Physiotherapy Conference Papers

What is the relevance of reflective practice in undergraduate e-portfolios to professional work practices?

Joanne Connaughton et al. — Tue, 13 Nov 2012 17:15:07 PST

Reflective practice is a graduate attribute that is typically difficult to assess and measure. Universities are increasingly turning to digital technology as a medium to support reflective skills. This is particularly relevant to undergraduate courses that incorporate professional field placements where students are off campus, including health professional courses. The aim of this study was to determine the relevance of reflective practice in undergraduate e-portfolios to current work practices of new graduate physiotherapists. Graduates (n=6) took part in a focus group which guided the development of a questionnaire sent to all 2010 physiotherapy graduates, addressing the use of e-portfolios and their impact on transition into the workforce. 42% (n=25) of graduates completed the questionnaire. The use of a structured framework for reflections, within the online medium, assisted to promote reflective practice. Graduates felt that they were more automatic in their reflections and resultant work practices, as a result of utilising assessed undergraduate e-portfolios. The future challenge for educators is to balance context, assessment and delivery of reflective practice tasks. E-portfolios are one medium that may assist with the development of reflective practice skills beyond graduation.

Treatment-based classification of low back pain – who are the unclear classifications?

T R. Stanton et al. — Thu, 01 Nov 2012 21:56:19 PDT

A recent focus in low back pain research has been to identify patient subgroups that respond best to certain treatments. To integrate these subgroup findings into a useable form, a treatment-based classification algorithm for LBP was created.^1,2 To allow the algorithm to be comprehensive – eg, provide a classification for all patients – additional criteria are provided to assist therapists’ decisions for patients who do not clearly meet a treatment subgroup (unclear classifications).

Recent research found that approximately 34% of patients will receive unclear classifications using the algorithm.³ It has also been shown that the reliability of the classification decision for unclear classifications is poor – significant variability between raters exists.³ In addition to poor reliability, outcomes for patients receiving unclear classifications may be inferior to outcomes of those receiving clear classifications.⁴ Thus the aim of the present study was to determine if people receiving unclear classifications are different from those with clear classifications in the hopes to refine the classification algorithm.

Functional changes in the primary somatosensory cortex in complex regional pain syndrome (CRPS): A systematic review

Flavia Di Pietro et al. — Mon, 03 Sep 2012 01:07:28 PDT

The brain plays a key role in CRPS. A widely-studied brain region in pain research is the primary somatosensory cortex (S1), a somatotopic map of our body’s surface which functionally reorganises in pain [1]. Changes in the S1 representation of the CRPS-affected body part have contributed to new CRPS treatments, e.g. graded motor imagery. This systematic review and meta-analysis aimed to determine whether CRPS is associated with: a) a change in the size of the S1 representation of the affected body part; b) altered S1 activity, in terms of activation levels and latency of responses.

Moving in an environment of induced sensory-motor incongruence does not influence pain sensitivity in healthy volunteers: A randomised within-subject cross-over experiment

Benedict M. Wand et al. — Mon, 03 Sep 2012 00:39:17 PDT

A mismatch between the brain's motor control and sensory systems has been suggested as one mechanism whereby maladaptive neuroplastic changes contribute to the experience of chronic pain. Several studies have investigated this hypothesis by artificially inducing a state of sensory-motor incongruence using mirrors. The data to date appear to suggest that creating an environment of sensori-motor incongruence induces various sensory changes and feeling of peculiarity, however the effect on pain is less clear. The aim of this study was to test the hypothesis that healthy participants would demonstrate reduced pain thresholds and report greater intensity of pain in a condition of induced sensory motor incongruence compared to conditions that did not promote incongruence.

Chronic Lower Back Pain: A Maladaptive Perceptions Model

Benedict M. Wand — Mon, 03 Sep 2012 00:03:21 PDT

High quality evidence suggests that current approaches to the management of CLBP show only limited effectiveness; one explanation of this finding is that current models of management are misdirected or incomplete. This talk proposes a model of CLBP underpinned by data on the psychological contributors to the LBP experience and recent evidence of neuroplastic changes in the brains of people with CLBP (see below). The model suggests that maladaptive cognitive perception about the nature of the back problem and future consequences drive behaviours that might bring about maladaptive neuroplastic changes. These central nervous system changes may enhance sensitivity, influence normal attentional processing and potentially create a state of maladaptive self perception of the back, in terms of how the back feels to the individual, the control they feel they have over their back and the meaning of sensory information from the back. Maladaptive cognitive perception and maladaptive self perception are potentially mutually reinforcing and contribute to the maintenance of the CLBP experience. Identification of these issues in the clinical setting and the implications of this model to the rehabilitation of people with CLBP will also be discussed.

Evidencing reflective practice with e-portfolios

Jo Connaughton et al. — Sun, 25 Mar 2012 23:03:49 PDT

Reflective practice is recognised as a graduate attribute in tertiary level health professional and education courses. Reflective practice has been defined as an ‘intentional and skilled activity in which a person analyses and describes his or her thoughts, actions, feelings, and behaviours and makes judgements about their effectiveness’ (Australian Physiotherapy Council, 2006).

