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Hybrid e-learning offered flexibility for students who could not attend in-person classes during the COVID-19 pandemic, but its effectiveness in teaching chest physiotherapy remains to be determined. This retrospective case-control study assessed physiotherapy students' academic performance and satisfaction with a hybrid classroom approach adopted during the COVID-19 pandemic for teaching airway clearance techniques. Physiotherapy students participated in a 'Critical area and airway clearance techniques' seminar in person or remotely. The evaluation included a multiple-choice quiz (0-20 points) for theoretical knowledge, a checklist (0-10 points) for practical skills, and a total score (0-30 points). Satisfaction was measured using a 5-point Likert scale. Quartile regression tests calculated median differences, 95% confidence intervals (CIs), and Cohen's d effect sizes for each assessment component. The analysis included 41 students (54% men, mean age: 23 ± 2.1). The face-to-face group outperformed the remote group in total scores (median difference: 6 [95% CI 2.89; 9.10], effect size: 1.48 [0.72; 2.23]) and practical skills (median difference: 4 [2.31; 5.68], effect size: 2.05 [1.35; 2.76]). However, there was no conclusive difference in theoretical knowledge (median difference: 2 [-0.24; 4.24], effect size: 0.61 [-0.07; 1.29]). Student satisfaction was similar. Physiotherapy students attending the 'Critical area and airway clearance techniques' seminar remotely achieved lower scores than their in-person counterparts, highlighting the potential limitations of hybrid teaching for this subject. The mean scores indicated that this method allowed students to acquire the necessary knowledge during the COVID-19 pandemic., (© 2024. The Author(s).)

Background: Clinical education is a crucial process in which students learn how to use theoretical knowledge in clinical settings. However, there is no standardized assessment tool routinely used to evaluate the clinical performance of physiotherapy students in Turkey. This study aimed to examine the psychometric (validity and reliability) and edumetric (acceptability, feasibility, and educational impact) properties of the Turkish version of the Assessment of Physiotherapy Practices (APP-T)., Methods: This methodological study included 7 clinical educators and 174 4th-grade physiotherapy students at three universities in Turkey. Students were assessed with the APP-T on completion of 4-week clinical placements. The construct validity was examined using the exploratory factor analysis. The internal consistency was determined using Cronbach's α-coefficient. The test-retest and inter-rater reliability were evaluated with the intra-class correlation coefficient (ICC). For the measurement error of the APP-T, standard error of measurement (SEM) and minimum detectable change (MDC) values were calculated. After the administration of the APP-T was completed, clinical educators were requested to provide feedback on the acceptability, applicability, and educational impact of the APP-T., Results: Exploratory factor analysis demonstrated the 20 items of the APP-T represent a single dominant dimension explaining 76.28% of the variance. Excellent test-retest and inter-rater reliability was detected by ICC = 0.94 and ICC = 0.77, respectively, and good internal consistency was detected by Cronbach's α = 0.935. The MDC 90 values for test-retest and inter-rater reliability were 3.11 and 6.86, respectively. Clinical educators provided generally positive feedback on the acceptability, feasibility, and educational impact of the APP-T., Conclusions: The current findings provided evidence for universities and clinical educators that the APP-T has sufficient psychometric and educational properties for evaluating the clinical performance of physiotherapy students in Turkey., (© 2024. The Author(s).)

Rationale: Advanced Practice Physiotherapy (APP) is a post-licensure higher level of practice that requires distinctly increased skills, clinical reasoning and experience. The four pillars that underpin APP are clinical practice, leadership, education and research. Multiple systematic reviews support that APP is beneficial to health care systems. While APP exists in over a dozen countries, it has yet to reach international recognition. A steppingstone in gaining global acknowledgement is understanding the educational pathway that physiotherapists traverse to become Advanced Practitioners. No systematic review has synthesized evidence to describe and evaluate the educational pathway for physiotherapists to APP. Therefore, the objectives of this review are 1) to describe the post-licensure educational pathways that physiotherapists engage in to advance their level of practice, 2) to evaluate the pillars of APP demonstrated by the physiotherapist after traversing a post-licensure educational pathway., Materials and Methods: A systematic mixed studies review using a data based convergent qualitative synthesis design will be conducted. MEDLINE (Ovid), Embase, CINAHL, the Cochrane Library, Web of Science, PEDro, SportDiscus, ProQuest Education databases as well as the grey literature will be searched from inception to 02/29/2024. Studies that aim to describe and or evaluate the capacity of educational pathways to influence the level of practice of the physiotherapist will be included. Two independent reviewers will screen studies, extract data and assess methodological quality (Quality Assessment of Diverse Studies). Quantitative data will be 'qualitized', and all data will be synthesized via a clustered textual description and directed content analysis. After synthesis, two reviewers will assess confidence in the cumulative evidence (GRADE-CERQual), which will inform the discussion., Implications: The optimal pathway(s) to Advanced Practice for the physiotherapist will be evaluated to inform future high-quality research investigating the effectiveness of post-licensure education in developing Advanced Practice physiotherapists., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Maddigan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Joint mobilizations are well-established and extensively researched treatment modality for adults. However, it remains largely unexplored in the pediatric population. Physical therapists hesitate to perform joint mobilization on children because of lack of knowledge, concern for the developing skeletal system, and the paucity of research on the topic. The aim of this article is to present a decision tool created for a continuing education course with the purpose to instruct pediatric therapists in the safe and effective use of joint mobilizations in children. It is based on the pediatric paradigm of developmental and functional assessment to best address the concerns and preferences of physical therapists (PTs). To advance research in pediatric joint mobilization, PTs should listen to the concerns of pediatric therapists and respond to those concerns with effective, evidence-supported training. This decision tree will serve as a resource for the education of pediatric therapists in the safe and effective use of joint mobilizations.

Background: Vascular pathologies of the head and neck are rare but can present as musculoskeletal problems. The International Federation of Orthopedic Manipulative Physical Therapists (IFOMPT) Cervical Framework (Framework) aims to assist evidence-based clinical reasoning for safe assessment and management of the cervical spine considering potential for vascular pathology. Clinical reasoning is critical to physiotherapy, and developing high-level clinical reasoning is a priority for postgraduate (post-licensure) educational programs., Objective: To explore the influence of the Framework on clinical reasoning processes in postgraduate physiotherapy students., Methods: Qualitative case study design using think aloud methodology and interpretive description, informed by COnsolidated criteria for REporting Qualitative research. Participants were postgraduate musculoskeletal physiotherapy students who learned about the Framework through standardized delivery. Two cervical spine cases explored clinical reasoning processes. Coding and analysis of transcripts were guided by Elstein's diagnostic reasoning components and the Postgraduate Musculoskeletal Physiotherapy Practice model. Data were analyzed using thematic analysis (inductive and deductive) for individuals and then across participants, enabling analysis of key steps in clinical reasoning processes and use of the Framework. Trustworthiness was enhanced with multiple strategies (e.g., second researcher challenged codes)., Results: For all participants (n = 8), the Framework supported clinical reasoning using primarily hypothetico-deductive processes. It informed vascular hypothesis generation in the patient history and testing the vascular hypothesis through patient history questions and selection of physical examination tests, to inform clarity and support for diagnosis and management. Most participant's clinical reasoning processes were characterized by high-level features (e.g., prioritization), however there was a continuum of proficiency. Clinical reasoning processes were informed by deep knowledge of the Framework integrated with a breadth of wider knowledge and supported by a range of personal characteristics (e.g., reflection)., Conclusions: Findings support use of the Framework as an educational resource in postgraduate physiotherapy programs to inform clinical reasoning processes for safe and effective assessment and management of cervical spine presentations considering potential for vascular pathology. Individualized approaches may be required to support students, owing to a continuum of clinical reasoning proficiency. Future research is required to explore use of the Framework to inform clinical reasoning processes in learners at different levels., (© 2024. The Author(s).)

