| 1. |
- Sandborgh, Maria, 1955-, et al.
(författare)
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Integration of Behavioral Medicine Competencies into Physical Therapy Curriculum in an Exemplary Swedish Program : Rationale, Process and Ten-year Review
- 2020
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Ingår i: Physiotherapy Theory and Practice. - Philadelphia : Taylor & Francis. - 0959-3985 .- 1532-5040. ; 36:3, s. 365-377
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Forskningsöversikt (refereegranskat)abstract
- In 2004, Mälardalen University, Sweden, introduced a new undergraduate entry-level physiotherapy program. Program developers constructed the curriculum with behavioral medicine content that reflected the contemporary definition and values of the physiotherapy profession aligning it with current best practices, evidence, and the International Classification of Functioning, Disability, and Health (ICF). The new curriculum conceptualized movement and function as modifiable behaviors in that they reflect behavioral contingencies, perceptions, beliefs, and lifestyle factors as well as pathophysiology and environmental factors. The purpose of this article is to describe how one university accordingly structured its new curriculum and its review. We describe the rationale for the curriculum's behavioral medicinecontent and competencies, its development and implementation, challenges, long-term outcomes, and its related research enterprise. We conclude that physiotherapy practiced by our graduates augments that taught in other programs based on accreditation reviews. With their expanded practice scope, graduates are systematically practicing within the constructs of health and function conceptualized within the ICF. Our intent in sharing our experience is to exemplify one university's initiative to best prepare students with respect to maximizing physiotherapy outcomes as well as establish a dialogue regarding minimum standards of behavioral medicine competencies in physiotherapy education and practice.
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| 2. |
- Söderlund, Anne, 1957-, et al.
(författare)
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Implementing a behavioral medicine approach in physiotherapy for patients with musculoskeletal pain : a scoping review
- 2020
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Ingår i: Pain Reports. - 2471-2531. ; 5:5
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Forskningsöversikt (refereegranskat)abstract
- In intervention research on musculoskeletal pain, physiotherapists often study behavioral and cognitive components. Evidence on applying these components has increased during the past decade. However, how to effectively integrate behavioral and cognitive components in the biopsychosocial management of musculoskeletal pain is challenging. The aim was to study the intervention components and patient outcomes of studies integrating behavioral and cognitive components in physiotherapy, to match the interventions with a definition of behavioral medicine in physiotherapy and to categorize the behavior change techniques targeted at patients with musculoskeletal pain in (1) randomized controlled effect trials or (2) implementation in clinical practice trials. A scoping review was used to conduct this study, and the PRISMA-ScR checklist was applied. Relevant studies were identified from the PubMed, MEDLINE, PsycINFO, CINAHL Plus, and Web of Science Core databases separately for the (1) randomized controlled effect trials and (2) implementation in clinical practice trials. Synthesis for the matching of the patient interventions with the existing definition of behavior medicine in physiotherapy showed that the interventions mostly integrated psychosocial, behavioral, and biomedical/physical aspects, and were thus quite consistent with the definition of behavioral medicine in physiotherapy. The reported behavior change techniques were few and were commonly in categories such as “information of natural consequences,” “feedback and monitoring,” and “goals and planning.” The patient outcomes for long-term follow-ups often showed positive effects. The results of this scoping review may inform future research, policies, and practice.
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| 3. |
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| 4. |
- Adhikari, Shambhu P., et al.
(författare)
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Alternatives to routinely used physiotherapy interventions for achieving maximum patients' benefits and minimising therapists' exposure in treatment of COVID-19 - a commentary
- 2020
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Ingår i: European Journal of Physiotherapy. - : ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD. - 2167-9169 .- 2167-9177. ; 22:6, s. 373-378
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Tidskriftsartikel (refereegranskat)abstract
- The evidence and effectiveness of physiotherapy interventions in treatment of patients with confirmed or suspected coronavirus disease 2019 (COVID-19) is limited. Routinely used interventions in physiotherapy imply a very high risk for physiotherapists because the duration of direct contact with patients is quite long. Physiotherapy may need to be administered by weighing the benefit-risk ratio. Therefore, there is a critical and urgent need to adopt alternatives or modified forms of physiotherapy interventions. As the situation for management of COVID-19 in low-resource contexts could differ from that in high resource context, interventions need to be adapted to the available resources and technology in various settings. Tele-physiotherapy could be a viable option for patients who are in acute care in the hospital, in rehabilitation unit or under quarantine at home due to confirmed or suspected COVID-19. Modification in physiotherapy interventions and adjustment in intervention parameters may serve as an alternative strategy. This article describes alternatives to and/or modification of routinely used physiotherapy interventions for achieving maximum patients' benefits and minimising therapists' exposure in treatment of individuals with confirmed or suspected COVID-19.
