BACKGROUND: Physiotherapy workforce shortages in rural Australia limit the profession's ability to meet community needs, resulting in the rationing of services. Recent research on recruitment and retention has primarily...BACKGROUND: Physiotherapy workforce shortages in rural Australia limit the profession's ability to meet community needs, resulting in the rationing of services. Recent research on recruitment and retention has primarily focused on medicine, nursing and allied health as a collective, leaving physiotherapy-specific factors underexplored. OBJECTIVES: To investigate what factors are perceived to influence the recruitment and retention of physiotherapists in rural Victoria, Australia. DESIGN: Qualitative design using in-depth semi-structured interviews, analysed using reflexive thematic analysis. PARTICIPANTS: Fifteen participants currently working in the Hume region of Victoria, including physiotherapists, their employers, and managers. RESULTS: Three themes were identified as key influences on recruitment and retention in Victoria's rural physiotherapy workforce. The first theme, 'a chronically stressed and tired workforce', reflected participants' perceptions of how persistent shortages perpetuate workforce instability, creating a vicious cycle. The second theme, 'the concrete clinical ceiling', highlighted limited career progression opportunities in rural areas, leading physiotherapists to seek opportunities in non-clinical roles. The third theme, 'unrecognised and undervalued', described how physiotherapists feel undervalued by the health system and society as clinicians. CONCLUSION: The findings highlight a vicious cycle in which poor retention increases recruitment needs, placing further strain on the existing workforce. Breaking this vicious cycle requires stronger pathways for vertical career progression in clinical practice, including formal recognition of specialist generalist physiotherapists. Supporting senior physiotherapists in supervising students and new graduates is also crucial for effective recruitment. These targeted, discipline-specific strategies may help address the complex and interrelated issues impacting Australia's rural physiotherapy workforce. CONTRIBUTION OF THE PAPER.
OBJECTIVES: To investigate if the length of entry-level education has an impact on the professional autonomy of European physiotherapists, and how professional organisations collaborate with educational facilities to sha...OBJECTIVES: To investigate if the length of entry-level education has an impact on the professional autonomy of European physiotherapists, and how professional organisations collaborate with educational facilities to shape the entry-level curriculum? DESIGN AND PARTICIPANTS: Mixed methods study using a survey and semi-structured interviews to explore perspectives from 37 policy experts from 37 European countries. RESULTS: In Europe, the length of education required before attaining the title of 'physiotherapist' varies between countries (3, 3.5, 4 or 5 years). The current European framework allows for recognised entry-level physiotherapists with either a diploma, a Bachelor's degree or a Master's degree. Regardless of the length of entry-level education, 26 of 37 (70%) countries reported that professional autonomy is not legalised for physiotherapists. Most of these countries (58%) have an entry-level education that prepares the physiotherapist to be autonomous. Most professional organisations (23/37, 62%) reported structural collaboration to shape entry-level education. However, the professional organisations in nine of 23 (40%) countries reported that they have a minor level of influence on the curriculum. CONCLUSION: The length of entry-level education programmes, ranging from 3 to 5 years, is directly associated with the graduates' readiness to practice autonomously. These findings underscore the need for a more harmonised approach to physiotherapy education in Europe. There is a compelling need for ongoing feedback mechanisms between practising physiotherapists and educational institutions. This will ensure that the curriculum continuously integrates emerging evidence and real-world practice requirements, thereby enhancing employability and professional efficacy.
OBJECTIVE: High intensity interval training (HIIT) is recognised within many international cardiac rehabilitation (CR) guidelines. In the United Kingdom (UK), however, similar guidance does not exist; moderate intensity...OBJECTIVE: High intensity interval training (HIIT) is recognised within many international cardiac rehabilitation (CR) guidelines. In the United Kingdom (UK), however, similar guidance does not exist; moderate intensity training regimens have traditionally been advocated. The aim is to develop a pragmatic technical report for practitioners working in CR in order to implement low-volume HIIT programmes for people with coronary artery disease (CAD). METHODS: We describe patient inclusion and exclusion criteria, clinical and safety considerations, and practical implications to support the implementation of low volume HIIT in practice. Detailed methodology relating to low-volume HIIT using the 10 × 1 minutes model is provided, alongside exercise training progression criteria. RESULTS: We provide corresponding percentage heart rate reserve (%HRR) training thresholds which can be used to guide individualised exercise prescription. Key considerations for familiarisation, supervision, monitoring, recording, and reporting are also discussed, underpinned by an overview of the acute physiological response to the training modality. CONCLUSIONS: We anticipate that this pragmatic evidence-based technical report will support practitioners in implementing low-volume HIIT in routine clinical practice, thus, allowing it to be offered as standard-care alongside more traditional moderate intensity exercise training programmes.
