ObjectiveTo measure confidence and attitudes of the current and emerging interprofessional workfo... more ObjectiveTo measure confidence and attitudes of the current and emerging interprofessional workforce concerning osteoarthritis (OA) care.MethodsStudy design is a multinational (Australia, New Zealand, Canada) cross‐sectional survey of clinicians (general practitioners [GPs], GP registrars, primary care nurses, and physiotherapists) and final‐year medical and physiotherapy students. GPs and GP registrars were only sampled in Australia/New Zealand and Australia, respectively. The study outcomes are as follows: confidence in OA knowledge and skills (customized instrument), biomedical attitudes to care (Pain Attitudes Beliefs Scale [PABS]), attitudes toward high‐ and low‐value care (customized items), attitudes toward exercise/physical activity (free‐text responses).ResultsA total of 1886 clinicians and 1161 students responded. Although a number of interprofessional differences were identified, confidence in OA knowledge and skills was consistently greatest among physiotherapists and lo...
1,2 2 1 Andrew Briggs, John Wark, Susan Kantor, Nicola Fazzalari, Alison Greig, Tim Wrigley and K... more 1,2 2 1 Andrew Briggs, John Wark, Susan Kantor, Nicola Fazzalari, Alison Greig, Tim Wrigley and Kim Bennell Centre for Health, Exercise and Sports Medicine, School of Physiotherapy, University of Melbourne, Australia. Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Australia. Institute of Medical and Veterinary Science, South Australia email: a.briggs3@pgrad.unimelb.edu.au , web: www.physioth.unimelb.edu.au/chesm/
Given their enormous socioeconomic burdens, lifestyle-related non-communicable diseases (heart di... more Given their enormous socioeconomic burdens, lifestyle-related non-communicable diseases (heart disease, cancer, chronic lung disease, hypertension, stroke, type 2 diabetes and obesity) have become priorities for the World Health Organization and health service delivery systems. Health systems have been criticized for relative inattention to the gap between knowledge and practice, related to preventing and managing non-communicable diseases. Physical therapy is one profession that can contribute effectively to patients'/clients' lifestyle change at the upstream end of their prevention and management. Efforts by entry-to-practice physical therapy education programs to align curricula with epidemiological trends towards health practice are varied. One explanation may be lack of a frame of reference to reduce this knowledge translation gap. The purpose of this article is to provide a current perspective on epidemiological indicators and societal priorities to inform physical the...
Interprofessional teams provide the promise of effective, comprehensive and reliable care. Interp... more Interprofessional teams provide the promise of effective, comprehensive and reliable care. Interprofessional education (IPE) promotes students' knowledge and attitudes to support interprofessional teamwork, and problem-based learning formats enable students to gain valuable teamwork experience. To design, implement, and evaluate an interprofessional problem-based learning module in a large Canadian university focusing on the effects of this format on students' knowledge, attitudes, and perceptions. A pre-post mixed-methods research design was used, with a convenience sample of 24 students from medicine, pharmacy, nursing, physical therapy, and occupational therapy. Participants in the module were divided into 5 teams composed of one member from each…
Evidence-informed healthcare (EIHC) is a systematic approach to clinical problem solving that fac... more Evidence-informed healthcare (EIHC) is a systematic approach to clinical problem solving that facilitates the integration of the best available research evidence with clinical expertise and our patient’s unique values and circumstances.1 To become an EIHC practitioner requires knowledge, skills and practice. The five-step model of EIHC (asking answerable clinical questions, acquiring the evidence, appraising the evidence, applying the evidence and assessing performance as an EIHC practitioner) forms the basis for both teaching EIHC and clinical practice.2 Despite many EIHC success stories, variation in the adoption of evidence-based practice remains a problem.3 Barriers to implementing EIHC are well documented, with lack of resources being the most common barrier,4 followed by lack of knowledge and skills about appraisal, negative perceptions about research, lack of resources and time, low self-efficacy, inadequate access to the literature and financial barriers.4 5 Some of these barriers are directly related to the steps of EIHC, indicating that there is a clear need to improve the teaching of EIHC across all professions. Interventions using multiple methods are most likely to improve knowledge and skills compared with single interventions or no interventions,6 with the most effective teaching strategies being those that are interactive and clinically integrated.7 Online learning with high levels of interactivity is increasingly used as a learning intervention8 and is as effective a strategy as lecture-based teaching.9 Online learning has the added advantage of providing learner-centred access to course materials at a time and place convenient to them and to tailor their learning to their own timing, pace and needs.8 Virtual patient cases are designed to represent real-life clinical scenarios and are well suited for facilitating the development of clinical reasoning skills,10 an essential element of EIHC. Cases designed using a problem-oriented training approach increase the …
Given their enormous socioeconomic burdens, lifestyle-related non-communicable diseases (heart di... more Given their enormous socioeconomic burdens, lifestyle-related non-communicable diseases (heart disease, cancer, chronic lung disease, hypertension, stroke, type 2 diabetes and obesity) have become priorities for the World Health Organization and health service delivery systems. Health systems have been criticized for relative inattention to the gap between knowledge and practice, related to preventing and managing non-communicable diseases. Physical therapy is one profession that can contribute effectively to patients'/clients' lifestyle change at the upstream end of their prevention and management. Efforts by entry-to-practice physical therapy education programs to align curricula with epidemiological trends towards health practice are varied. One explanation may be lack of a frame of reference to reduce this knowledge translation gap. The purpose of this article is to provide a current perspective on epidemiological indicators and societal priorities to inform physical the...
