican Republic and Nicaragua. This study used data from Nicaragua (n=76) and Dominican Republic (n=62) (collected in 2018-2019). Multivariable linear regression was utilized to determine factors associated with carbon monoxide levels and systolic blood pressure. Among all participants (n=138), approximately half lived in Nicaragua (n=76, 55.1%) and half lived in Dominican Republic (n=62, 44.9%). The overall smoking prevalence in each country was low (9.2% in Nicaragua and 4.8% in Dominican Republic). Age was associated with higher carbon monoxide levels and higher systolic blood pressure measurements in each country. Future studies should examine a broader range of contextual and behavioral factors related to carbon monoxide and peak flow measurements in the two countries.

Predictors of Success on the Credentialing Examination in Radiography for First- and Non-First-Generation Students

Background: Identifying predictors of student success is fundamental across higher education in the United States, particularly for historically underserved first-generation students. In radiologic technology programs, the literature suggests that variables prior to and during matriculation in these programs affects scores on the American Registry of Radiologic Technologists (ARRT) credentialing examination in Radiography. However, the evidence in this area has not considered the educational patterns for first-generation students. Purpose: This study sought to improve our understanding about how select student background characteristics and experiences prior to and during the years enrolled in radiologic technology programs accredited by the Joint Review Committee on Education in Radiologic Technology (JRCERT) affect scores on the ARRT credentialing examination in radiography, especially for first-generation students. Method: The researchers surveyed graduates from radiologic technology programs in 2018 and 2019 who attempted the radiography credentialing examination in these two years. Results: A total of 286 cases were included in the analysis, which revealed different patterns and effects of predictor variables on credentialing examination scores for first- and non-first-generation students. Whereas 10 variables prior to and during matriculation affected examination scores for first-generation students, only 8 did for their non-first-generation peers. Conclusion: Identifying predictors of success in radiologic technology programs helps professionals in these programs design environments that provide opportunities for students to enhance their chances to be successful on the Radiography exam, especially first-generation students.

Contribution of the Human Microbiome and Proteus mirabilis to Onset and Progression of Rheumatoid Arthritis: Potential for Targeted Therapy

The human microbiome has been shown to play a role in the regulation of human health, behavior, and disease. Data suggests that microorganisms that co-evolved within humans have an enhanced ability to prevent the development of a large spectrum of immune-related disorders but may also lead to the onset of conditions when homeostasis is disrupted. In many conditions, a link between dysbiosis (microbial imbalance or microbiome upset) has been identified and associated with immune conditions such as rheumatoid arthritis (RA). This review provides insight into how an individual’s unique microbiome, combined with a genetic predisposition and environmental factors may lead to the onset and progression of RA. While research efforts have been largely focused on Porphyromonas gingivalis in the generation of citrullinated products as a trigger in the onset and progression of RA, recent research efforts have also indicated that Proteus mirabilis may play a key role in the development of anti-citrullinated antibodies through shared epitope sequences IRRET and ESRRAL. Thus, this review also highlights how targeting dysbiosis with alternative approaches may help to reduce microbial resistance as well as potentially improve outcomes. Further investigation is needed to see if potential future treatments for RA could benefit from personalized medicine based on an individual’s unique microbiome

Interprofessional Education at a Distance: The Hybrid Interprofessional Education Model

Background: Interprofessional education (IPE) is a critical component of health professions education but planning and implementation are challenged by logistical, physical, personnel, and recently global pandemic COVID-19 barriers. Purpose: This report describes the development and design of the proposed Hybrid Interprofessional Education (HIPE) model, a blended learning IPE model developed to mitigate barriers using a flexible framework and online collaborative technologies to deliver experiences based on Interprofessional Education Collaborative (IPEC) core competencies. Operational principles, model design, an example of model implementation, and outcomes are reported. Method: Fifty-four student physical therapists and physician assistants attending remote campuses of the same university participated and completed an exit survey. Descriptive statistics were calculated for Likert scale and semantic differential scale survey items and thematic analysis was conducted for open question responses. Results: Analysis revealed students felt improved understanding of interprofessional practice, the other profession’s role, teamwork, and communication. Responses supported online, asynchronous delivery and the web application used but not the synchronous activity portion. Three themes arose from comments: learning with and from, interactions, and activity design. Conclusion: The HIPE model was used to deliver IPE that supported perceptions of student learning in IPEC core competencies when physical proximity was not possible. Further iterative research and model refinement are needed. Future research should include investigation of student learning outcomes when using the HIPE model.