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Due to COVID-19 outbreak, to lighten the burden of acute and critical care hospitals, some respiratory rehabilitation departments have been used to host patients with COVID-19 in the post-acute phase. This new and unexpected situation required a change of roles and scheduling of the rehabilitation teams. In this manuscript we describe the unexpected and urgent organizatiol change of the Cardio-Pulmory Rehabilitation (CPR) service during the COVID-19 emergency in a Northern Italian rehabilitation hospital, focusing on the Respiratory Physiotherapists' (RPTs) role. A quick three-days complete reorganization of the entire hospital was needed. A COVID-19 care team including a multidiscipliry panel of physicians, nurses, and RPTs was quickly performed to mage 90 beds for post acute patients with COVID-19. Within the team, the RPTs changed their shifts, so as to be available 16h per day, 7 days out of 7. Remodelled tasks in charge of RPTs were: oxygen therapy daily monitoring, non invasive ventilation (NIV) and continuous positive airways pressure (CPAP) delivery, protion and postural changes to improve oxygetion, reconditioning with leg/arm cranking and exercises, initial and fil patients' functiol assessment by short-physical performance battery (SPPB) and 1-minute sit-to-stand test (1-STS) to evaluate motor conditions and exercise-induced oxygen desaturation. Three €œwhat-to-do€ algorithms were developed to guide: i) oxygen de-escalation by reducing inhaled fraction of oxygen (FiO2); ii) oxygetion improvement through the use of Venturi mask; iii) reconditioning and physical activity. One-hundred seventy patients were treated in one month. As main topics, RPTs have been involved in oxygen therapy magement in almost a third of the admitted patients, reconditioning exercises in 60% of the cases, and initial and fil functiol motor capacity assessment in all patients. Details of activities performed by the RPT in one typical working day are also shown. Our reorganization has exploited the professiol skills and clinical expertise of the RPTs. This re-organization can provide practical insights to other facilities that are facing this crisis, and may be a starting point for implementing post-COVID-19 rehabilitation. Future studies will have to improve and review this organization.

Background Physiotherapist-led (PT-led) orthopaedic triage is an evolving model of care for patients with musculoskeletal disorders. Objectives for this study were to establish the current evidence body on the impact of PT-led orthopaedic triage on health, quality, and service outcomes for patients referred for orthopaedic consultation, compared with standard (orthopaedic surgeon) care. Methods Medline, EMBASE, Scopus and CINAHL were searched from inception until 7 May 2018; search updated 24 April 2020. Search terms (including derivatives) included physiotherapy, advanced/extended scope, musculoskeletal/orthopaedic, triage. The search was framed as Population   =  patients referred for orthopaedic consultation; Intervention  = PT-led orthopaedic triage; Comparison  = standard care; Outcomes  = health, quality and process outcomes. Only randomised controlled trials (RCTs) and prospective comparative cohort studies were eligible for inclusion. Screening, study selection, data extraction, and assessment of methodological quality were performed independently by reviewer pairs. Quality was scored with the Downs and Black checklist. Certainty of evidence was determined using GRADE. PROSPERO registration number CRD42017070950. Results We included two RCTs and eleven cohort studies ( n  = 1357 participants) of variable methodological quality (range 14–23 of possible 28). Certainty of evidence was low to moderate. There was no difference between PT-led orthopaedic triage and standard care for patient-reported outcomes (two RCTs). Perceived quality of care with PT-led orthopaedic triage was higher (two RCTs, four cohort studies) or equal (one cohort study) compared with standard care. PT-led orthopaedic triage had higher surgery conversion rates (one RCT, three cohort studies) (55–91% vs 22–38%), lower (two RCTs) or equal rate (two cohort studies) of referral for investigations, shorter waiting times (one RCT, one cohort study), and lower costs (one RCT). Furthermore, there was high agreement between physiotherapists’ and orthopaedic surgeons’ treatment approach (eight cohort studies), referral for investigation (five cohort studies), and diagnosis (nine cohort studies). Study limitations were t he low number of RCTs, and variable methodological quality. Conclusions Evidence of low to moderate certainty suggests that PT-led orthopaedic triage leads to similar diagnostic decisions as standard care, has a higher conversion-to-surgery rate, reduces waiting times, is cost effective and valued by patients, and that health outcomes are equivalent.