To begin to master the skill of reflective practice, physiotherapy students from the university complete reflective journals whilst on clinical placement. Journals are commenced in first year during pre-clinical hours and then during formal clinical placements in second, third and fourth year. In 2009, students commenced writing their journals in blog format. A framework for reflective practice was developed (Connaughton & Edgar, 2011) to assist students with structuring their thoughts.

Finding ways to facilitate student learning in practical laboratories

Jacqui Francis-Coad — Sun, 25 Mar 2012 22:46:34 PDT

No Abstract available

A better practice idea to maximise resident participation and functional performance in a low care residential facility

Jacqui Francis-Coad — Sun, 25 Mar 2012 21:58:28 PDT

Providing interventions for elderly individuals that engage participation in a timely and economic way is a challenge facing physiotherapists working in low care residential facilities. On assessment, many present with common impairments that impact on their functional performance; these could be individually targeted using a circuit group format. This paper reports on a 10-station circuit exercise program designed by the physiotherapist to improve functional performance as measured by the timed up and go test. The intervention was performed twice weekly over a three month period. Eighteen residents provided pre and post intervention measures and the results showed a trend of improvement with minimal attrition. Residents also provided qualitative feedback through self report, quotes included ‘this makes me feel young again’ and ‘I look forward to the circuit club, its good fun’. Following an Aged Care Standards and Accreditation Agency facility audit the program received a better practice commendation and is easily replicable in similar settings.

Patient satisfaction with musculoskeletal physiotherapy care in Australia is high

Vivian Yung et al. — Thu, 30 Jun 2011 21:32:32 PDT

Patient satisfaction is an important outcome of care and is intrinsically valuable to clinicians. The level of patient satisfaction with musculoskeletal physiotherapy care in Australia is unknown. Increased understanding of patient satisfaction will benefit patients by facilitating clinicians to optimise clinical service delivery.

What factors determine patient satisfaction with musculoskeletal physiotherapy care in Australia?

Julia Hush et al. — Thu, 30 Jun 2011 21:17:24 PDT

Patient satisfaction is an important patient-focussed indicator of the quality of physiotherapy care. We have completed an evaluation of patient satisfaction with musculoskeletal physiotherapy in Australia using the 20-item MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care (MRPS). In this paper we report on factors that influence patient satisfaction in this cultural context.

Treating chronic nonspecific low back pain with a sensorimotor retraining approach: An exploratory multiple-baseline study of 3 participants

Benedict M. Wand et al. — Thu, 30 Jun 2011 21:05:00 PDT

Chronic nonspecific low back pain (CNSLBP) is a common healthcare problem for which current interventions are only moderately successful [1]. There is growing evidence of extensive cortical reorganisation and perceptual disturbances which may contribute to the condition [2]. The aim of this study was to test whether a graded sensorimotor retraining program, aimed at influencing cortical representation, would reduce pain intensity, interference of pain on daily life and self reported disability.

Tactile thresholds are preserved yet complex sensory function is impaired over the lumbar spine of chronic non-specific low back pain patients: A preliminary investigation

Benedict M. Wand et al. — Thu, 30 Jun 2011 20:12:41 PDT

Evidence indicates that chronic non-specific low back pain (CNSLBP) is associated with alteration in the brain’s cortical representation of the back, resulting in body perception disturbance and contributing to the condition [1,2]. This study investigated perception via ‘cortical’ sensory tests, in this case two-point discrimination and graphaesthesia—whose results partly depend on the integrity of cortical representation [2]. The hypothesis was dysfunction in these higher-order tasks, with simple tactile thresholds remaining unchanged. Furthermore a relationship between cortical sensation and severity of the condition was predicted.

Transcranial direct current stimulation of the motor cortex in the treatment of chronic non-specific low back pain. A randomised, double-blind exploratory study

Neil E. O'Connell et al. — Thu, 30 Jun 2011 19:23:28 PDT

This exploratory study aimed to test the proof of principle that active anodal transcranial direct current stimulation (tDCS) applied to the motor cortex reduces pain significantly more than sham stimulation in a group of participants with chronic non-specific low back pain.

Non-invasive brain stimulation techniques for chronic pain. A Cochrane systematic review and meta-analysis

Neil E. O'Connell et al. — Thu, 30 Jun 2011 19:04:16 PDT

Poster Presentation

Non-invasive brain stimulation techniques aim to induce an electrical stimulation of the brain in an attempt to reduce chronic pain by directly altering brain activity. They include repetitive transcranial magnetic stimulation (rTMS), cranial electrotherapy stimulation (CES) and transcranial direct current stimulation (tDCS). These approaches to pain treatment are relatively novel. It is important to assess the existing literature robustly to ascertain the current level of supporting evidence and to inform future research and potential clinical use.

Evaluation of a treatment-based classification algorithm for low back pain

Tasha R. Stanton et al. — Thu, 30 Jun 2011 18:38:10 PDT

Poster Presentation

Theme: How can we better translate evidence into clinical practice?

Background: Several studies have investigated criteria for classifying patients with low back pain into treatment-based subgroups. A comprehensive algorithm was recently created to translate these criteria into a clinical decision-making guide. This study investigated the translation of the individual subgroup criteria into a comprehensive algorithm by studying the prevalence of patients meeting each treatment subgroup, more than one treatment subgroup, and none of the treatment subgroups. The reliability of the classification decision was also investigated.