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| 5. |
- Aryuwat, Pimwalunn, et al.
(författare)
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Factors Associated with Resilience among Thai Nursing Students in the Context of Clinical Education : A Cross-sectional Study
- 2024
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Ingår i: Education Sciences. - 2227-7102. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- Resilience aids nursing students in dealing with adversities during their nursing education. This study examined the relationship between nursing students’ resilience and relevant variables in the context of clinical education. Methods: A cross-sectional study was conducted to collect data from 319 undergraduate nursing students in Northeast Thailand. The Connor–Davidson Resilience Scale, the Multidimensional Scale of Perceived Social Support, the Learning Experience Scale or the Personal Responsibility Orientation to Self-Direction in Learning Scale, and the Stressors in Nursing Students scale were administered. A multiple regression analysis was performed for factors presumed to be associated with resilience. Results reported that Thai nursing students’ average resilience score was 71.79 ± 16.33. Multiple regression analysis indicated factors associated with resilience, in which social support (β = 0.354, p < 0.001, 95%CI: 0.240 to 0.469) and self-directed learning (β = 0.787, p < 0.001, 95%CI: 0.606 to 0.968) showed a positive association, while stress (β = −0.083, p = 0.025, 95%CI: −0.083 to −0.006) had a negative association. The final model accounted for 43.4% of the variance in the resilience score. In conclusion, self-directed learning, social support, and perceived stress among nursing students during clinical education are associated with their resilience.
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| 8. |
- Fritz, Johanna, et al.
(författare)
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Implementation of a behavioral medicine approach in physiotherapy: impact and sustainability
- 2020
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 42:24, s. 3467-3474
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To explore the effects on and sustainability of physiotherapists' clinical behavior when using facilitation to support the implementation of a behavioral medicine approach in primary health care for patients with persistent musculoskeletal pain. Methods: A quasi-experimental pre-/post-test trial was conducted. Fifteen physiotherapists were included in the experimental group, and nine in the control group. Based on social cognitive theory and the Promoting Action on Research Implementation in Health Services framework, facilitation with multifaceted implementation methods was used during a six-month period. Clinical behaviors were investigated with a study-specific questionnaire, structured observations, self-reports and patient records. Descriptive and non-parametric statistical methods were used for analyzing differences over time and effect size. Results: A sustained increase in self-efficacy for applying the behavioral medicine approach was found. Clinical actions and verbal expressions changed significantly, and the effect size was large; however, changes were not sustained at follow-ups. The behavioral changes were mainly related to the goal setting, self-monitoring and functional behavioral analysis components. No changes in clinical behavior were found in the control group. Conclusion: Tailored multifaceted facilitation can support the implementation of a behavioral medicine approach in physiotherapy in primary health care, but more comprehensive actions targeting sustainability are needed.
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| 9. |
- Fritz, Johanna, 1974-
(författare)
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Implementation of a behavioural medicine approach in physiotherapy : Determinants, clinical behaviours, patient outcomes and the implementation process
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Current research shows that a behavioural medicine approach in physiotherapy increases the ability to participate in daily activities and decreases sick leave in patients with persistent musculoskeletal pain. A behavioural medicine approach means that the physiotherapist systematically considers biopsychosocial factors of importance for the patient's activity and participation. Active patient involvement is central, and behaviour change techniques are used. One in seven of the patients in primary health care suffers from persistent musculoskeletal pain. Therefore, primary health care needs to implement a behavioural medicine approach in physiotherapy. However, the implementation of new methods is challenging. It is important to increase the knowledge about how to implement a behavioural medicine approach into physiotherapy clinical practice to make recommended treatment available to more patients with persistent musculoskeletal pain. The overall aim of this thesis was therefore to develop and evaluate methods for supporting the implementation of a behavioural medicine approach in physiotherapy for patients with persistent musculoskeletal pain.In study I, determinants of using a behavioural medicine approach in physiotherapy were identified using a qualitative multiple-case study design. An implementation intervention was