Background Work on the Act on the Profession of Physiotherapist had been conducted since the 1990s. However, it was not until October 2015 that the legal regulations were eventually introduced, following which physiotherapists gained professional independence and became a profession of public trust. The aim of the study was to assess the factors influencing the knowledge of these legal regulations among physiotherapists. Material and Methods The study involved 399 physiotherapists and physiotherapy students (28.8±5.9 years old) who completed an anonymous questionnaire, in the form of a knowledge test, consisting of 24 questions on the general aspects of the reference Act. Results Overall, 30.3% of the respondents proved to have a significant knowledge about the rights and obligations resulting from the Act. The physiotherapists who were entered into the National Register of Physiotherapists (2.6 times) and residents of large cities (1.8 times) had a greater knowledge of the Act. There was a correlation between seniority and gender, and the knowledge of legal regulations. Conclusions The main factors influencing the state of knowledge about the Act are the entry to the National Register of Physiotherapists, the place of residence and seniority. This proves better access to up-to-date information in cities and a greater interest in the Act among those people who have obtained the right to practice their profession. Med Pr. 2021;72(4):407–14

Healthcare professionals perform daily activities that can lead to musculoskeletal disorders (MSDs). The objective of this review was to summarize these MSDs by body areas in relation to healthcare professions. The underlying question is, worldwide, whether there are areas that are more exposed depending on the occupation or whether there are common areas that are highly exposed to MSDs. This issue has been extended to risk factors and responses to reduce MSDs. The review was conducted according to the PRISMA guidelines between February and May 2022. Google scholar and Science Direct databases were scanned to identify relevant studies. Two authors independently reviewed, critically appraised, and extracted data from these studies. Overall and body area prevalence, risk factors, and responses to MSDs were synthetized by occupational activity. Among the 21,766 records identified, 36 covering six healthcare professions were included. The lower back, neck, shoulder and hand/wrist were the most exposed areas for all healthcare professionals. Surgeons and dentists presented the highest prevalence of lower back (>60%), shoulder and upper extremity (35–55%) MSDs. The highest prevalence of MSDs in the lower limbs was found for nurses (>25%). The main causes reported for all healthcare professionals were maintenance and repetition of awkward postures, and the main responses were to modify these postures. Trends by continent seem to emerge regarding the prevalence of MSDs by healthcare profession. Africa and Europe showed prevalence three times higher than Asia and America for lower back MSDs among physiotherapists. African and Asian nurses presented rates three times higher for elbow MSDs than Oceanians. It becomes necessary to objectively evaluate postures and their level of risk using ergonomic tools, as well as to adapt the work environment to reduce exposure to MSDs with regard to the specificities of each profession.

Background The role of an advanced practice physiotherapist has been introduced in many countries to improve access to care for patients with hip and knee arthritis. Traditional models of care have shown a gender bias, with women less often referred and recommended for surgery than men. This study sought to understand if patient gender affects access to care in the clinical encounter with the advanced practice provider. Our objectives were: (1) To determine if a gender difference exists in the clinical decision to offer a consultation with a surgeon; (2) To determine if a gender difference exists in patients’ decisions to accept a consultation with a surgeon among those patients to whom it is offered; and, (3) To describe patients’ reasons for not accepting a consultation with a surgeon. Methods This was a prospective study of 815 patients presenting to a tertiary care centre for assessment of hip and knee arthritis, with referral onward to an orthopaedic surgeon when indicated. We performed a multiple logistic regression analysis adjusting for severity to address the first objective and a simple logistic regression analysis to answer the second objective. Reasons for not accepting a surgical consultation were obtained by questionnaire. Results Eight hundred and fifteen patients (511 women, 304 men) fulfilled study eligibility criteria. There was no difference in the probability of being referred to a surgeon for men and women (difference adjusted for severity = − 0.02, 95% CI: − 0.07, 0.02). Neither was there a difference in the acceptance of a referral for men and women (difference = − 0.05, 95% CI: − 0.09, 0.00). Of the 14 reasons for declining a surgical consultation, 5 showed a difference with more women than men indicating a preference for non-surgical treatment along with fears/concerns about surgery. Conclusions There is no strong evidence to suggest there is a difference in proportion of males and females proceeding to surgical consultation in the model of care that utilizes advanced practice orthopaedic providers in triage. This study adds to the evidence that supports the use of suitably trained alternate providers in roles that reduce wait times to care and add value in contexts where health human resources are limited. The care model is a viable strategy to assist in managing the growing backlog in orthopaedic care, recently exacerbated by the COVID-19 pandemic.