Questions: What is the student experience of near peer-led simulation in physiotherapy education from the perspectives of students (near peer learners and near peer teachers)? What are their expectations, perceptions and engagement in this as a teaching and learning activity? Are there any short-term benefits?, Design: Convergent mixed-methods study., Participants: From a graduate entry Doctor of Physiotherapy course, 111 first-year and 20 second-year students participated., Intervention: Near peer-led simulation was delivered within first-year cardiorespiratory, musculoskeletal and neurological physiotherapy curricula and as a precursor to second-year clinical placements. First-year students were near peer learners. Second-year students were near peer teachers and the simulated patients., Outcome Measures: Focus groups, pre/post-simulation questionnaires and direct observation. Data were triangulated and presented in overall themes., Results: Five themes emerged: near peer-led simulation improved the students' confidence and the opportunity to make mistakes in a supportive and safe environment was valued; peer feedback was an integral part of the learning process that enriched the learning experience; the authenticity and realism created seriousness, promoted engagement and facilitated perceived knowledge transfer; there were benefits for learning for both peer learners and peer teachers; and the anticipation and emotional impact was evident., Conclusion: Near peer-led simulation was viewed by students as a valuable and engaging activity. Students perceived a broad range of benefits on their learning, especially from peer feedback (giving and receiving) on their performance, and had increased confidence following simulation. Peer-led simulation is an authentic and valuable component of entry-to-practice physiotherapy education., (Copyright © 2023 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

Background: Self-assessment is a method that allows students to reflect on and critically evaluate their performance, increases students' involvement in learning, and improves academic achievement. In physiotherapy (PT) education, clinical training is a crucial component, guided by clinical educators (CEs), who assess and provide feedback, fostering student development. Limited research has investigated the impact of self-assessment on PT clinical training outcomes. This study aims to assess the effect of mid-term self-assessment during PT clinical training on students' competence and on level of agreement between students' self-assessment and CEs' assessment at the end of the training., Methods: 23 CEs and their 52 undergraduate PT students participated in the study. The students underwent eight weeks of clinical training in outpatient PT clinics in groups of two or three. For each group, one CE performed student assessment at the mid-term and the end of the training using the Assessment of Physiotherapy Practice (APP) form, an assessment tool used to evaluate clinical competence in PT clinical training. One student from each group was randomly assigned to join the intervention group (IG). These students completed a self-assessment process at the mid-term of the training. All students were asked to complete a self-assessment form at the end of the training., Results: The median CE's evaluation score halfway through the training was 80 [50-96] and 91 [65-100] at the end of the training, with no significant differences between the two groups. The level of agreement between the student and CE's evaluation at the end of the training was not significantly different between the groups (p = 0.05). It noted that students who scored themselves higher than their CEs tended to have lower APP scores than others, based on CEs' assessment. These students were found to have less academic experience. Nevertheless, those from the IG improved significantly, based on the CE's assessment, during the second half of the training, compared to the controls., Conclusion: The main finding of the present study is that student participation in self-assessment during PT clinical training is advantageous, mainly for individuals undergoing their initial clinical training and in the early stages of their academic studies., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Threshold concepts describe learning experiences that transform our understanding of a concept. Threshold concepts are variously: troublesome, transformative, irreversible, integrative and bounded., Purpose: The aim of this narrative review is to consider the case for characterising pain science and practice as a threshold concept within undergraduate and pre-registration physiotherapy education. This article considers the underlying tenets of threshold concepts as they relate to teaching and learning and the relative merits and limitations of characterising pain science and practice as a threshold concept within undergraduate and pre-registration physiotherapy education from both pedagogical and epidemiological perspectives. By evaluating pain, as it relates to physiotherapy education and practice, according to the five defining characteristics of a threshold concept then presenting data related to the epidemiology and impact of pain, the worthiness of characterising pain science and practice as a threshold concept will be discussed and further debate invited., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Evidence-based practice (EBP) is the gold standard approach in physiotherapy, and it is essential that students are aware that it is the appropriate way to provide the patient with the best possible treatment. Undergraduate research (UR) can positively influence learning outcomes and research competencies related to EBP compared to traditional methods of higher education. The aim of this study was to evaluate the effect of implementing a research-based activity (i.e., active participation in a randomised controlled trial [RCT]) in the UR programme on the learning and acquisition of research methodology-related competencies by first-year physiotherapy students., Methods: Students in the first academic year of the Bachelor´s Degree in Physiotherapy of University of Deusto (Donostia-San Sebastian, Spain) who were enrolled in the subject 'Introduction to Research Methodology' were invited to take part in a real RCT which consisted of three groups: intervention, placebo, and control group. While the RCT was carried out, researchers and/or participants roles were combined among students during the semester. At the end, a questionnaire that included open and closed questions was used to evaluate the effectiveness of the UR strategies used in students´ acquisition of theoretical knowledge, research competencies, self-efficacy of RCT skills and procedures. Lecturers also completed the questionnaire to evaluate their experience., Results: From the 114 students enrolled in the subject, 102 participated in the RCT and 110 answered the final questionnaire. Regarding the development of research competencies, UR had a positive or very positive impact on critical thinking (67% and 18%, respectively) and in the assessment of methodological quality (66% and 23%, respectively). Furthermore, most students reported that the implementation of the RCT facilitated their knowledge of placebo, detection of bias, development of critical thinking and a better understanding of methodological issues in research. Lecturers reported an additional burden that was difficult to reconcile with daily duties., Conclusion: The novel UR program provided students with a new opportunity to improve their knowledge of RCT procedures, thus making the learning process more meaningful. Therefore, ways of teaching and learning focused on improving research and inquiry attitudes should be considered and integrated into the health care curriculum, especially in physiotherapy programs, to ensure the transfer of EBP for the provision of the best care., Trial Registration: Australian New Zealand Clinical Registry: ACTRN12622000263796p (14/02/2022)., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objectives: This study includes two separate parts: the objective for part A was to evaluate the practical manual therapy skills of undergraduate physiotherapy students who had learned manual therapy techniques either online or in classroom depending on the phases of the pandemic. The objective for part B was to evaluate in a randomized prospective design the effectiveness of video-based versus traditional teaching of a manual therapy technique., Design: Cross-sectional cohort study (part A) and randomized controlled trial (part B)., Setting: University of Luebeck, undergraduate physiotherapy students in years 1-3., Method: In part A, physiotherapy students who had learned manual therapy either online (during the pandemic) or in classroom (prior to and after the lock down periods of the pandemic) were videotaped while performing two manual techniques on the knee joint and on the lumbar spine. Recordings were analyzed independently by two blinded raters according to a 10-item list of criteria. Inter-rater reliability was assessed using Cohen's kappa for each item. Performance across cohorts was analyzed using analysis of variance. In part B, students were randomized to learn a new technique on the cervical spine either from a lecturer or from the same lecturer on a video recording (independent variable). Practical performance of the technique was analyzed by two raters blinded to group allocation according to a 10-item list of criteria (dependent variable). Results were analyzed statistically by using ANCOVA with year of study as a covariate., Results: Sixty-three and 56 students participated in part A and part B of the study, respectively. The inter-rater reliability for video analyses for both parts of the study was moderate (k = 0.402 to 0.441). In part A, there was no statistically significant difference across years of study for the practical performance of the technique on the back F(2,59) = 2.271; p  = 0.112 or the knee joint F(2,59) = 3.028; p  = 0.056. In part B, performance was significantly better when learned from a lecturer and practiced on a peer than when learned from a video and practiced on a rescue dummy ( p  < 0.001)., Conclusion: Practical skill performance can be acquired from videos but immediate skill reproduction is significantly better when the technique is presented by a lecturer in classroom and practiced on peer students.

Background: During workplace-based clinical placements, best practice assessment states students should expect consistency between assessors rating their performance. To assist clinical educators (CEs) to provide consistent assessment of physiotherapy student performance, nine paediatric vignettes depicting various standards of simulated student performance, as assessed by the Assessment of Physiotherapy Practice (APP), were developed. The APP defines adequate on the global rating scale (GRS) as the minimally acceptable standard for an entry-level physiotherapist. The project aimed to evaluate consistency of paediatric physiotherapy educators assessing simulated student performance using the APP GRS., Methods: Three paediatric scenarios representing neurodevelopment across three age ranges, infant, toddler and adolescent, were developed and scripted that depicted a 'not adequate', 'adequate' and 'good-excellent' performance based on the APP GRS. An expert panel (n = 9) conducted face and content validation. Once agreement was reached for all scripts, each video was filmed. A purposive sample of physiotherapists providing paediatric clinical education in Australia were invited to participate in the study. Thirty-five CEs, with minimum 3-years clinical experience and had supervised a student within the past year, were sent three videos at four-week intervals. Videos depicted the same clinical scenario, however performance varied with each video. Participants rated the performance on the four categories: 'not adequate', 'adequate', 'good' and 'excellent' Consistency among raters was assessed using percentage agreement to establish reliability., Results: The vignettes were assessed a combined total of 59 times. Across scenarios, percentage agreement at the not adequate level was 100%. In contrast, the adequate scenarios for the Infant, Toddler and Adolescent video failed to meet the 75% agreement level. However, when combining adequate or good-excellent, percentage agreement was > 86%. The study demonstrated strong consensus when comparing not adequate to adequate or better performance. Importantly, no performance scripted as not adequate was passed by any assessor., Conclusions: Experienced educators demonstrate consistency in identifying not adequate from adequate or good-excellent performance when assessing a simulated student performance using the APP. Recommendation for practice: These validated video vignettes will be a valuable training tool to improve educator consistency when assessing student performance in paediatric physiotherapy., (© 2023. The Author(s).)