Http Dx Doi Org 10 1080 00140130410001663569, Feb 20, 2007
The objective of this study was to quantitatively analyse the sitting posture of school children ... more The objective of this study was to quantitatively analyse the sitting posture of school children interacting with both old (book) and new (laptop and desktop computers) information technologies to test the hypothesis that posture is effected by the type of information technology (IT) used. A mixed model design was used to test the effect of IT type (within subjects) and age and gender (between subjects). The sitting posture of 32 children aged 4-17 years was measured whilst they read from a book, laptop, and desktop computer at a standard school chair and desk. Video images were captured and then digitized to calculate mean angles for head tilt, neck flexion, trunk flexion, and gaze angle. Posture was found to be influenced by IT type (p < 0.001), age (p < 0.001) and gender (p = 0.024) and significantly correlated to the stature of the participants. Measurement of resting posture and the maximal range of motion of the upper and lower cervical spines in the sagittal plane was also undertaken. The biophysical impact and the suitability of the three different information technologies are discussed.
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2007
Balance impairments have been identified in people with osteoporosis. Although an association bet... more Balance impairments have been identified in people with osteoporosis. Although an association between thoracic kyphosis and impaired balance has been reported, the specific role of vertebral fractures has not been considered. This study aimed to investigate the independent effects of osteoporotic vertebral fracture and thoracic kyphosis on balance characteristics in an osteoporotic population. Twenty-two individuals with osteoporosis were divided into groups with (n=10) and without (n=12) radiologically diagnosed fracture, and into groups with low (n=11) and high (n=11) thoracic kyphosis. Force-plate-derived balance parameters were recorded during three static standing tasks of 70-s duration. Balance measures were compared between fracture and kyphosis groups, and significant differences were further explored through subgroup analyses, to tease out the relationships between confounded independent variables (fracture and kyphosis) and balance measures. In the anterior-posterior direc...
st tr ra ac ct t Background: The aetiology of osteoporotic vertebral fracture is multifactorial a... more st tr ra ac ct t Background: The aetiology of osteoporotic vertebral fracture is multifactorial and may be conceptualised using a systems framework. Previous studies have established several correlates of vertebral fracture including reduced vertebral cross-sectional area, weakness in back extensor muscles, reduced bone mineral density, increasing age, worsening kyphosis and recent vertebral fracture. Alterations in these physical characteristics may
Evidence suggests there is increasing use of computers by children and poor workstation designs f... more Evidence suggests there is increasing use of computers by children and poor workstation designs for children. This laboratory study investigated the effect of adjusting computer display height and desk height on upper quadrant posture and muscle activity. Thirty three children aged 4-17 years worked on a desktop computer at a standard school workstation and at a workstation adjusted to the individual, typically consisting of a lower display and desk height. The adjustments resulted in increased head tilt, neck flexion, gaze angle, cervical erector spinae activity and a trend for lower right upper trapezius activity. The recent evidence that suggests more head and neck flexion is not necessarily worse is discussed and normative values for children's head tilt and neck flexion presented. The role of forearm support in decreasing trapezius activity is also discussed.
This study explored inter-relationships between vertebral fracture, thoracic kyphosis and trunk m... more This study explored inter-relationships between vertebral fracture, thoracic kyphosis and trunk muscle control in elderly people with osteoporosis. Osteoporotic vertebral fractures are associated with increased risk of further vertebral fractures; but underlying mechanisms remain unclear. Several factors may explain this association, including changes in postural alignment (thoracic kyphosis) and altered trunk muscle contraction patterns. Both factors may increase risk of further fracture because of increased vertebral loading and impaired balance, which may increase falls risk. This study compared postural adjustments in 24 individuals with osteoporosis with and without vertebral fracture and with varying degrees of thoracic kyphosis. Trunk muscle electromyographic activity (EMG) associated with voluntary arm movements was recorded and compared between individuals with and without vertebral fracture, and between those with low and high thoracic kyphosis. Overall, elderly participan...