INTRODUCTION: Chest physiotherapy is routinely provided to mechanically ventilated (MV) patients in intensive care units (ICUs) to aid secretion clearance. Physiotherapists may instil saline down the endotracheal tube to...INTRODUCTION: Chest physiotherapy is routinely provided to mechanically ventilated (MV) patients in intensive care units (ICUs) to aid secretion clearance. Physiotherapists may instil saline down the endotracheal tube to aid secretion clearance. However, there is limited evidence and no UK guidelines on the use of saline instillation (SI). OBJECTIVE: To evaluate the feasibility of a definitive trial examining the efficacy of SI during chest physiotherapy on secretion yield in patients with ventilator-acquired pneumonia (VAP). METHODS: A randomised crossover feasibility trial was performed on patients with VAP at a large UK ICU. Patients underwent twice daily chest physiotherapy sessions, alternating between SI vs. Non-SI for three days or until extubation. Primary outcomes were feasibility measures: recruitment, retention, and protocol fidelity. Secondary outcomes included safety outcomes and secretion yield, assessed using two approaches: "adjusted wet sputum weight" and "sputum pellet weight". RESULTS: Of 32 eligible patients, 94% (N = 30) were recruited, of whom 7% (N = 2) were subsequently withdrawn; 21 (70%) completed all six sessions. No adverse events occurred in SI sessions. The adjusted wet sputum weight appeared to underestimate secretion yield in SI sessions, resulting in a negative median value (-0.49 g; IQR: -2.39, 1.11), which was significantly lower than Non-SI sessions (median: 0.99 g; IQR: 0.26, 2.11; p < 0.001). Analysis using sputum pellet weight reversed the direction of this effect, with medians of 3.49 g (IQR: 1.96, 5.55) vs. 1.70 g (IQR: 0.99, 2.60) for SI vs. non-SI sessions (p < 0.001). CONCLUSION: A trial of SI during chest physiotherapy for MV patients with VAP would be feasible. However, further validation of a method for processing sputum samples is required before proceeding to a definitive trial. CONTRIBUTION OF THE PAPER.
Cancer patients face a significantly higher risk of cardiovascular diseases (CVD), with heart disease mortality rates exceeding those in the general population. Cardio-Oncology Rehabilitation (CORe) programs have emerged...Cancer patients face a significantly higher risk of cardiovascular diseases (CVD), with heart disease mortality rates exceeding those in the general population. Cardio-Oncology Rehabilitation (CORe) programs have emerged as a therapeutic tool, incorporating cardiovascular risk assessment, exercise training, and nutritional guidance. Despite evidence supporting the effectiveness of CORe programs in improving functional capacity, muscle mass, strength, and quality of life, their clinical implementation remains limited. CORe programs are designed similarly to traditional cardiac rehabilitation but tailored to meet the specific needs of cancer patients. They generally include three phases: inpatient (risk stratification and health education), outpatient (including supervised and/or telemonitored exercise), and maintenance (long-term support through collaboration with primary care providers and patient associations). Effective collaboration among medical doctors (e.g., cardiologists, oncologists) and physiotherapists is crucial. CORe programs offer effective strategies for managing and preventing CVD in cancer patients through a comprehensive approach to patient care. Ongoing research is essential to confirm their long-term benefits and support wider clinical implementation. CONTRIBUTION OF THE PAPER.