Physical rehabilitation is recommended after total knee arthroplasty (TKA). With the expected increase in TKA over the next few decades, it is important to find new ways of delivering cost-effective interventions. Technological interventions have been developed with this intent, but only preliminary evidence exists regarding their validity, with short follow-up times. This study aimed to present the follow-up results of a feasibility study comparing two different home-based programs after TKA: conventional face-to-face sessions and a digital intervention performed through the use of an artificial intelligence-powered biofeedback system under remote clinical monitoring. The digital intervention uses a motion tracker allowing 3D movement quantification, a mobile app and a Web portal. This study presents the results of the previous single-center, prospective, parallel-group, feasibility study including an 8-week active treatment stage and further assessments at 3 and 6 months post-TKA. Primary outcome was the Timed Up and Go score, and secondary outcomes were the Knee Osteoarthritis Outcome Scale (KOOS) score and knee range of motion. A total of 59 patients completed the study (30 in the digital intervention group and 29 in the conventional rehabilitation group) and follow-up assessments. During the active treatment stage, patients in the digital intervention group demonstrated high engagement and satisfaction levels, with an 82% retention rate. Both groups attained clinically relevant improvements from baseline to 6 months post-TKA. At the end of the 8-week program, clinical outcomes were superior in the digital intervention group. At the 3- and 6-month assessments, the outcomes remained superior for the Timed Up and Go score (P<.001) and all KOOS subscale scores (at 3 months, P<.001 overall; at 6 months, KOOS Symptoms: P=.006, Pain: P=.002, Activities of Daily Living: P=.001, Sports: P=.003, and Quality of Life: P=.001). There was progressive convergence between both groups in terms of the knee range of motion, which remained higher for standing flexion in the digital intervention group than the conventional group at 6 months (P=.01). For the primary outcome, at 6 months, the median difference between groups was 4.87 seconds (95% CI 1.85-7.47), in favor of the digital intervention group. The present study demonstrates that this novel digital intervention for independent home-based rehabilitation after TKA is feasible, engaging, and capable of maximizing clinical outcomes in comparison to conventional rehabilitation in the short and medium term; in addition, this intervention is far less demanding in terms of human resources. ClinicalTrials.gov NCT03047252; https://clinicaltrials.gov/ct2/show/NCT03047252.

Job burnout is a threat for physical therapists. Little research has been conducted to identify possible protective factors against burnout in this population. Accordingly, we utilized the job demands-resources (JD-R) model and self-determination theory to guide our examination of basic psychological needs as factors to predict burnout in physical therapists. One hundred and two licensed physical therapists completed surveys. Higher levels of autonomy, competence and relatedness predicted burnout, even after accounting for job demands. Job resources, such as the basic psychological needs outlined by the self-determination theory, along with perceived respect, buffer the negative effects of secondary trauma on burnout. The job resource of perceived respect also buffers the negative effects of the physical demands of the job on burnout. These findings suggest that while job demands can be difficult to change, increasing the fulfillment of job resources can help ameliorate burnout in physical therapists. The present findings highlight the need for workplace interventions which cultivate the satisfaction of the basic psychological needs of autonomy, competence, and relatedness to address burnout among physical therapists.

The COVID-19 pandemic and ensuing lockdowns have restricted regular clinical physiotherapy services. This has necessitated a sudden shift to the use of telerehabilitation to prevent disruption in the delivery of physiotherapy interventions. This survey investigates the perceptions of physiotherapists in India and their willingness to use telerehabilitation during the pandemic. An electronic questionnaire was sent to 176 physiotherapists around India, and 118 completed questionnaires were received (acceptance rate of 67.04%). A majority of the respondents (n=67; 77%) had used telerehabilitation for the first time during the pandemic, and 72.9% (n=86) found telerehabilitation to be a viable option for healthcare delivery during the pandemic. Some of the barriers identified were lack of training (n=64; 52%) and a lack of connection between information and communication technology experts and clinicians (n=62; 52.5%). Overall, physiotherapists in India expressed a positive perception of telerehabilitation and are willing to use such services.

As the worldwide COVID-19 pandemic spread, many physiotherapists chose telerehabilitation (TR) to continue delivering therapy. This study was conducted to document the perceived benefits and challenges of TR faced by pediatric physiotherapists in western and southern India.  Using the snowball method, electronic survey forms were distributed to 275 pediatric physiotherapists in Western and Southern India; 110 responses were available for analysis. A majority of respondents had experience with TR (n=83, 75.5%), while others had never used TR (n=27, 24.5%). TR was reported to be less effective than in-person therapy for treating children and adolescents during the COVID-19 pandemic. Therapists reported significant difficulties during TR sessions; these included assessing and modifying exercises for children. As the popularity of TR grows, pediatric physiotherapists will need to be aware of the benefits and challenges they will face during TR sessions. Most pediatric physiotherapists believed the interaction between parents and therapists is a requisite for optimal service delivery.

The objective of this research work is to design an automatic rehabilitation device in charge of limb therapy in specialized rehabilitation centers. Within the methodology, the quantitative approach was followed, presenting a type of prospective research with a non- experimental design, for this the design of the device was elaborated in its different stages, which were segmented into electronic design, Adaptive structure and Control interface. For this, different matrices were elaborated to obtain the most important characteristics of the adaptive design. In addition, torque and weight calculations were carried out so that the device can work in optimal conditions. It was concluded in the realization of the design of the control and programming system, the adaptive structure of the same device, the power and control circuits for the electronic part, all this making use of the engineering programs Autodesk Inventor, Proteus, Pic C Compiler. Likewise, the simulation was carried out to ensure the correct functioning of the device. Finally, a stress analysis was performed, obtaining a fairly high safety factor.