Physiotherapy has a strictly theoretical body of knowledge, but for the most part, the physiotherapist's learning is practical. The practical part is fundamental to acquire clinical skills that the physiotherapist will later use in professional practice. The main aim of this study was to assess the effectiveness of movement representation strategies (MRS) in the improvement of manual skills of physiotherapy students as an educational innovation strategy. We randomly assigned 30 participants to an action observation practice (AOP), motor imagery practice (MIP), or sham observation (SO) group. A high velocity, low amplitude lumbar manipulation technique that is widely used in clinical physiotherapy practice was taught in one session. The primary outcomes were required time and test score. The secondary outcomes were perceived mental fatigue and perceived difficulty for learning. The outcomes were assessed preintervention and immediately after the intervention (postintervention). The main results showed that both AOP and MIP improved the total time required and the test score, as well as entailed less perceived difficulty for learning. However, both strategies showed a higher level of mental fatigue after the intervention, which was higher in the MIP group. Based on the results obtained, it seems that the application of MRS promotes greater learning of manual motor tasks in physiotherapy students and could be used as educational innovation strategies.

Background: Specific personal and behavioural characteristics are required for competent health care practice. Research investigating relationships between these characteristics and course performance of health professions students is expanding, yet little research is conducted within the undergraduate physiotherapy student population. This study aimed to explore the relationships between personality, approaches to learning, and coping strategies of undergraduate physiotherapy students and their performance in academic, clinical and in-course assessment tasks and course progression., Methods: Participants from six cohorts of undergraduate physiotherapy students (commencing years 2012-2017, 66% response rate) completed questionnaires measuring personality (NEO-FFI-3), approaches to learning (RASI) and coping strategies (Brief COPE). Correlation and multiple regression analysis were conducted to investigate relationships between scores on written examinations, in-course assessment tasks and assessments of clinical performance. Mann-Whitney U test was used to compare subgroups on these measures in those who completed or did not complete the course., Results: Conscientiousness and a strategic approach to learning predicted higher scores in written examinations, and for most clinical and in-course assessments with conscientiousness being a stronger predictor. A lack of purpose (surface) learning approach was predictive of lower clinical placement scores. Non-course completers had higher scores for lack of purpose (surface) approach to learning and lower scores for the coping strategies of support seeking and humour., Conclusions: This study confirms the importance of conscientiousness and a strategic learning approach on the academic and clinical performance of undergraduate physiotherapy students. Identifying learners with a surface learning approach and low support seeking coping strategies could assist in providing support to students at risk of poor performance and minimising attrition., (© 2023. The Author(s).)

Background: Various psychological issues and serious health concerns during the imposed lockdown by coronavirus disease 2019 (COVID-19) have induced many changes in the treatment of patients. More effective self-management strategies through tele-rehabilitation are suggested to be applied for patients with chronic neck pain to reduce referrals to health cares and disability support through COVID-19. Also, the pain neuroscience education (PNE) approach is an educational method used by health professionals to assist patients in understanding the biology, physiology, and psychosocial factors affecting their pain experience and aligning with the cognitions and beliefs associated with pain and recurrent disability. PNE combined with tele-rehabilitation could be a new solution to encourage patients to manage their condition by themselves and increase the continuity of practice instead of face-to-face sessions., Objective: This randomized control trial (RCT) aims to investigate the effects of PNE with online and face-to-face exercise interventions, and the control group received biomedical education + standardized physical therapy on neck pain and disability, psychological factors, and function in non-traumatic chronic neck pain., Methods/design: Patients with non-traumatic chronic neck pain (patient-centered care and active involvement of patients and the public) will be recruited via flyers displayed in hospitals and universities to participate in an RCT with two experimental and one control group designed to investigate the effects of PNE with online and face-to-face exercise interventions, and the control group received biomedical education + standardized physical therapy on neck pain and disability, psychological factors, and function in non-traumatic chronic neck pain. The outcomes will be measured at baseline, after PNE, and after 3 months of an exercise intervention. All outcomes are presented as mean ± SD, and statistical significance was set at α level of < 0.05. The normal distribution of the variables was verified by the Kolmogorov-Smirnov test, following a descriptive analysis., Discussion: It seems that PNE plus online and face-to-face exercise interventions are appropriate educational models for the treatment of patients with neck pain during COVID-19. Also, online training seems to encourage patients to continue their treatment., Trial Registration: Iranian Registry of Clinical Trials IRCT20150503022068N5. Registered on 09 September 2021., (© 2022. The Author(s).)

Physical distance was one of the safety measures that were applied during the outbreak of COVID-19 and universities all over the world were forced to shift toward online teaching (OT). The aim of the study was to answer six research questions related to the profile of OT in Egyptian Physical Therapy Colleges during the COVID-19 outbreak. A google form questionnaire was used to survey 102 Egyptian Physical Therapy Educators (EPTEs) who were engaged in teaching Physical Therapy undergraduate programs in Egyptian universities during the spring semester of the academic year 2020-2021. Results showed that the EPTEs frequently (N= 51; 58.0%) used OT both from work and home. Private universities showed a significant advantage over public universities regarding the provision of institutional training (N= 101, P= 0.003) and availability of institutional educational support centers (N=99, P= 0.0001). Most (N= 30; 63.8%) university website users were full or associate professors, while (N= 24; 53.3%) Microsoft Teams users were lecturers. The EPTEs who had a positive attitude toward the suitability of OT for practical and clinical instructions were a minority (N= 48; 22.9%) and (N= 24; 29.2%) respectively. The EPTEs perceived different themes for advantages, disadvantages, and challenges regarding their experience with OT. Less than one-tenth (N= 10; 9%) of EPTEs showed the highest positive attitude toward the readiness of their colleges for the application of OT. Most (N= 68; 68%) of the EPTEs reported the presence of negative effects on their social life and (N= 30; 30%) of them reported high levels of financial overwhelming. In conclusion, the EPTEs had a limited and primitive profile of experience with OT during the COVID-19 outbreak in 2021. OT might not be the perfect teaching approach for Egyptian Physical therapy Colleges, especially for practical and clinical courses .                       .

Electrical currents are didactic contents widely applied in the training of physiotherapy students, but the treatment is considered a stressful situation for both the patient who receives it and the student who applies it. The aim of this study was to evaluate the stress-associated autonomic response of physiotherapy students receiving interferential current by measuring and analysing heart rate variability. An observational case-control study was conducted. Ninety healthy male volunteers, all physiotherapy degree students, were enrolled while attending laboratory practice during the 2020-2021 academic year. Participants were randomly allocated to a sham electrotherapy group (44 subjects), in which heart rate variability was recorded for 10 min, both at rest and during the application of sham technique on the lower back (10 min), and an electrotherapy group (46 subjects), applying the same procedure with the electrical current flowing. Outcome measures included baseline (seated position) and postintervention (prone position) time domain parameter, diameters of the Poincaré plot 1 and 2, stress score, and sympathetic/parasympathetic ratio. The sham electrotherapy group exhibited significant increases in time domain parameter ( p = 0.027) and diameters of the Poincaré plot 1 ( p = 0.032), with a small effect size (d ≤ 0.5). The electrotherapy group exhibited significant increases in time domain parameter and diameters of the Poincaré plot 1 and 2 ( p < 0.001) and decreases in the stress score and sympathetic/parasympathetic ratio ( p < 0.001), with a large effect size (d > 0.8) other than for the time domain parameter (d = 0.42), indicating increased parasympathetic and decreased sympathetic activity. After interventions, there were significant differences between groups in diameters of the Poincaré plot 2 ( p < 0.001), stress score ( p = 0.01) and sympathetic/parasympathetic ratio ( p = 0.003), with moderate effect size (d > 0.5). The application of the interferential current technique produces stress-associated autonomic response characterized by greater parasympathetic activity and decreased sympathetic activity. Further studies are needed to determine possible adverse effects.