BACKGROUND: The content and quality of dementia guideline recommendations relevant to physiotherapy remains unknown. CLINICAL QUESTION: What is the content and methodological quality of dementia guideline recommendations...BACKGROUND: The content and quality of dementia guideline recommendations relevant to physiotherapy remains unknown. CLINICAL QUESTION: What is the content and methodological quality of dementia guideline recommendations within the physiotherapy scope of practice? DESIGN: Systematic review of clinical practice guidelines. DATA SOURCES: MEDLINE, Embase, CINAHL, AgeLine, Google, guideline databases, and relevant websites (to January 2025). STUDY SELECTION: Guidelines in English, screened through a three-phase process by two independent reviewers, were eligible if recommendations were relevant to adults with dementia and within the physiotherapy scope of practice. DATA APPRAISAL AND SYNTHESIS METHODS: Guideline characteristics and recommendation content were extracted. Recommendations using GRADE methodology with certainty of evidence and strength of recommendation scores were synthesised. Quality was assessed using AGREE II and AGREE-REX. RESULTS: Twenty-one relevant guidelines were identified. Twelve used GRADE methodology, eight presented GRADE scores. Thirty-three recommendations with GRADE scores met the physiotherapy scope of practice, categorised into ten topics: exercise (n = 11), acupuncture (n = 1), psychosocial and environmental interventions (n = 1), tailored activities (n = 2), carer support (n = 3), pain management (n = 5), falls risk management (n = 1), outcomes and outcome measures (n = 4), care planning (n = 1), and care setting transitions (n = 4). Methodological quality of guidelines and recommendations varied significantly. LIMITATIONS: Non-English language publications were excluded. Only recommendations presenting GRADE scores were synthesised. CONCLUSION: Current dementia guidelines partially reflect the physiotherapy scope of practice. Varying methodological quality and inconsistent rating methods challenge interpretation and implementation. Robust physiotherapy-specific guidelines are needed to demonstrate the value of physiotherapy for people with dementia, and inform clinical practice, education, and policy. SYSTEMATIC REVIEW REGISTRATION NUMBER: Systematic Review Registration Number PROSPERO CRD42023412107. CONTRIBUTION OF THE PAPER.
OBJECTIVES: Describe the development and delivery of the interventions in the Ankle Fracture Treatment Enhancing Rehabilitation (AFTER) trial, a randomised controlled trial comparing the effectiveness of supervised versu...OBJECTIVES: Describe the development and delivery of the interventions in the Ankle Fracture Treatment Enhancing Rehabilitation (AFTER) trial, a randomised controlled trial comparing the effectiveness of supervised versus self-directed rehabilitation for adults aged ≥50 years with an ankle fracture. DESIGN: Intervention development. SETTING: UK National Health Service (NHS) hospitals. METHOD: We developed the interventions in stages. First, we reviewed two UK clinical guidelines and the existing research evidence. We then conducted a clinical practice survey (n = 59 physiotherapists) to inform a stakeholder meeting which identified key intervention components. Subsequently, we designed the interventions, tested them in a pilot trial (n = 61 participants), then refined them for the definitive AFTER trial. RESULTS/FINDINGS: The definitive AFTER trial interventions start after randomisation, which occurs when the participant's cast/boot is removed and weightbearing and ankle movement restrictions are lifted. Participants allocated to self-directed rehabilitation receive a high-quality advice workbook, a progressively challenging self-directed exercise programme that they follow to self-manage their recovery, and strategies to encourage exercise adherence. Supervised rehabilitation participants receive a high-quality workbook, then 4 to 6 one-to-one face-to-face/remote sessions with a physiotherapist. The physiotherapist provides specific advice, home exercises, and uses strategies to facilitate adherence to prescribed exercises. The supervised rehabilitation intervention is tailored to individual participants during review sessions. CONCLUSIONS: The definitive AFTER trial will provide high-quality evidence to guide rehabilitation provision for older adults with an ankle fracture. Results are anticipated in 2025. TRIAL REGISTRATION NUMBER: ISRCTN registry (identifier: ISRCTN11830323). CONTRIBUTION OF THE PAPER.
Physiotherapy
· 2026 Jun · PMID 40199650
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OBJECTIVE: To assess the impact of combining positive expiratory pressure (PEP) and nebulisation on lung delivery by measuring the urinary concentration of amikacin, used as a biomarker in people with cystic fibrosis. DE...OBJECTIVE: To assess the impact of combining positive expiratory pressure (PEP) and nebulisation on lung delivery by measuring the urinary concentration of amikacin, used as a biomarker in people with cystic fibrosis. DESIGN: Randomised crossover study. PARTICIPANTS: Nine people with cystic fibrosis. INTERVENTION: A solution of amikacin was nebulised using a nebuliser alone or a nebuliser in combination with a PEP device. OUTCOME MEASURES: After nebulisation, urine samples were collected over 24 hours. The total amount of amikacin excreted in urine was calculated, reflecting the lung dose. The elimination rate constant was also calculated, and represents total drug elimination by excretion and metabolism. RESULTS: No differences in lung dose, half-life or elimination rate constant were observed between the two methods of nebulisation. Lung dose divided by respiratory rate was significantly greater for nebulisation in combination with PEP. CONCLUSION: The use of nebulisation in combination with PEP does not result in clinically significant improvements in drug delivery in people with mild-to-moderate cystic fibrosis. However, this combination can be used safely to reduce the duration of physiotherapy sessions without compromising drug delivery. TRIAL REGISTRATION: NCT02535130. CONTRIBUTION OF THE PAPER.
