Almost 80% of participants saw 10 or less JHS patients each year (Table 1) suggesting that JHS is not widely encountered by respondents to this survey. This is perhaps surprising given the high reported prevalence of symptomatic hypermobility (Simpson 2006). It is clear that high quality epidemiological evidence related to the prevalence of JHS in the general population is lacking, although the prevalence in Omani women attending musculoskeletal outpatient physiotherapy services was established to be 55% (Clark and Simmonds 2011). It is therefore likely that the condition continues to not be adequately identified in clinical practise (Hakim and Grahame 2004), supported by the observation that almost 68% of respondents reported that they had not received any formal education or training related to JHS. Referrals were received mainly from GPs or Rheumatology consultants, although the specific referral details are unknown. Patient self-referral was reported by approximately 21% of respondents which contrasts with 46% of musculoskeletal services available for self-referral across the UK (CSP 2011).
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Gaining patient consent for assessment and treatment is the physical enactment of the professional value of respect for the patient’s autonomy . Taking this into consideration, it is somewhat surprising that it has received relatively little attention in the physiotherapeutic literature . Autonomy is closely linked to the notion of agency (individual action), both concepts denoting images of selfhood, choice and freedom . Two pre-requisites of autonomy have been identified . The first is rational thought. Autonomy is not simply doing what one wants, but rather doing what one has decided to do, the latter implying some reasoning. The second requirement of autonomous action is liberty (i.e. freedom from external influences) .
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For those patients who are not acutely unwell, health improvement practices and holistic functional assessment should be integral to patient care, from diagnosis to the end of life. Physiotherapy for patients should promote phys- ical activity, functional independence, and self-management as routine management of their PH. This will require physiotherapy to apply the existing research evidence and collaborate with local services to deliver quality care in line with patient needs, throughout the lifespan of their disease. There is a further need to design and test physiotherapy interventions for physical activity in PH that can be deliv- ered within a variety of healthcare systems and strategies.
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In relation to clinical assessment and treatment, the results of the present study elicit several observations. In the clinical assessment 40% of respondents stated that they would have carried out further physical examination tests. Although comments included screening of the cervical/thoracic spine, observation and palpation, one-third of respondents, mainly those with NSE, expressly mentioned performing specific orthopaedic tests. These findings are in keeping with the UK survey , but in contrast with current evidence that indicates the poor validity and reliability of these tests [11,12].
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Each SBE session was designed and conducted by the SLIPAH group in consultation with university teaching staff and form part of the regular academic unit curricu- lum during the Paediatric Physiotherapy Practice prac- tical classes in weeks 4, 8 and 12 of a 12-week semester (Fig. 1). The scenario for each SBE session specifically targeted one of the primary clinical domains of paediat- ric physiotherapy and was delivered with the corre- sponding musculoskeletal, cardiorespiratory and neurodevelopmental modules of the unit. In the week prior to the SBE session, the students were requested to independently undertake an eLearning package to pre- pare them for each session (https://www.sdc.qld.edu.au/ ). The three eLearning packages suggested were on Gen- eral Allied Health Paediatric Principles, Cardiorespira- tory acute paediatric physiotherapy, and spina bifida and spinal disabilities.
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Further physical examination tests that would be carried out included assessment of other joints such as the cervical and/or thoracic spine; specific muscle tests, including loading capacity; special tests, including cuff integrity, instability and impingement tests; scapular assessment; capsular and muscle length tests; palpation; neural dynamics; and functional assessments including balance, kinetic chain and core stability.
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51. O’Donoghue G, Cusack, T and Doody C (2012) Contemporary undergraduate physiotherapy education in terms of physical activity and exercise prescription: practice tutors’ knowledge, attitudes and beliefs. Physiotherapy. 98, 2, 167-173. 52. O’Donoghue G, Cunningham, C, Murphy, F et al (2014) Assessment and management of risk factors for the prevention of lifestyle-related disease: a cross- sectional survey of current activities, barriers and perceived training needs of primary care physiotherapists in the Republic of Ireland. Physiotherapy. 100(2):116-22. 53.O'Donoghue G, Doody C, Cusack T. Physical activity and exercise promotion and prescription: Recommendations for contemporary professional entry-level
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assessment of PA status was frequently informal or absent. Assessment of PA status is essential if change is to be measured and identifying inactive individuals facilitates a more economically viable, targeted approach to PA promotion . Secondly, findings suggest that in line with evidence from other health professions, PA guidelines are not widely used to inform clinical practice [23,24]. Finally on this point, findings suggest that signposting is often perceived to be time consuming, complex and difficult to do in routine clinical contacts.