ObjectiveTo measure confidence and attitudes of the current and emerging interprofessional workfo... more ObjectiveTo measure confidence and attitudes of the current and emerging interprofessional workforce concerning osteoarthritis (OA) care.MethodsStudy design is a multinational (Australia, New Zealand, Canada) cross‐sectional survey of clinicians (general practitioners [GPs], GP registrars, primary care nurses, and physiotherapists) and final‐year medical and physiotherapy students. GPs and GP registrars were only sampled in Australia/New Zealand and Australia, respectively. The study outcomes are as follows: confidence in OA knowledge and skills (customized instrument), biomedical attitudes to care (Pain Attitudes Beliefs Scale [PABS]), attitudes toward high‐ and low‐value care (customized items), attitudes toward exercise/physical activity (free‐text responses).ResultsA total of 1886 clinicians and 1161 students responded. Although a number of interprofessional differences were identified, confidence in OA knowledge and skills was consistently greatest among physiotherapists and lo...
1,2 2 1 Andrew Briggs, John Wark, Susan Kantor, Nicola Fazzalari, Alison Greig, Tim Wrigley and K... more 1,2 2 1 Andrew Briggs, John Wark, Susan Kantor, Nicola Fazzalari, Alison Greig, Tim Wrigley and Kim Bennell Centre for Health, Exercise and Sports Medicine, School of Physiotherapy, University of Melbourne, Australia. Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Australia. Institute of Medical and Veterinary Science, South Australia email: a.briggs3@pgrad.unimelb.edu.au , web: www.physioth.unimelb.edu.au/chesm/
Given their enormous socioeconomic burdens, lifestyle-related non-communicable diseases (heart di... more Given their enormous socioeconomic burdens, lifestyle-related non-communicable diseases (heart disease, cancer, chronic lung disease, hypertension, stroke, type 2 diabetes and obesity) have become priorities for the World Health Organization and health service delivery systems. Health systems have been criticized for relative inattention to the gap between knowledge and practice, related to preventing and managing non-communicable diseases. Physical therapy is one profession that can contribute effectively to patients'/clients' lifestyle change at the upstream end of their prevention and management. Efforts by entry-to-practice physical therapy education programs to align curricula with epidemiological trends towards health practice are varied. One explanation may be lack of a frame of reference to reduce this knowledge translation gap. The purpose of this article is to provide a current perspective on epidemiological indicators and societal priorities to inform physical the...
Interprofessional teams provide the promise of effective, comprehensive and reliable care. Interp... more Interprofessional teams provide the promise of effective, comprehensive and reliable care. Interprofessional education (IPE) promotes students' knowledge and attitudes to support interprofessional teamwork, and problem-based learning formats enable students to gain valuable teamwork experience. To design, implement, and evaluate an interprofessional problem-based learning module in a large Canadian university focusing on the effects of this format on students' knowledge, attitudes, and perceptions. A pre-post mixed-methods research design was used, with a convenience sample of 24 students from medicine, pharmacy, nursing, physical therapy, and occupational therapy. Participants in the module were divided into 5 teams composed of one member from each…
Evidence-informed healthcare (EIHC) is a systematic approach to clinical problem solving that fac... more Evidence-informed healthcare (EIHC) is a systematic approach to clinical problem solving that facilitates the integration of the best available research evidence with clinical expertise and our patient’s unique values and circumstances.1 To become an EIHC practitioner requires knowledge, skills and practice. The five-step model of EIHC (asking answerable clinical questions, acquiring the evidence, appraising the evidence, applying the evidence and assessing performance as an EIHC practitioner) forms the basis for both teaching EIHC and clinical practice.2 Despite many EIHC success stories, variation in the adoption of evidence-based practice remains a problem.3 Barriers to implementing EIHC are well documented, with lack of resources being the most common barrier,4 followed by lack of knowledge and skills about appraisal, negative perceptions about research, lack of resources and time, low self-efficacy, inadequate access to the literature and financial barriers.4 5 Some of these barriers are directly related to the steps of EIHC, indicating that there is a clear need to improve the teaching of EIHC across all professions. Interventions using multiple methods are most likely to improve knowledge and skills compared with single interventions or no interventions,6 with the most effective teaching strategies being those that are interactive and clinically integrated.7 Online learning with high levels of interactivity is increasingly used as a learning intervention8 and is as effective a strategy as lecture-based teaching.9 Online learning has the added advantage of providing learner-centred access to course materials at a time and place convenient to them and to tailor their learning to their own timing, pace and needs.8 Virtual patient cases are designed to represent real-life clinical scenarios and are well suited for facilitating the development of clinical reasoning skills,10 an essential element of EIHC. Cases designed using a problem-oriented training approach increase the …
Given their enormous socioeconomic burdens, lifestyle-related non-communicable diseases (heart di... more Given their enormous socioeconomic burdens, lifestyle-related non-communicable diseases (heart disease, cancer, chronic lung disease, hypertension, stroke, type 2 diabetes and obesity) have become priorities for the World Health Organization and health service delivery systems. Health systems have been criticized for relative inattention to the gap between knowledge and practice, related to preventing and managing non-communicable diseases. Physical therapy is one profession that can contribute effectively to patients'/clients' lifestyle change at the upstream end of their prevention and management. Efforts by entry-to-practice physical therapy education programs to align curricula with epidemiological trends towards health practice are varied. One explanation may be lack of a frame of reference to reduce this knowledge translation gap. The purpose of this article is to provide a current perspective on epidemiological indicators and societal priorities to inform physical the...