Scully AE, Thilarajah S, Yuan MLZ
… +6 more, Sreeram A, Li PTJ, Wen BTJ, In CTM, Liang TY, Khim KL
Physiotherapy
· 2025 Jun · PMID 40156977
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OBJECTIVES: A collaborative model of care between physiotherapists (PTs) and exercise professionals (EPs) is needed to increase physical activity (PA) after stroke. We investigated the knowledge, attitudes and practices...OBJECTIVES: A collaborative model of care between physiotherapists (PTs) and exercise professionals (EPs) is needed to increase physical activity (PA) after stroke. We investigated the knowledge, attitudes and practices of PA promotion among PTs, the interest of EPs, and the barriers and facilitators to PA promotion faced by PTs and EPs in Singapore. DESIGN: We conducted two web-based surveys between August and November 2019, and January and July 2021. PARTICIPANTS: Eligible participants were PTs who saw at least one stroke survivor in the last three months, and certified EPs who saw at least one client in the last six months. We reported categorical data using frequencies and percentages. RESULTS: Of 102 PTs and 44 EPs who initiated the surveys, 71 (70%) PTs and 35 (80%) EPs completed the surveys. Most knowledge questions were answered correctly. Almost all PTs perceived PA promotion as part of their role but only half (38/71;54%) practiced this often. Few (11/71;15%) used formal PA assessments. Most used goal setting (66/71;93%), advice/counselling (58/71;82%) and identification of barriers and solutions (51/71;72%). There was great interest from EPs to work with health professionals (30/35;86%) and stroke survivors (28/35;80%). While PTs faced barriers such as lack of time and resources, EPs faced barriers such as lack of referrals, knowledge and skills in stroke and exercise prescription. CONCLUSION: Our study identified elements useful for informing a model of care between PTs and EPs in promoting post-stroke PA. Future research should focus on developing resources, pathways and training programs specific to stroke. CONTRIBUTION OF THE PAPER.
Salazar-Méndez J, Núñez-Cortés R, Cuyul-Vásquez I
… +7 more, Sazo-Rodriguez S, Calatayud J, Guzmán-Muñoz E, Aguayo A, Carrasco B, González A, Suso-Martí L
Physiotherapy
· 2025 Jun · PMID 40155228
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OBJECTIVES: This trial aimed to provide estimates of effect and feasibility of a physical activity intervention for hospitalized cancer survivors using smartwatches for goal-setting and feedback. DESIGN: A feasibility, s...OBJECTIVES: This trial aimed to provide estimates of effect and feasibility of a physical activity intervention for hospitalized cancer survivors using smartwatches for goal-setting and feedback. DESIGN: A feasibility, single-blinded, randomized trial. SETTING: Acute cancer unit in a tertiary hospital. PARTICIPANTS: Adult hospitalized cancer survivors undergoing cancer treatment (n = 24). INTERVENTIONS: Participants were randomized to usual care or 2 sessions of a behavioural intervention using goal setting and feedback. MAIN OUTCOME MEASURES: Blinded assessments occurred at admission (T0), discharge (T1) and 4-weeks post-discharge (T2). The primary outcome was accelerometer-measured daily step count and sedentary time. Secondary measures evaluated feasibility (demand, implementation, acceptability, practicality), mobility, self-efficacy, and health service outcomes. RESULTS: The trial was hampered by low recruitment rate (n = 24, 29% of target). There were moderate estimates of effect favouring the experimental group for mobility at T1 (mean difference [MD] 11 points, 95% CI -1 to 22). No other effects favored the experimental group. Estimates of step counts (T1 MD -284, 95% CI -1491 to +943; T2 -2249, 95% CI -6062 to +1565) and sedentary time (T1 MD +0.9 hours, 95% CI +0.1 to +2; T2 +2.8 hours, 95% CI -0.3 to +5.2) favored the usual care group. There was no difference in health service outcomes. The intervention was well accepted and no adverse events occurred. CONCLUSION: A physical activity intervention for cancer survivors admitted to hospital was safe and acceptable but slow recruitment and uncertainty surrounding its efficacy hampered trial feasibility. Future trials should consider whole-of-ward interventions using novel trial designs. TRIAL REGISTRATION: ACTRN12622001007729. CONTRIBUTION OF THE PAPER.