Background: In physiotherapy there is a growing body of literature exploring the benefits simulation could have in the university-setting, prior to the commencement of work-integrated learning. MASK-ED™ simulation is one form of simulation that could be beneficial for student learning and improve performance in the clinical setting. MASK-ED™ simulation involves an educator donning a silicone mask and portraying a patient role that has been specifically developed to meet learning objectives., Objective: To evaluate the effectiveness of MASK-ED™ simulation compared to role-play with peers for training pre-clinical physiotherapy students., Methods: A single-centre, single-blind, cluster randomized trial with concealed allocation, between group post-measures, and intention-to-treat analysis was conducted at an Australian university between February 2018 - January 2021. Participants were 144 physiotherapy students, cluster randomized by tutorial groups (exp n = 70, con n = 74), undertaking their neurological curricula. The experimental group was exposed to MASK-ED™ simulation in five out of a potential thirty-two tutorials (16%) whilst the control continued with role-play with peers. The primary outcome measure was Assessment of Physiotherapy Practice scores from the students' rehabilitation work-integrated learning clinical placement. These were compared between the experimental and control groups using Mann-Whitney U tests. Secondary outcome measures include practical and written examination scores. These were compared between groups via independent t-tests. Participant satisfaction surveys were also administered to the experimental group., Results: One hundred thirty-two participants' (exp n = 62, con n = 72) results were analyzed. There were no significant differences between the experimental and control groups for Assessment of Physiotherapy Practice scores (p = 0.699-0.995). There were no significant differences found between the groups, across the secondary outcome measures. Participants found MASK-ED™ simulation was somewhat helpful for preparing them for clinical practice, however felt that a group setting was not as effective as a one-on-one encounter would have been., Conclusions: MASK-ED™ simulation was no more effective than role-play with peers in preparing physiotherapy students for work-integrated learning. The influence of the design of simulation on effective learning and the number of classroom-based simulation encounters required to impact clinical performance requires further investigation., (© 2022. The Author(s).)

Purpose: To describe doctor of physical therapy (DPT) students' perceptions following their engagement in a health promotion and wellness service-learning event (SLE) with boy scouts., Methods: A descriptive study using a sample of convenience examined engagement in an SLE with adolescents. Reflective journals summarized student experiences with the population, confidence in executing a fitness examination and motivational interviewing (MI), and anticipated challenges and benefits before and after the SLE. Journals were analyzed for themes and associated frequencies., Results: Pre-event themes included expected communication challenges, a mutually beneficial SLE, and increased competency with the population, fitness testing, and MI. Post-event themes included communication barriers not realized, unexpected challenges, and increased confidence with the population, fitness testing, and MI., Conclusion: Engaging with adolescents in SLEs provides DPT students with skills and confidence for future clinical practice. See the Digital Abstract (available: at: http://links.lww.com/PPT/A347)., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Academy of Pediatric Physical Therapy of the American Physical Therapy Association.)

Introduction: Competence-based learning must be integrated into the practical development of Physiotherapy. Teamwork, interpersonal relations, analytical skills or critical/clinical thinking are some examples of internationally recommended competences in this kind of university studies. Therefore, there is a need to evaluate this learning in Physiotherapy through valid tools that facilitate this task., Objective: To analyze the psychometric properties according to competences in Clinical Practices (RECOPC-FIS II) in order to assess 14 transversal or universal competences of under-graduate students in the Physiotherapy degree., Methods: A validation study was conducted with 197 students in the 3rd and 4th year of the Physiotherapy degree and 202 clinical tutors who assessed these students using the RECOPC-FIS II. Different psychometric properties were analyzed: factor structure, internal consistency and sensitivity to change., Results: The RECOPC-FIS II has a high internal consistency. Its 14 items saturate in a single factor. Regarding the sensitivity to change, the rubric showed higher scores in the Practicum of the 4th year with respect to that of the 3rd year, reaching significant differences in all of them., Conclusion: The RECOPC-FIS II is a valid and reliable instrument to assess the transversal competencies of undergraduate students of Physiotherapy during their clinical practice. Therefore, it is intended to facilitate the acquisition of essential skills for the development of their professional career. The flexibility of this tool would allow its adaptation to other health science courses., Competing Interests: The authors have declared that no competing interests exist.

Although there are increasing reports on the usefulness of sonopalpation with ultrasound imaging, many previous studies have reported interventions without a control group. This single-blind, parallel-group randomised controlled trial aimed to determine whether educational instruction with sonopalpation for physical therapy students has a more superior effect on skill improvement than traditional instruction without ultrasonography. Twenty-nine physical therapy students participated in the study and were randomised using block randomisation into an ultrasound imaging group (n = 15) and a control group (n = 14). Subsequently, they underwent three training sessions focusing on the shoulder joint. Participants underwent a scoring assessment of their palpation skills at pre-intervention, post-intervention, and follow-up 3 months after training. The raters were blinded to the subjects' group. The Friedman and Mann-Whitney U tests were used for data analysis. The intervention group showed a significant increase in scores at post-intervention and the 3-month follow-up; the effect sizes were large (0.849 and 0.849, respectively). A comparison of the scores at different time points after the intervention at the 3-month follow-up revealed no significant difference between the groups. Education using ultrasound imaging may be non-inferior to education without it; nevertheless, further studies are needed to demonstrate superiority., (© 2022. The Author(s).)

Background: Pain is a complex, global and multidimensional phenomena that impacts the lives of millions of people. Chronic pain (lasting more than 3 months) is particularly burdensome for individuals, health and social care systems. Physiotherapists have a fundamental role in supporting people who are experiencing pain. However, the appropriateness of pain education in pre-registration physiotherapy training programmes has been questioned.Recent research reports identify the need to integrate the voice of patients to inform the development of the pre-registration curriculum. The aim of this meta-ethnography was to develop new conceptual understanding of patients' needs when accessing physiotherapy for pain management. The concepts were viewed through an educational lens to create a patient needs-based model to inform physiotherapy training., Methods: Noblit and Hare's seven-stage meta-ethnography was used to conduct this qualitative systematic review. Five databases (MEDLINE, CINAHL Complete, ERIC, PsycINFO and AMED) were searched with eligibility criteria: qualitative methodology, reports patient experience of physiotherapy, adult participants with musculoskeletal pain, reported in English. Databases were searched to January 2018. Emerge reporting guidelines guided the preparation of this manuscript., Results: A total of 366 citations were screened, 43 full texts retrieved and 18 studies included in the final synthesis. Interpretive qualitative synthesis resulted in six distinct categories that represent patients' needs when in pain. Analysing categories through an education lens resulted in three overall lines of argument to inform physiotherapy training. The categories and lines of argument are represented in a 'needs-based' model to inform pre-registration physiotherapy training., Discussion: The findings provide new and novel interpretations of qualitative data in an area of research that lacks patient input. This is a valuable addition to pain education research. Findings support the work of others relative to patient centredness in physiotherapy., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Current guidelines recommend management of musculoskeletal pain conditions from a biopsychosocial approach; however, biopsychosocial interventions delivered by physical therapists vary considerably in effectiveness. It is unknown whether the differences are explained by the intervention itself, the training and/or competency of physical therapists delivering the intervention, or fidelity of the intervention. The aim was to investigate and map the training, competency assessments, and fidelity checking of individualized biopsychosocial interventions delivered by physical therapists to treat musculoskeletal pain conditions., Methods: A scoping review methodology was employed, using Arksey and O'Malley's framework. Seven electronic databases were searched between January and March 2019, with a bridge search completed in January 2020. Full-text peer-reviewed articles, with an individualized biopsychosocial intervention were considered, and 35 studies were included., Results: Reporting overall was sparse and highly variable. There was a broad spectrum of training. More sophisticated training involved workshops combining didactic and experiential learning over longer durations with supervision and feedback. Less sophisticated training was brief, involving lectures or seminars, with no supervision or feedback. Competency assessments and fidelity testing were underperformed., Conclusions: Training in some interventions might not have facilitated the implementation of skills or techniques to enable the paradigm shift and behavior change required for physical therapists to effectively deliver a biopsychosocial intervention. Lack of competency assessments and fidelity checking could have impacted the methodological quality of biopsychosocial interventions., Impact: This study highlighted problematic reporting, training, assessment of competency, and fidelity checking of physical therapist-delivered individualized biopsychosocial interventions. Findings here highlight why previous interventions could have shown small effect sizes and point to areas for improvement in future interventions. These findings can help inform future research and facilitate more widespread implementation of physical therapist-delivered biopsychosocial interventions for people with musculoskeletal pain and thereby improve their quality of life., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: The delivery of physiotherapy via telehealth could provide more equitable access to services for patients. Videoconference-based telehealth has been shown to be an effective and acceptable mode of service delivery for exercise-based interventions for chronic knee pain; however, specific training in telehealth is required for physiotherapists to effectively and consistently deliver care using telehealth. The development and evaluation of training programs to upskill health care professionals in the management of osteoarthritis (OA) has also been identified as an important priority to improve OA care delivery., Objective: This study aims to explore physiotherapists' experiences with and perceptions of an e-learning program about best practice knee OA management (focused on a structured program of education, exercise, and physical activity) that includes telehealth delivery via videoconferencing., Methods: We conducted a qualitative study using individual semistructured telephone interviews, nested within the Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis randomized controlled trial, referred to as the PEAK trial. A total of 15 Australian physiotherapists from metropolitan and regional private practices were interviewed following the completion of an e-learning program. The PEAK trial e-learning program involved self-directed learning modules, a mock video consultation with a researcher (simulated patient), and 4 audited practice video consultations with pilot patients with chronic knee pain. Interviews were audio recorded and transcribed verbatim. Data were thematically analyzed., Results: A total of five themes (with associated subthemes) were identified: the experience of self-directed e-learning (physiotherapists were more familiar with in-person learning; however, they valued the comprehensive, self-paced web-based modules. Unwieldy technological features could be frustrating); practice makes perfect (physiotherapists benefited from the mock consultation with the researcher and practice sessions with pilot patients alongside individualized performance feedback, resulting in confidence and preparedness to implement new skills); the telehealth journey (although inexperienced with telehealth before training, physiotherapists were confident and able to deliver remote care following training; however, they still experienced some technological challenges); the whole package (the combination of self-directed learning modules, mock consultation, and practice consultations with pilot patients was felt to be an effective learning approach, and patient information booklets supported the training package); and impact on broader clinical practice (training consolidated and refined existing OA management skills and enabled a switch to telehealth when the COVID-19 pandemic affected in-person clinical care)., Conclusions: Findings provide evidence for the perceived effectiveness and acceptability of an e-learning program to train physiotherapists (in the context of a clinical trial) on best practice knee OA management, including telehealth delivery via videoconferencing. The implementation of e-learning programs to upskill physiotherapists in telehealth appears to be warranted, given the increasing adoption of telehealth service models for the delivery of clinical care., (©Sarah E Jones, Penny K Campbell, Alexander J Kimp, Kim Bennell, Nadine E Foster, Trevor Russell, Rana S Hinman. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 30.04.2021.)