developed based on these determinants and on theoretical assumptions regarding behaviour change and learning. The implementation intervention was tested in a quasi-experimental trial for six months and evaluated by focusing on physiotherapists' clinical behaviour changes in study II and the effects on patients' health in study III. In study IV, a process evaluation was conducted with a mixed methods design to explain the impact mechanisms of the implementation intervention. Altogether, 28 physiotherapists, 159 patients and three managers participated in the project.The determinants identified in study I were associated with the physiotherapist, the patient and the workplace. An implementation intervention was developed based on these determinants and on assumptions in the social cognitive theory, the constructivist learning theory, and the Promoting Action on Research Implementation in Health Services (PARIHS) framework. The implementation intervention consisted of outreach visits, peer coaching, educational materials, individual goalsetting, video feedback, self-monitoring in a diary, the stimulation of manager support and an information leaflet for patients. Immediately after the implementation period, the physiotherapists significantly changed their clinical behaviour, but these changes were not sustained. The patients treated by these physiotherapists achieved no further health improvement compared to a control group. Outreach visits, peer coaching, educational material and individual goalsetting were perceived by the physiotherapists as the most useful methods and supported the implementation through multiple learning methods, action planning, processing experiences, synergy effects with self-efficacy beliefs, and extrinsic motivation.In conclusion, this thesis contributes to an increased understanding of the complexity regarding what affects the implementation of a behavioural medicine approach in physiotherapy and the promising methods and their impact mechanisms that support this implementation. A distinction between achieving clinical behaviour changes and sustaining these changes is highlighted. This implies that an implementation intervention needs to support both factors in order for the implementation of a behavioural medicine approach to benefit the patients. The thesis also illustrates how combined theoretical perspectives can inform an implementation intervention in physiotherapy in a useful way.
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| 10. |
- Fritz, Johanna, et al.
(författare)
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Patients' health outcomes after an implementation intervention targeting the physiotherapists' clinical behaviour.
- 2021
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Ingår i: Archives of physiotherapy. - : Springer Science and Business Media LLC. - 2057-0082. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A behavioural medicine approach in physiotherapy has shown positive effects on increased and sustained activities and participation, including reduced sick leave for patients with persistent musculoskeletal pain. The aim of this study was to explore the health outcomes of patients with persistent musculoskeletal pain treated by physiotherapists who had received active compared with passive support when implementing a behavioural medicine approach.METHODS: An explorative and comparative pre-/post-test trial was conducted. A total of 155 patients with musculoskeletal pain ≥4 weeks were consecutively recruited by physiotherapists in primary healthcare who had received active or passive support when implementing a behavioural medicine approach. Data concerning health outcomes for patients were collected using questionnaires before and after the physiotherapy treatment and at half-, one- and two-year follow-ups. Descriptive, non-parametric and parametric bi- and multivariate statistics were used.RESULTS: There were no differences over time between the patients treated by physiotherapists who had received active compared to passive implementation support regarding pain-related disability, pain intensity, self-rated health, self-efficacy in performing daily activities, catastrophic thinking related to pain, and fear of movement. Significant improvements over time were identified in both groups regarding all variables and the effect sizes were large. The percentage of patients on sick leave significantly decreased in the patient group treated by physiotherapists who had received active implementation support.CONCLUSION: It is very important to include patient outcomes when evaluating the implementation of multicomponent interventions. It seems that the implementation method did not play a major role for the patients' outcomes in this study. Most of the patients' health outcomes improved regardless of whether they were treated by physiotherapists who had received active or passive support when implementing a behavioural medicine approach. This was likely because the active implementation support was not extensive enough to enable the physiotherapists to sustain the behavioural medicine approach.TRIAL REGISTRATION: The study protocol was retrospectively registered in ClinicalTrials.gov . ID NCT03118453 , March 20, 2017.
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| 11. |
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| 12. |
- Lagerlund, H., et al.