Http Dx Doi Org 10 1080 00140130410001663569, Feb 20, 2007
The objective of this study was to quantitatively analyse the sitting posture of school children ... more The objective of this study was to quantitatively analyse the sitting posture of school children interacting with both old (book) and new (laptop and desktop computers) information technologies to test the hypothesis that posture is effected by the type of information technology (IT) used. A mixed model design was used to test the effect of IT type (within subjects) and age and gender (between subjects). The sitting posture of 32 children aged 4-17 years was measured whilst they read from a book, laptop, and desktop computer at a standard school chair and desk. Video images were captured and then digitized to calculate mean angles for head tilt, neck flexion, trunk flexion, and gaze angle. Posture was found to be influenced by IT type (p < 0.001), age (p < 0.001) and gender (p = 0.024) and significantly correlated to the stature of the participants. Measurement of resting posture and the maximal range of motion of the upper and lower cervical spines in the sagittal plane was also undertaken. The biophysical impact and the suitability of the three different information technologies are discussed.
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2007
Balance impairments have been identified in people with osteoporosis. Although an association bet... more Balance impairments have been identified in people with osteoporosis. Although an association between thoracic kyphosis and impaired balance has been reported, the specific role of vertebral fractures has not been considered. This study aimed to investigate the independent effects of osteoporotic vertebral fracture and thoracic kyphosis on balance characteristics in an osteoporotic population. Twenty-two individuals with osteoporosis were divided into groups with (n=10) and without (n=12) radiologically diagnosed fracture, and into groups with low (n=11) and high (n=11) thoracic kyphosis. Force-plate-derived balance parameters were recorded during three static standing tasks of 70-s duration. Balance measures were compared between fracture and kyphosis groups, and significant differences were further explored through subgroup analyses, to tease out the relationships between confounded independent variables (fracture and kyphosis) and balance measures. In the anterior-posterior direc...
st tr ra ac ct t Background: The aetiology of osteoporotic vertebral fracture is multifactorial a... more st tr ra ac ct t Background: The aetiology of osteoporotic vertebral fracture is multifactorial and may be conceptualised using a systems framework. Previous studies have established several correlates of vertebral fracture including reduced vertebral cross-sectional area, weakness in back extensor muscles, reduced bone mineral density, increasing age, worsening kyphosis and recent vertebral fracture. Alterations in these physical characteristics may
Evidence suggests there is increasing use of computers by children and poor workstation designs f... more Evidence suggests there is increasing use of computers by children and poor workstation designs for children. This laboratory study investigated the effect of adjusting computer display height and desk height on upper quadrant posture and muscle activity. Thirty three children aged 4-17 years worked on a desktop computer at a standard school workstation and at a workstation adjusted to the individual, typically consisting of a lower display and desk height. The adjustments resulted in increased head tilt, neck flexion, gaze angle, cervical erector spinae activity and a trend for lower right upper trapezius activity. The recent evidence that suggests more head and neck flexion is not necessarily worse is discussed and normative values for children's head tilt and neck flexion presented. The role of forearm support in decreasing trapezius activity is also discussed.
This study explored inter-relationships between vertebral fracture, thoracic kyphosis and trunk m... more This study explored inter-relationships between vertebral fracture, thoracic kyphosis and trunk muscle control in elderly people with osteoporosis. Osteoporotic vertebral fractures are associated with increased risk of further vertebral fractures; but underlying mechanisms remain unclear. Several factors may explain this association, including changes in postural alignment (thoracic kyphosis) and altered trunk muscle contraction patterns. Both factors may increase risk of further fracture because of increased vertebral loading and impaired balance, which may increase falls risk. This study compared postural adjustments in 24 individuals with osteoporosis with and without vertebral fracture and with varying degrees of thoracic kyphosis. Trunk muscle electromyographic activity (EMG) associated with voluntary arm movements was recorded and compared between individuals with and without vertebral fracture, and between those with low and high thoracic kyphosis. Overall, elderly participan...
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