Objective: The objectives of this cross-sectional qualitative study were to explore the perspectives of students enrolled in one physical therapist undergraduate education program in Australia about their experience with transitioning to full eLearning and student recommendations to improve the learning experience during the COVID-19 pandemic., Methods: Seven focus groups with 28 undergraduate physical therapist students were conducted following the transitioning to full eLearning as a result of strict physical distancing measures. Focus group questions explored the students' experiences of the transition from face-to-face to full eLearning approach and the students' recommendations for improving future eLearning experiences. Data were analyzed using inductive thematic analysis., Results: The 3 themes identified were: (1) students presenting heightened negative feelings such as anxiety, stress, and reduced motivation to study; (2) students continuing to value the face-to-face learning, as it provided social support and facilitated feedback from peers and tutors; (3) student recommendations for eLearning included having online lectures and supplementary videos but face-to-face practical classes and developing healthy learning habits such as scheduled times for studying, exercise, and other activities that regulate stress., Conclusions: The transition to a full eLearning approach in an undergraduate physical therapist education program during the COVID-19 pandemic revealed that students had heightened negative emotions due to the pandemic. Students valued face-to-face practical classes to learn and receive social support from peers and tutors. Student recommendations to future eLearning suggested changes to curriculum development geared toward a greater blended approach to learning. Blended learning may include using online lectures instead of face-to-face lectures and online resources to supplement student learning of practical skills., Impact: As higher education moves toward a more blended approach, lessons learned from this study can help educators design future physical therapist education programs. The findings can also assist programs in delivering a full eLearning approach as the COVID-19 pandemic continues., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

In recent years, the use of diagnostic imaging in physical therapist practice in the United States has gained considerable interest. In several countries around the world and in the US military, patient direct referral for diagnostic imaging has been considered normative practice for decades. US physical therapy program accreditation standards now stipulate that diagnostic imaging content must be included in physical therapist educational curricula. The American Physical Therapy Association has made efforts to pursue practice authority for imaging referral. A recent review of state practice acts and other statutory language concluded that many states have no prohibitions against physical therapists referring for imaging studies. Additionally, physical therapists can now pursue certification as musculoskeletal sonographers. In light of these advances, and with a growing number of physical therapists serving patients who have not yet seen another health care provider, it may be helpful for those who have been actively involved in the use of imaging in physical therapist practice to provide their collective recommendations to serve as a guideline to those interested in incorporating this practice privilege. The purpose of this perspective article is to provide an overview of the key elements necessary for effective implementation of referral for imaging in physical therapist practice while emphasizing the cornerstone of effective communication., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The movement system has been adopted as the key identity for the physical therapy profession, and recognition of physical therapists' primary expertise in managing movement dysfunction is an important achievement. However, existing movement system models seem inadequate for guiding education, practice, or research. Lack of a clear, broadly applicable model may hamper progress in physical therapists actually adopting this identity. We propose a model composed of 4 primary elements essential to all movement: motion, force, energy, and control. Although these elements overlap and interact, they can each be examined and tested with some degree of specificity. The proposed 4-element model incorporates specific guidance for visual, qualitative assessment of movement during functional tasks that can be used to develop hypotheses about movement dysfunction and serve as a precursor to more quantitative tests and measures. Human movement always occurs within an environmental context and is affected by personal factors, and these concepts are represented within the model. The proposed scheme is consistent with other widely used models within the profession, such as the International Classification of Functioning, Disability and Health and the Patient Management Model. We demonstrate with multiple examples how the model can be applied to a broad spectrum of patients across the lifespan with musculoskeletal, neurologic, and cardiopulmonary disorders., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

This study described the results of online interprofessional education (IPE) between physical therapy and health information management students. Using the published Student Perceptions of Interprofessional Clinical Education - Revised, version 2 (SPICE-R2) survey, this study measured changes in perception about IPE before and after three online interactions. Survey results included an overall score and three factors: Interprofessional Teamwork and Team-Based Practice (T), Roles/Responsibilities for Collaborative Practice (R), and Patient Outcomes from Collaborative Practice (O). Data were analyzed using two-way analysis of variance tests using time and program as factors. The overall scores improved significantly for time (ρ=.019). The T factor demonstrated a significant change for program (ρ=.006) and the R factor improved significantly over time (ρ=.005) and by program (ρ=.022). Narrative student comments focused on role and responsibility clarification, communication and coordination, and participation in a realistic experience involving multiple professions. The students believed that the experience was beneficial and important., (Copyright © 2021 by the American Health Information Management Association.)

Objective: More rehabilitation students are engaging in short-term international experiences to gain clinical experience with a novel population or setting. Further investigation of the impacts on the students and host populations resulting from these initiatives is needed. The purpose of this study was to examine the benefits and harms of short-term international academic experiences completed by rehabilitation students for both the student and the host populations., Methods: PubMed, Embase, and CINAHL were searched for studies from 1998 through March 2019; any study design was eligible for review. Independent reviewers screened and selected studies. To be eligible, articles had to include a rehabilitation student participating in a short-term clinical or community-based experience. Two independent reviewers extracted data from included studies. Outcomes included benefits and harms of international academic experiences on students and host populations. Oxford Level of Evidence was used for quality assessment. Nineteen studies met eligibility criteria., Results: The most prevalent benefits and harms to students were increases in cultural and clinical competence and emotional health risks. The most prevalent benefits and harms to hosts were novel training and decreased productivity., Conclusions: Highlighting benefits and harms serves a pivotal role in investigating ways to create more effective, mutually beneficial relationships between home and host populations. Future research should aim for a deeper analysis of the impact of short-term international academic experiences on host populations to develop and deepen sustainable partnerships., Impact: With more rehabilitation students engaging in short-term international academic experiences, this review provides important guidance for the profession, including the recommendation that outcomes regarding the potential benefits and harms for home and host populations should be collected at 3 key times: immediately pre-departure for the host country, immediately post-departure in the home country, and 1-year post-arrival in the home country., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Purpose: To describe perspectives of pediatric physical therapy clinical facilitators on contemporary curricula for Australian entry-level physical therapy programs., Methods: Physical therapy clinical facilitators completed an online survey based on the Academy of Pediatric Physical Therapy of the APTA essential competencies., Results: Conditions including cerebral palsy, cystic fibrosis, and prematurity were highly rated by most participants to include in an entry-level program. Exercise prescription, goal-directed training, and group-based physical therapy were the highest rated interventions. Outcome measures considered important to include were the Alberta Infant Motor Scale and Goal Attainment Scale. Students should demonstrate knowledge and skills using relevant frameworks and have practical opportunities to interact with children., Conclusion: Pediatric clinical facilitators perceived that theoretical knowledge on frameworks, human development, movement skills, pediatric conditions, exercise prescription, and outcome measurement as well as face-to-face experiences with children are important to include in Australian entry-level physical therapy programs.