(författare)
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Behaviour-directed interventions for problematic person transfer situations in two dementia care dyads : a single-case design study
- 2022
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Ingår i: BMC Geriatrics. - : BioMed Central Ltd. - 1471-2318. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Persons with dementia living in nursing homes need assistance with moving and transfers; however, caregivers assisting persons with dementia in their daily person transfers report strain-related and complicated transfer-related behavioural problems. The reciprocity of complex dyadic transfer-related behaviours is affected by environmental factors, the health status of the person with dementia and the caregiver’s skills and knowledge. The aim of this study was to explore tailored interventions guided by a functional behaviour analysis for problematic person transfer situations in two dementia care dyads. Methods: This study was a quasi-experimental single-case study with an A-B design. Tailored interventions were developed in a five-step model for functional behavioural analysis. The study was conducted in a dementia special care unit at a nursing home, and the inclusion criteria were caregivers’ experiences of physical strain and/or resistiveness to care, which led to complex transfer-related behaviour. Two care dyads were included. Transfer situations were video-recorded and evaluated with the Dyadic Interaction in Dementia Transfer Assessment Scale, Pain Assessment in Advanced Dementia Scale, and Resistiveness to Care Scale for Dementia of the Alzheimer’s Type. The caregiver experience was evaluated with study-specific items addressing caregiver self-efficacy, catastrophizing thoughts, perceived control, and perceived physical strain. Scorings were graphically displayed. The graphs were inspected visually to identify changes in trend, level, latency, and variability. Nonoverlap of all pairs (NAP), including 90% confidence intervals (CIs), was calculated to complement the visual inspection. Results: Verbal and nonverbal discomfort decreased in care dyad 1, which mirrored the caregiver changes in adapting their actions to the needs of the person with dementia. High variability was seen in both the intervention and the baseline phases in care dyad 2. In both care dyads, caregiver transfer-related behaviour improved. Conclusions: The results indicate that the transfer-related behaviours of the care dyad might be improved through a behaviour-directed intervention tailored to meet the care dyad´s needs. The small number of cases and observations limits the generalizability, and the results should be interpreted in consideration of the piloting approach of the study.
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| 15. |
- Tan, Edwin C. K., et al.
(författare)
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Validating a model for medication-related dental outcomes in older people
- 2022
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Ingår i: Oral Diseases. - : Wiley. - 1354-523X .- 1601-0825. ; 28:6, s. 1697-1704
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To externally validate a model for medication-related dental outcomes in (a) a general older population with dementia and (b) a matched population without dementia.Subjects and Methods: This validation study used population-based data from seven Swedish national registers (2008–2017). Individuals aged 60+ with dementia were matched to those without dementia on age, gender, and county of residence at the date of diagnosis (index date). The exposure was continuous use of xerogenic medications during the 3-year period before index date. The primary outcome was the number of tooth extraction and restorative procedures within 3 years after index date.Results: A total of 334,220 individuals were included in the final sample. In the dementia cohort, the use of urological drugs (incidence rate ratio [IRR] 1.08, 95% CI 1.03–1.13), respiratory medicines (IRR 1.10, 95% CI 1.04–1.17), and proton-pump inhibitors (IRR 1.09, 95% CI 1.05–1.13) was associated with the primary outcome. In the non-dementia cohort, respiratory medicines (IRR 1.03, CI 1.00–1.05), proton-pump inhibitors (IRR 1.06, CI 1.04–1.08), opioids (IRR 1.05, CI 1.03–1.07), and antidepressants (IRR 1.06, CI 1.04–1.08) were associated with the primary outcome.Conclusions: Although there were differences in prescription patterns, the model performed similarly in both those with and without dementia.
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| 16. |
- Tan, Edwin C. K., et al.
(författare)
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Xerogenic Medications as a Predictor for Dental Health Intervention in People with Dementia
- 2020
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Ingår i: Journal of Alzheimer's Disease. - 1387-2877 .- 1875-8908. ; 75:4, s. 1263-1271
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Tidskriftsartikel (refereegranskat)abstract
- Background: Older adults with dementia often have poor oral health. Chronic use of xerogenic medications may contribute to adverse dental outcomes.Objective: To investigate the impact of xerogenic medication classes on the predicted risk for dental interventions in people with dementia.Methods: Thiswas a population-based cohort study involving 30,955 individuals registered in the Swedish Dementia Registry (SveDem) from 2008 to 2015. Data were linked with other national registers. The exposure was xerogenic medication classes used in the three years prior to dementia diagnosis (baseline). The primary outcome was the composite of number of tooth extractions and dental restorations over the three-year follow-up period. Secondary outcomes included the number of tooth extractions and number of dental restorations. Poisson regression models were used to estimate the association between the exposure and outcomes. Analyses were adjusted for age, gender, Mini-Mental State Examination, living arrangement, dementia disorder, average number of medications, Charlson’s comorbidity index, number of dental visits, and number of teeth.Results: After adjusting for potential covariates, the use of urological drugs (incidence rate ratio [IRR] 1.16, 95% CI 1.04–1.28), proton pump inhibitors (IRR 1.13, 95% CI 1.04–1.23), and opioids (IRR 1.19, 95% CI 1.06–1.34) were significantly associated with the primary composite outcome.Conclusion: The use of specific classes of xerogenic medications was associated with an increased risk for tooth extractions and restorations in people with dementia. The risks and benefits of xerogenic medications, in the context of oral health, should be carefully assessed in this vulnerable population.
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