INTRODUCTION: Nasopharyngeal (NP) and oropharyngeal (OP) suctioning are airway clearance techniques (ACTs) used to maintain airway patency and enhance gas exchange by removing secretions in an acutely unwell self-ventila...INTRODUCTION: Nasopharyngeal (NP) and oropharyngeal (OP) suctioning are airway clearance techniques (ACTs) used to maintain airway patency and enhance gas exchange by removing secretions in an acutely unwell self-ventilating patient. Data on the current use of NP and OP suctioning by physiotherapists are scarce. AIM AND OBJECTIVES: To investigate the use of NP and OP suctioning by physiotherapists in the UK. METHODS: An anonymous online questionnaire was developed in Microsoft Forms. UK-registered physiotherapists working in respiratory practice were invited to complete the survey via professional organisations and social media between May and June 2021. Data were analysed descriptively. RESULTS: Respondents (N=134) mainly worked in the National Health Service (99%) in England (89%) across various clinical speciality levels. The median (IQR) frequency of treatment involving either NP or OP suctioning was 3 (1,5) in the preceding month. Suctioning was usually reported as being successful (92%) and most commonly administered following manual airway clearance techniques (78%), mechanical in/exsufflation (61%), and/or positioning and postural drainage (52%). The majority of respondents reported they performed suctioning with a lubricant (98%) and a nasal pharyngeal airway in situ (95%). Respondents reported experience of a number of adverse effects in relation to NP or OP suction, most notably bleeding (80%), hypoxaemia (63%), and tachycardia (58%). CONCLUSIONS: Although NP/OP suctioning is an important ACT in UK physiotherapy practice, it is highly invasive and carries the risk of adverse effects and negative patient experience. Further research and development of adaptations and less invasive alternatives to the technique are warranted. CONTRIBUTION OF THE PAPER.
OBJECTIVES: This systematic review aimed to evaluate the effects of high-intensity laser therapy (HILT) on pain intensity, disability, and electrophysiological parameters in individuals diagnosed with carpal tunnel syndr...OBJECTIVES: This systematic review aimed to evaluate the effects of high-intensity laser therapy (HILT) on pain intensity, disability, and electrophysiological parameters in individuals diagnosed with carpal tunnel syndrome (CTS). DATA SOURCES AND SYNTHESIS: A search of electronic databases, including PubMed, Web of Science, Scopus, CINAHL, Science Direct, Cochrane Library, the PEDro database, and Google Scholar (updated until February 18, 2025), was conducted for randomized controlled trials (RCTs). DATA EXTRACTION AND QUALITY ASSESSMENT: Data were extracted independently by three researchers. The quality of RCTs was assessed using the Cochrane Risk of Bias (RoB) 2.0 tool, while evidence certainty was evaluated with the GRADE approach. Primary outcomes included pain intensity, with secondary outcomes comprising electrophysiological parameters and disability. RESULTS: Nine RCTs met inclusion criteria. Most studies exhibited a low risk of bias across RoB2 domains, except for outcome measurement, resulting in an overall RoB of 44%. Meta-analyses demonstrated that HILT, alone or combined with interventions such as splinting, exercise, TENS, vitamin B supplements, or ergonomic modifications, significantly reduced pain (SMD = 0.7 to 1.6) and disability (SMD = 0.68). Electrophysiological improvements included enhanced distal motor latency (SMD = 0.98) and sensory conduction velocity (SMD = 0.8), particularly when combined with median nerve gliding or splinting. CONCLUSION: This review confirms HILT's effectiveness in reducing pain and disability and improving electrophysiological parameters in CTS. However, evidence certainty remains moderate to low. Future RCTs should standardize outcome measures to evaluate HILT's clinical impact beyond statistical significance, and comparative studies with LLLT are needed to refine laser therapy protocols. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42023470170 (October 17, 2023). CONTRIBUTION OF THE PAPER.