Background: Patient-reported outcome measures (PROMs) assess disability and progress toward functional goals while promoting patient-centered practice. They can be used by health professionals in any specialty and in a multitude of settings. This study reviews implementation strategies and lessons learned in a capacity-building program that took place with pediatric physiotherapists in Rwanda., Methods: Use of PROMs and patient-centered practice were integrated into 4 consecutive continuing professional development courses offered to 164 participants in Rwanda. We sought to identify a simple generic measure with proven validity in cross-cultural settings. The Patient-Specific Functional Scale was chosen due to its ease of use and ability to measure change in a wide range of patient conditions. Didactic classroom training and clinical site visits were 2 essential pedagogical elements of the capacity-building strategy. Site visits allowed for evaluation of skill levels and facilitation of knowledge transfer to patient care settings. Unique pairs of Rwandan colleagues were trained to serve as coteachers in each course to maximize sustainability of new techniques. This study presents data on a subset of 65 participants who completed a 48-hour pediatric rehabilitation course., Results: After classroom instruction, 78% of participants were observed independently determining functional limitations with their patients. Additionally, pre- and post-tests indicated that therapists substantially increased their understanding of patient-centered practice after attending courses. Interviews conducted 26 months after the conclusion of the project revealed mixed success in sustainability of the use of PROMs, although perceived confidence remained high., Conclusion: Challenges in long-term sustainability of new practices call attention to the need to target not only clinicians when introducing new methodologies, but also the Ministry of Health, hospital administration, and university faculty. Lessons learned from this study may be useful to other medical professionals planning capacity-building programs in low- and middle-income countries., (© Mann et al.)

Background: This study targeted the association of program characteristics of 203 Doctor of Physical Therapy (DPT) programs in the United States (US) reported by the Commission on Accreditation in Physical Therapy Education (CAPTE) in their 2017 Annual Accreditation Report (AAR) with measures of core faculty research volume. The association of institutional, program, and faculty characteristics of an institution with core faculty research volume was investigated., Methods: This observational study analyzed data provided in the AAR about program research volume. Predictor variables included institutional, program and faculty characteristics. Research volume was measured as a ratio of 1) number of peer-reviewed publications, 2) National Institutes of Health (NIH) funding, and 3) faculty with grants, per number of core faculty. Research volume was stratified by quartiles and analyzed using logistic regression analyses. The highest 25% were analyzed against the lowest 75%., Results: In the multivariate logistic regression analyses, research Carnegie classification was positively associated with NIH funding (OR = 4.04; 95% CI = 1.92, 8.48) and number of peer reviewed publications (OR = 7.63; 95% CI = 3.39, 17.14). Square footage of research space was positively associated with number of peer reviewed publications (OR = 4.58; 95% CI = 2.08, 10.11). Private status was negatively associated with NIH funding (OR = 0.37; 95% CI = 0.17, 0.83) and faculty holding grants (OR = 0.38; 95% CI = 0.19, 0.76)., Conclusions: There is strong evidence that research culture (e.g., research Carnegie status and dedicated research space) is related to research productivity in DPT programs in the US. Private status was indicative of a non-research intensive environment, which may be reflective of a current trend of small, non-research based private institutions initiating DPT programs.

Background: Intensive Care Units (ICUs) are daunting environments for physiotherapy (PT) students performing clinical rotations. To prepare students for this environment, a newly developed, evidence-based e-learning module was designed and implemented in the undergraduate curriculum. The aim of this study was to investigate whether e-learning is a feasible method in preparing PT students for clinical work in complex ICU environments, as perceived by students and experts., Methods: A mixed methods proof of concept study was undertaken. Participants were final-year students of an international curriculum, and experts from didactic and clinical fields. An e-learning module consisting of 7 separate chapters based on the latest scientific evidence and clinical expertise was developed, piloted and incorporated into the undergraduate curriculum as a compulsory course to be completed prior to clinical ICU rotations. Data were collected through 3 focus group meetings and 5 semi-structured interviews; these meetings and interviews were audio recorded, transcribed verbatim and analyzed., Results: The study sample comprised of 14 students and 5 experts. Thematic analysis revealed three themes: expected competencies of PT students in ICU, feeling prepared for ICU clinical work and dealing with local variety. The e-learning module enabled students to anticipate clinical situations and PT tasks in the ICU. Higher level clinical reasoning skills, handling of lines and wires and dealing with out-of-textbook situations could not be achieved with the e-learning module alone., Conclusions: An e-learning module can sufficiently prepare PT students for their clinical tasks in the ICU, as long as it is integrated with, or closely connected to, the students' clinical placement.

Background: Development of an entry-level physiotherapy curriculum in China currently follows the World Confederation for Physical Therapy (WCPT) guidelines, however there is no standard, validated, assessment tool for physiotherapy practice in use in China. This article reports the process of translation of the "Assessment of Physiotherapy Practice" (APP), a validated assessment instrument adopted by all universities in Australia and New Zealand, into Chinese (APP-Chinese) and its implementation by Chinese physiotherapy clinical educators (CEs) and students during clinical placements., Methods: The process of forward and backward translation of the APP was undertaken by a team of academics from universities in Shanghai, Hong Kong, United States and Australia. An APP-Chinese version was produced and used for assessment of the clinical performance of 4th year students at a university in Shanghai. Feedback on the implementation of the APP-Chinese was solicited from students and CEs using the same two questionnaires employed to assess implementation of the original APP., Results: All CEs agreed that the rules used to score the APP-Chinese were helpful in assessing student performance. Over 90% of the CEs considered the APP-Chinese was pragmatic for use in the clinical environment in China. All students agreed with the rating of their performance on the APP-Chinese marked by their educators, and that the performance indicators were useful in guiding their expected performance behaviour., Conclusion: The APP-Chinese is the first standardised assessment tool for evaluation of clinical performance of physiotherapy students in China and was shown to be well accepted by both students and CEs in the clinical education unit and university involved in this study.

Background: Three-dimensional digital anatomy applications can provide a powerful supplement to more traditional learning modalities. The challenge for medical libraries and educators is to select an app that best supports anatomical learning objectives and then effectively integrate it into health sciences curricula. App selection is particularly important when traditional learning modalities, such as cadaver dissection, are not feasible. Selection was a challenge at the authors' university, as the doctor of physical therapy (DPT) program expanded into a hybrid online environment., Case Presentation: Reported here are our: (1) analysis and identification of an anatomy app to supplement cadaver lab instruction for DPT students who were enrolled in a hybrid program, where the majority of instruction took place online; (2) description of the implementation process; and (3) discussion of student feedback and the library's perspective. Features and shortcomings of two anatomy apps, Complete Anatomy (CA) 2019 by 3D4 Medical and Human Anatomy Atlas (HAA) 2019 by Visible Body, were reviewed. CA was selected based on smoother navigation, visually appealing graphics, and user customization tools. The library purchased 1,000 CA redemption codes as a pilot program. Video recordings and live demonstrations of the app were used for instruction. Student feedback indicated extensive use. Based on success of the pilot, the library will purchase additional licenses., Conclusions: Medical libraries can use our experience as an example to help select anatomy resources that would be useful when considering the conversion of health sciences programs into online environments and further guide app integration to supplement other anatomical models., (Copyright: © 2020, Authors.)

Objective: In educating students in the health professions about evidence-based practice, instructors and librarians typically use the patient, intervention, comparison, outcome (PICO) framework for asking clinical questions. A recent study proposed an alternative framework for the rehabilitation professions. The present study investigated the effectiveness of teaching the alternative framework in an educational setting., Methods: A randomized controlled trial was conducted with students in occupational therapy (OT) and physical therapy (PT) to determine if the alternative framework for asking clinical questions was effective for identifying information needs and searching the literature. Participants were randomly allocated to a control or experimental group to receive ninety minutes of information literacy instruction from a librarian about formulating clinical questions and searching the literature using MEDLINE. The control group received instruction that included the PICO question framework, and the experimental group received instruction that included the alternative framework., Results: There were no significant differences in search performance or search skills (strategy and clinical question formulation) between the two groups. Both the control and experimental groups demonstrated a modest but significant increase in information literacy self-efficacy after the instruction; however, there was no difference between the two groups., Conclusion: When taught in an information literacy session, the new, alternative framework is as effective as PICO when assessing OT and PT students' searching skills. Librarian-led workshops using either question formulation framework led to an increase in information literacy self-efficacy post-instruction., (Copyright: © 2020, Authors.)