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Ninety-seven percent of the participants had a physiotherapy department in their hospital of practice, 94.0% had phys- iotherapists as close friends, 83.6% had a physiotherapy training program in their institution of residency, 73.1% and 70.1% had worked with physiotherapists before in the management of gynecologic patients and obstetric patients, respectively, 67.2% had physiotherapy as a degree program in their school of basic medical training, and 92.5% noted that physiotherapy had not worsened the condition of their patients. These factors could have influenced utilization of physiotherapy services in a positive way. It is noteworthy that only 14.9% of the participants had physiotherapy postings in their hospital and only 10.4% went on ward rounds with physiotherapists. It was observed that the present status of the participants resulted in better knowledge of the role of physiotherapy service in obstetrics and gynecology but not necessarily their attitudes. Senior registrars had a better attitude than consultants towards the role of physiotherapists in obstetrics and gynecology, despite their lesser knowledge. This indicates that better knowledge does not necessarily translate into a positive attitude.
Lack of sufficient EBP skills is maybe a more plausible explanation for why students prioritized practice experi- ence over EBP and experienced difficulties. Descriptions from the interviews indicated that students applied re- search evidence without consideration of validity and expe- rienced frustrations and low confidence in relation to searching for research evidence. In addition, there were few examples of students using knowledge sources such as systematic reviews or clinical guidelines; sources that are considered helpful to better seek evidence-based informa- tion . Furthermore, it did not seem to help students that an increasing amount of systematic reviews and guide- lines with relevance to physiotherapy are produced . Our findings agree with several surveys among physiother- apists and other allied health professions, where lack of skills is cited as a common barrier to EBP [48,49,52-54,58]. Higher levels of confidence in critical appraisal or in implementing EBP have been reported in some studies [33,50,51]; however, these results might be explained by low response rates that again might reflect a lack of ability or interest in EBP among non-respondents. Previous quali- tative studies among physiotherapists and occupational therapists refer to similar findings as in our study: lack of skills in critical appraisal inhibited the development of EBP ; lack of access, skill or time was perceived as barriers to performing computerized searches ; and, the scien- tific language was hard to understand . Considering this, continuing to improve skills in searching and critical appraisal, in addition to increasing awareness of knowledge sources, might be important to promote EBP among stu- dents in clinical placements.
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The result also showed a significant mean difference of AFB perceptions based on genders, but not for mode of study (MOS) and field of study (FOS). It shows that male and female has different view of how they perceived AFB provided by their supervisors. Female depicted significant mean difference compared to male as female tends to be more emotional. This is opined by Higgins et al (2001) that students make an emotional effort on their work progress so they expect a “return” on the investment. So, the females tend to have an emotional state of mind when perceiving AFB. Hence, it is recommended for the supervisors to employ a balanced practice of the form of AFB to their PG students. It is best for supervisors to improve their duration on giving assessment feedback to the supervisee. Supervisors should make time to provide AFB since students have the tendency to get emotional on the feedback of their research progress. A well-balanced and well-practiced AFB encourages students to continuously construct their own learning and to counter the dissatisfaction of students on AFB practice in HE.
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Our study also showed the gaps in pulmonary reha- bilitation services for PLWHA. Participants reported that they had suffered a respiratory complication which had resulted in admission in the past 6 months but not all participants received chest physiotherapy treatment and none of them ever received outpatient pulmonary rehabilitation services after discharge. The reason for this might be because this service is not regarded as a standard operating procedure for all PLWHA who present with a pulmonary complication. This finding is similar to what has been reported in Uganda that chronic pulmonary diseases caused by TB or COPD carry a large but silent burden of human suffering yet its treatment and rehabilitation for patients are not regarded as a health priority . Wilches et al.  indicated that in chronic pulmonary patients like TB patients, although receiving all the pharmacological efforts available, they generally continue having physi- cal limitations as the great inflammatory component causes serious injuries that trigger fibroblastic reaction, fibrosis and chest wall retraction, affecting mobility,
The second precondition of developing an SMS is to have learning progression with end- and sub-targets. Physiotherapy studies already did a good job in developing the curriculum. The national transcript is developed by SROF and explains the physiotherapy curriculum. The document has to be revised for next school year. The interviewed teachers know these learning progression exists but they claim to not have a good overview of the learning progression. So, SROF should not only revise the document but also raise awareness and attention among stakeholders. One of the teachers from Saxion mentioned that the literature among all physiotherapy studies should be the same. This is not necessary. If the learning progression with end- and sub-targets are known, each school have its own autonomy to create the courses. This is also the case in primary education in the Netherlands. The CITO tests are aimed at the national curriculum. Each school uses its own learning methods which are tuned at this curriculum. A remark has to be made: there has to be carefully dealt with specializations in the study programme. So, it is necessary to tune the physiotherapy curriculum but not the shape of educational methods to fulfill this curriculum.