First-year Doctor of Physical Therapy (DPT) students entering a problem-based learning (PBL) program are faced with a number of pedagogical challenges, including the development of self-directed learning skills, resource unfamiliarity, and group dynamics. These challenges can make learning anatomy in a self-directed manner less efficient. Prematriculation introduction of strategies to improve anatomy learning may help prepare students for a rigorous DPT program and improve anatomy learning efficiency. The present study describes a 2-day anatomy workshop offered to incoming students before a DPT program was initiated. Knowledge acquired during both days of the workshop resulted in statistically significant improvements in anatomy postquiz scores for each corresponding prequiz ( P < 0.001 for lower and upper limb quizzes). Workshop participants survey responses demonstrated that anatomy confidence and PBL preparedness increased at distinct intervals following the workshop and was significantly higher than controls after the first semester ( P < 0.01 for anatomy confidence and PBL preparedness). Multivariate regression analyses demonstrated statistically significant relationships between semester anatomy practical scores and workshop participation ( P = 0.03 for practical 1 and P = 0.049 for practical 2 ) and undergraduate grade point average ( P < 0.001 for practical 1 and P = 0.03 for practical 2 ). First-year DPT students reported the anatomy workshop to be a valuable experience for learning strategies to improve anatomy self-efficacy. An introductory anatomy workshop is an effective strategy to improve self-directed anatomy learning efficiency before the start of a rigorous DPT program.

Introduction: Children born extremely preterm (EP: <28 weeks gestation) and/or extremely low birth weight (ELBW: <1000 g) are at increased risk of motor impairment compared with children born at term. Children with motor impairment have lower rates of physical activity (PA) participation compared with their typically developing peers. PA participation is an important outcome for children with motor impairment, however, there is limited evidence available to support interventions that improve PA participation in this population. The aim of this study is to assess the feasibility, including the recruitment and retention, acceptability and fidelity, of a preschool dance participation intervention for children born EP/EBLW with motor impairment called Dance PaRticipation intervention for Extremely prEterm children with Motor Impairment at prEschool age., Methods and Analysis: This feasibility case series trial will recruit EP/ELBW children with motor impairment (n=10) from the Victorian Infant Collaborative Study 2016/2017 cohort, a prospective longitudinal cohort study. Up to 10 community-based dance teachers will be recruited and provided with physiotherapy-led training and support to facilitate the participation of EP/ELBW children in community dance classes. A mixed-methods approach (quantitative and qualitative) will be used to analyse the primary aim, to determine the feasibility of the intervention from the perspectives of families and dance teachers., Ethics and Dissemination: This study is approved by the Human Research Ethics Committees of The Royal Children's Hospital and The Royal Women's Hospital, Melbourne. Study outcomes will be disseminated through conference presentations, peer-reviewed publications and social media., Trial Registration Number: ACTRN12619001266156., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Weight stigmatization is reflected in anti-fat attitudes and stereotypical perceptions of people who are overweight; it has been demonstrated to be prevalent in many segments of society across multiple countries. Studies examining the prevalence of weight stigmatization use different research tools, which can hinder inter-study comparisons. There is also evidence indicating weight stigmatization among registered physical therapists, although its magnitude differs between studies. Limited information exists regarding the attitudes and beliefs of physical therapy (PT) students toward individuals with obesity. Examining weight stigmatization among PT students is particularly important for developing appropriate educational interventions that may influence the professional lives of future physical therapists., Objective: This study aims to characterize and compare the stigmatizing attitudes and beliefs of PT students and certified physical therapists regarding people with obesity in Israel. Its secondary objective is to translate three weight stigmatization questionnaires into Hebrew and determine their psychometric properties., Methods: A cross-sectional, anonymous, and computerized self-report survey was completed by 285 certified physical therapists (average age 39.6 ± 10.1 years) and 115 PT students (average age 26.4 ± 4.9 years). The study used three validated weight stigma questionnaires employed in earlier studies to determine different aspects of weight stigmatization: the Fat Phobia Scale (short form; FPS), Anti-Fat Attitudes (AFA) questionnaire, and Beliefs about Obese People (BAOP). These questionnaires were translated into Hebrew and their psychometric properties ascertained., Results: Similar to the original English versions, the translated versions of the three questionnaires demonstrated good internal consistency (Cronbach's α values of FPS = 0.77; AFA = 0.75; BOAP = 0.59). The three questionnaires showed a low correlation. No significant difference was noted in the FPS and AFA scores between groups, reflecting that both demonstrated average weight stigmatization (FBS in both groups: average score of 3.6 out of 5; AFA therapists: 3.3 ± 1.2, students: 3.0 ± 1.2 out of 9). However, significant between-group differences were observed for BOAP, which examines beliefs regarding individuals' control over their weight (therapists: 16.4 ± 5.6, students: 18.0 ± 5.7 out of 48; p < 0.01)., Conclusion: Student and certified physical therapists demonstrate average levels of weight stigmatization, as reflected in the FPS and AFA scores. Nevertheless, compared to certified physical therapists, physical therapist students believe more strongly that obesity cannot be controlled by the individual. The students' beliefs could affect their clinical judgment and behavior as health care professionals in the future. Therefore, anti-fat attitudes and stereotypical perceptions should be addressed and remediated early using educational interventions during the study period., (© 2020 The Author(s) Published by S. Karger AG, Basel.)

Objective: To explore the association of body mass index with cardiorespiratory fitness and other health correlates among physiotherapy students., Methods: This cross-sectional study was conducted from February to July 2018 at the Peoples University of Medical and Health Sciences for Women, Nawabshah, Pakistan, comprising female undergraduate physiotherapy students aged 17-25 years. All the eligible participants were assessed using a self-report questionnaire, body mass index, and standardised cardiorespiratory fitness criteria. SPSS 20 was used for data analysis., Results: There were 228 subjects with a mean age of 20.89±1.66 years. Of the total, 77(33.8%) students were overweight/obese and 52(22.8%) were underweight. Overall, 212(93%) reported good quality of life, and 189(82.9%) were satisfied with their general health. Also, 180(79%) subjects had a post-exercise heart rate below average. There was a significant negative correlation for body mass index and maximum oxygen uptake, body mass index and age, and maximum oxygen uptake and subjective quality of life (p<0.05 each)., Conclusions: The frequency of both overweight/obesity and underweight physiotherapy undergraduates was high.

Background: Attainment gaps for students with disabilities have been noted in pre-registration physiotherapy courses in the UK. Previous research suggests disclosure, lack of staff knowledge and poor communication between University and placement sites may be relevant, but these are limited to small case studies with students with visual or physical disabilities. The purpose of this study was to explore disabled physiotherapy students' experiences of their education in order to elucidate factors that may influence success., Methods: Qualitative study drawing on phenomenological traditions. Four focus groups including 15 students with disabilities were conducted. Transcripts were analysed thematically. Procedures for transparency and rigour such as member checking and peer debriefing were implemented., Results: Three major themes were derived from data. "It was quite a relief" explores the personal and social implications of diagnosis. "They're not natural" focuses on academic assessment and the specifics of adjustments made and not made within that context. "My dyslexia doesn't switch off" explores the inaccessibility of the learning environment and dissects the contrast between the 24-h nature of having a specific learning condition and the somewhat piecemeal nature of adjustments during their education., Conclusions: This study indicates that having a specific learning disability or anxiety creates a number of hurdles to success in physiotherapy education. Most were within the University setting and were perceived to result from staff ignorance or piecemeal approaches to inclusion. A lack of consistency alongside facilitated dialogue and acknowledgement of enhancements results in frustration, ambiguity towards disclosure and reinforcement of a deficit model. Such an approach belies the intention of the profession and the NHS and does not maximise the potential of widening participation.

Background: The Australian Physiotherapy Council mandates that physiotherapy clinical education be sufficient to produce graduates who are competent to practice across the lifespan. Due to a lack of opportunities for paediatric clinical placements, there is a risk of graduates not having the opportunity to develop competency in paediatric physiotherapy. To address this risk, simulation-based education (SBE) has been proposed as an educational strategy to address the placement shortfall. Despite encouraging evidence for its use in physiotherapy education, there is limited evidence supporting its use specifically in paediatric populations. The aims of this research were to investigate the effect of SBE on student self-efficacy in the physiotherapy assessment and management of paediatric clients, and to determine student satisfaction with SBE as a learning strategy., Methods: Three interactive SBE sessions were run during the undergraduate paediatric physiotherapy unit at the campus of one Australian university. Self-efficacy was surveyed before and after each session, to determine confidence in clinical skills, clinical decision-making, treatment preparation and planning, communication skills; evaluating and modifying interventions, and interprofessional practice. Student satisfaction with SBE as a learning strategy was surveyed after the final SBE session., Results: For the 164 participants included in this study, self-efficacy survey response rate varied from 77 to 96% for each session. Significant increases in mean student self-efficacy were recorded for all questions (p <  0.001). A total of 139 (85%) responded to the learning reactionnaire with 78.6% indicating they were very satisfied with SBE as a learning strategy. Written comments from 41 participants identified 'experience' as the primary theme., Conclusion: SBE had a significant positive effect on student self-efficacy in the physiotherapy assessment and management of paediatric patients. Students also perceived SBE to be a valuable learning experience. Future research is needed to investigate whether the improvement in self-efficacy achieved through SBE translates into improved student performance during workplace-based clinical placements.