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Methods: Observational study using data from the Netherlands Information Network of General Practice and the National Information Service for Allied Health Care. These registration networks collect healthcare-related information on patient contacts including diagnoses, prescriptions, referrals, treatment and evaluation on an ongoing basis. Results: Many patients develop symptoms gradually and 35% of patients with shoulder syndromes waited more than three months before visiting a physiotherapist. In 64% of all patients, treatment goals are fully reached at the end of physiotherapy treatment. In general practice, around one third of the patients return after the referral for physiotherapy. Patients with shoulder syndromes who are referred for physiotherapy have more consultations with their GP and are prescribed less medication than patients without a referral. Often, this referral is made at the first consultation. In physiotherapy practice, referred patients differ from self-referrals. Self-referrals are younger, they more often have recurrent complaints and their complaints are more often related to sports and leisure activities.
wartime with formalization of extended scope/advanced practice roles in the United States during the Vietnam War. But today, aging of the population and increased prevalence of chronic diseases is taxing health care sys- tems thus demanding broader implementation and ex- pansion of such models . Formal evaluation of these new models is necessary to insure timely access to effica- cious and effective health care services. Evaluations in- volve a variety of different research designs to assess structure, process and outcomes related to these new models of care. These include evaluation of the extended scope practitioner’s competencies (e.g. diagnostic accur- acy) and satisfaction with their new roles, the patient’s satisfaction with the new service delivery models, cost of the new models of care and whether they have improved outcomes (such as reduced wait times, expedited recov- ery and improved function for the recipients of the care).
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In literature the terms clinical competence and professional competence are used interchangeably. Although many authors use the terms professional competence or clinical competence in relation to (para-) medical health professions (V. Cross, 2001; Megan Dalton et al., 2012; Epstein & Hundert, 2002; Hayes, Huber, Rogers, & Sanders, 1999; van der Vleuten & Schuwirth, 2005; Wass, Van der Vleuten, Shatzer, & Jones, 2001) only a very few of them give a clear definition of the meaning of professional competence and clinical competence. Carr (Carr, 2004) refers to a definition given by Southgate defining competence in a doctor as “being composed of cognitive, interpersonal skills, moral and personality attributes. It is in part the will, to consistently select and perform relevant clinical tasks in the context of the social environment in order to resolve health problems of individuals in an efficient, effective economic and humane manner”. The most explicit definition is given by Epstein and Hundert (2002) who define professional competence within the medical profession as “the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values and reflection in daily practice for the benefit of the individual and community being served”. In relation to physiotherapy education most authors use clinical competence with a reference to the performance of students in their clinical education period. When talking about measuring the clinical competence of students some authors also describe this as grading the performance of the student during the clinical education period (Hayes et al., 1999; Joseph, Hendricks, & Frantz, 2011; Roach et al., 2012)
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The objective of this was double folded- firstly, it enabled us to develop and evaluate the e-resource on clinical anat- omy for physiotherapy students. Secondly, it helps us un- derstand the functional feasibility of using Moodle LMS to develop and distribute such an online resource . This clinical anatomy learning resource is unique in a way that it stands different from routine online quizzes and web re- sources. It supplements the conventional classroom teach- ing with web based learning . This is completely inter- active and engaging in a way that it utilizes a combination of features used in other online resources . At each stage, the students are provided by answers, clues and ref- erences to online study material, so that the resource acts as a complete guide to encourage learning, evaluation, crit- ical thinking and decision-making.
The objective of the study was to evaluate the actual status of the community pharmacy practice and quality of services and to identify the gaps and barriers to implement the best pharmacy practice and care. Cross-sectional descriptive survey was conducted for the pharmacies/pharmacists where pre-coded multiple choice closed questions were used with response format: activity fully applied, partially applied, applicable or not applicable. Set of 155 indicators was developed covering five essential components: pharmacy structure and practice; patient safety; manufacture practice; staff workflow and competences and quality assurance. The actual score was 64 out of 100. Pharmacy services related to manufacture practice and quality assurance were identified as the areas of highest priority for improvement, followed by the services related to patient safety. Priorities for intervention by key stakeholders (national authorities, academia, professional associations and pharmacists) and recommendations for introducing new and improving the existing roles of the pharmacists were defined.
New models of care have emerged where interdiscip- linary collaboration is favored; in these new models, physiotherapists replace orthopaedic surgeons as the first person seen when the patient is referred to the or- thopaedics service and only surgical candidates or com- plex cases are referred to the surgeon. These models aim at improving access to care, with equal or better effect- iveness, while containing costs and retaining patient sat- isfaction . Many countries have already implemented these models and have defined an “advanced practice” or extended scope role for physiotherapists in which they formulate a diagnosis, triage potential surgical candi- dates, order imaging or laboratory tests and prescribe medication for patients with musculoskeletal disorders . With the emergence of these new advanced prac- tice models, there is a need to evaluate their efficacy and efficiency.
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Assessment of content validity is also difficult in the tool developed by Godfrey (110). The authors describe using two existing CATs as a basis for their CAT and that decisions over which items to include were made by ‘expert consensus’ although no details on the experts, criteria, or decision making process are provided. Godfrey et al then used their new CAT to see if any items were predictive of clinical change in patients. This information contributes to content validity indirectly by providing potential predictive validity. For example, if specific competency items in the new CAT are strongly associated with clinical change then they can be used to make a prediction of outcome (evidence based on relationship to other variables). This adds weight to their inclusion in a CAT (evidence based on test content) although ideally a causal link needs to be established. Unfortunately none of the factors found within the Godfrey tool using factor analysis were associated with clinical outcome in this study. This finding could be due to many factors, further explored in Chapter Five, but this lack of association means that overall the Godfrey CAT lacks validity evidence on test content.
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