Context/Objective Autonomic dysreflexia is a clinical syndrome affecting persons with spinal cord lesions. The aim of the study was to detect the level of knowledge among students about autonomic dysreflexia in persons with spinal cord lesions. Design: Single centre questionnaire study. Setting: Faculty of Health Studies, Rijeka, Croatia. Participants Nursing (n = 43) and physiotherapy (n = 48) students. Outcome Measures: AD knowledge test. Results: More of the half of the students (57%) had contact with persons with spinal cord lesions during work, especially nursing students. The self-estimated knowledge of autonomic dysreflexia was judged as poor or none in 73.6% of students. On the autonomic dysreflexia knowledge test, nursing students collected mean of 5.6 points and physiotherapy students 4.9 points (P = 0.173). There was no difference in the autonomic dysreflexia test results regardless of work experience or group affiliation. Conclusion: The level of knowledge about autonomic dysreflexia among students was low. Our results suggest the need for more education of students and health care professionals to apply adequate treatment to persons with episodes of autonomic dysreflexia.

Background: Behaviour can be defined as the internally coordinated responses (actions or inactions) of whole living organisms (individuals or groups) to internal and/or external stimuli, excluding responses more easily understood as developmental changes. Unlike personality traits, that are thought to be biologically consistent, behaviour, through the application of cognition and reasoning is open to change across time and circumstance, although most humans will display preferred ways of behaving. The objective of this study was to: i) identify the behaviour styles of physiotherapy students and investigate if there is a relationship (predictive or otherwise) between students' unique behaviour patterns and their clinical placement grades and; ii) examine if this relationship differs when student's in a Master's level program as well as student's in a Bachelor's level program are explored separately., Methods: This cross-sectional study with 132 (F = 78, M = 54) physiotherapy students was conducted across two Australian university settings. Measures included Everything DiSC Workplace profile, Assessment of Physiotherapy Practice (APP)., Results: Physiotherapy students (n = 133) profiled the following ways: Dominance (D) style n = 20 (15%), Influence (i) style n = 33 (25%), Steadiness (S) style n = 36 (27%) and Conscientiousness (C) n = 44 (33%). Students with the individual DiSC styles of i and Conscientiousness / Steadiness (CS) were in the lowest APP quartile for clinical grades and the D style was in the highest quartile. Binary logistic regressions revealed students with an i DiSC style had 3.96 times higher odds, and students with a CS DiSC style had 4.34 times higher odds, of failing a clinical placement. When explored independently, the same trend remained for Master's level students. Bachelor's level students with DiSC styles of S and C had failed placements, however these styles were not significantly associated with failure (DiSC S Style: Exp(B) 1.667, p = 0.713 (CI: 0.109 to 25.433), DiSC C Style: Exp(B) 11.00, p = 0.097 (CI: 0.646 to 187.166))., Conclusion: Physiotherapy students with DiSC styles i and CS appear to be more likely to fail physiotherapy clinical placements. Further research with larger undergraduate samples is required to establish if relations differ for undergraduate versus postgraduate students.

Background: Adequate pain education of health professionals is fundamental in the management of pain. Although an interprofessional consensus of core competencies for health professional pre-licensure education in pain have been established, the degree of their incorporation into physical therapy curriculum varies greatly. The purpose of this study was to 1. Assess students' pain knowledge and their attitudes and beliefs in a pre-licensure physical therapy curriculum using a cross sectional comparison, and 2. Using a sub-sample of this population, we evaluated if an elective course on pain based on International Association for the Study of Pain (IASP) guidelines had an effect on students' knowledge and beliefs., Methods: The Neurophysiology of Pain Questionnaire (NPQ) and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) was completed by first semester (n = 72) and final (n = 56) semester doctor of physical therapy (DPT) students. Final semester students completed surveys before and after participation in an elective course of their choosing (pain elective (PE) or other electives (OE))., Results: Participation rate was > 90% (n = 128/140). We found mean differences in NPQ scores between final semester (3rd year) students (76.9%) compared to first semester students (64%), p < 0.001. Third year students showed a mean difference on PABS-PT subscales, showing decreased biomedical (p < 0.001) and increased biopsychosocial (p = 0.005) scores compared to first semester students. Only final semester students that participated in the PE improved their NPQ scores (from 79 to 86%, p < 0.001) and demonstrated a significant change in the expected direction on PABS-PT subscales with increased biopsychosocial (p = 0.003) and decreased biological scores (p < 0.001)., Conclusions: We suggest that although core pre-licensure DPT education improves students' pain knowledge and changes their attitudes towards pain, taking a IASP based pain elective continues to improve their pain neurobiology knowledge and also further changes their attitudes and beliefs towards pain. Therefore, a stand-alone course on pain in addition to pain concepts threaded throughout the curriculum may help ensure that entry-level DPT students are better prepared to effectively work with patients with pain.

Background: The purpose of the study was to describe the design, implementation and evaluation of a flipped classroom teaching approach in physiotherapy education. The flipped classroom is a blended learning approach in which students receive digital lectures as homework, while active learning activities are used in the classroom. Flipped classroom teaching enables a learning environment that aims to develop higher-order cognitive skills., Methods: The study design was a historically controlled, prospective, cohort study. An eight week theoretical course on musculoskeletal disorders was redesigned, moving from a conventional approach to a flipped classroom model. Pre-class learning material consisted of about 12 h of video lectures and other digital learning resources that were split up over the duration of the course. In-class activities consisted of seven full-day seminars where students worked in groups in order to solve problem-based assignments. The assignments were designed to reflect authentic clinical problems and required critical thinking and reasoning. Outcomes were measured with course-grades and compared with historical controls of conventional teaching, using descriptive statistics. Self-perceived learning outcomes and students' experiences were also collected in a survey., Results: Fifty-one students passed the course exam, two failed and one did not attend (n = 54). The share of students with Excellent, Very good and Good (ABC) performances increased by more than 10% relative to any previous year. In addition, Satisfactory, Sufficient and Failed performances (DEF) decreased by more than 10%. Almost two thirds of the students preferred the flipped classroom approach as compared with conventional teaching. Interaction with peers and educators, and flexibility, were the most positive factors that were reported by students. Long seminars, time-constraints and low motivation with respect to preparation and educators' roles were the most common complaints., Conclusions: A flipped classroom approach in physiotherapy education resulted in improved student performances in this professional programme, when compared with conventional teaching. Students responded positively to the collaborative learning environment, especially with respect to the associated autonomy and flexibility. There were indicators that all groups did not work optimally and that accountability to other group members did not always ensure pre-classroom preparations.

Background: Low back pain (LBP) is a public health concern because it is highly prevalent and the leading cause of disability worldwide. Psychologically informed physical therapy (PIPT) is a secondary prevention approach that first aims to identify individuals at high risk for transitioning to chronicity and then provides tailored treatment to reduce that risk. Training models that are feasible to implement with acceptable training quality are needed to improve scalability for widespread implementation of PIPT. This manuscript describes the PIPT training program that was developed for training physical therapists providing PIPT in the TARGET trial., Methods: The PIPT training program was developed, tested, and modified using an iterative process. Content development consisted of stakeholder engagement, beta testing, modification of training, and confirmation of final course objectives. Methods of delivery consisted of a website that included brief online educational modules followed by a live 8-h workshop that included video-based mock case scenarios and case-based role playing. Attitudes, beliefs, and confidence in implementing PIPT principles were assessed before and immediately after training to measure training quality and impact., Results: Early stakeholder engagement and beta testing indicated the need for increased emphasis on experiential learning opportunities and patient-centered communication training. Booster training varied extensively across TARGET sites with involvement of 'clinician champions' providing brief follow-up sessions identified as best practice. Favorable post-training changes in physical therapist attitudes and beliefs toward biopsychosocial treatment orientation and increased confidence in implementing PIPT principles were observed., Conclusions: PIPT training for provider participation in the TARGET trial was feasible to deliver. Course content was acceptable to physical therapists and resulted in improved beliefs and confidence in applying PIPT skills during clinical practice. Ongoing consultation and site-based continuing education were methods by which specific TARGET sites maintained or augmented PIPT skill training; however, implementing ongoing training was challenging in general. Due to the pragmatic nature of the TARGET trial, it was not possible to directly measure the effect of PIPT training on treatment fidelity, which was a limitation of our approach., Trial Registration: ClinicalTrials.gov, NCT02647658 . Registered on 6 January 2016.