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Overview of styles, content, learning effects and attitudes of students towards digitally enhanced physiotherapy education - a scoping review.
Background: Digital competences are essential for lifelong learning, as highlighted by the European Commission and emphasized in the Digital Education Action Plan 2021-2027. The COVID-19 pandemic necessitated an unprecedented shift to online education, profoundly impacting fields like physiotherapy that heavily rely on practical skills. This scoping review aims to provide an overview of currently applied digitally enhanced learning methods, content, effect on knowledge gain and student perceptions in physiotherapy education. Methods: Following PRISMA guidelines for scoping reviews, a comprehensive search was conducted across multiple databases, including Medline, Web of Science, and ERIC, incorporating hand searches and expert consultations. Studies were included if they reported on any digitally enhanced educational methods in physiotherapy education, involving qualitative studies, clinical trials, observational studies, or case reports published in English or German from 2010 to February 2024. Data extraction focused on the digital tools that were used, the educational contents, individually measured outcomes, and the impact of digital education. Results: Out of 2988 screened studies, 67 met the inclusion criteria, encompassing 7160 participants. These sources of evidence primarily used quantitative methods (n = 51), with a minority using qualitative (n = 7) or mixed methods (n = 6). Nearly half employed hybrid educational approaches. Outcome measures included knowledge, performance, perception, satisfaction, and attitudes. Most sources of evidence reported positive impacts of digitally enhanced education, particularly in knowledge transfer and skill performance. Synchronous and asynchronous methods were used, with varying success across theoretical and practical courses. Gamification and virtual reality emerged as promising tools for enhancing engagement and learning outcomes. However, challenges included the limited direct interaction and perceived self-efficacy among students. Conclusion: Digitally enhanced learning formats in physiotherapy education can enhance learning experiences and is generally welcomed by students, especially when blended with traditional methods. The integration of innovative digital strategies holds promise for the future of physiotherapy training, contingent on comprehensive support and training for educators and students alike.
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Extracorporeal Shock Wave Therapy for Treating Foot Ulcers in Adults With Type 1 and Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Extracorporeal shock wave therapy (ESWT) as a new adjuvant therapy has shown a potential capability to promote diabetic foot ulcer (DFU) healing. The purpose of this study was to assess the efficacy and safety of ESWT on the healing of DFUs. The Cochrane Library, PubMed, Embase, Web of Science, China Biology Medicine and reference lists were searched for studies published up to December 2018. Randomized controlled trials of any design, including ESWT for patients with DFU, were included. Two reviewers extracted data, including the wound surface area (WSA), percentage of re-epithelialization, population of complete cure and unchanged and other related outcomes. Eight randomized controlled trials (N=339) were included. ESWT was found to be associated with a greater reduction of WSA by 1.54 cm2, and increase of re-epithelialization by 26.31%. A greater population with complete cure was found at the end of treatment (risk ratio [RR] = 2.22; 95% confidence interval [CI], 1.46 to 3.40); however, there was no statistically significant difference at the end of follow up (p=0.052). It can also reduce treatment inefficiency by 4.8-fold (95% CI, 0.12 to 0.37). In addition, ESWT also showed a higher superiority than hyperbaric oxygen therapy in the population for complete cure and unchanged ulcer (RR=1.83; 95% CI, 1.14 to 2.94 and RR=0.25; 95% CI, 0.13 to 0.48, respectively). ESWT is a feasible adjuvant treatment for DFUs. It can effectively improve the complete cure rate, shorten the healing period of DFUs and significantly reduce treatment ineffectiveness. This can provide new therapeutic ideas for clinical practice of intractable and recurrent DFUs.
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Medicines management activity with physiotherapy and podiatry: A systematic mixed studies review
Objective: Making best use of existing skills to increase service capacity is a global challenge. The aim was to systematically review physiotherapy and podiatrist prescribing and medicines management activity, including evidence of impact on patient care, levels of knowledge and attitudes towards extended medicines role. Methods: A search of MEDLINE, CINAHL, and Cochrane databases, using terms to identify prescribing and medicines management across a range of roles, was conducted from January 1985 to May 2016 for physiotherapy, and January 1968 to May 2016 for podiatry. Hand searching of citations and databases from professional organisations was undertaken. Data were extracted and analysed descriptively, and quality appraised by 2 reviewers using the mixed methods appraisal tool. Results:1316 papers were identified, and 21 included in the review. No studies were identified that reported prescribing and no studies specific to podiatry met the inclusion criteria. Physiotherapists were highly involved in administering medicines, providing medicines advice, and recommending new medicines. Patient satisfaction, cost and outcomes were equivalent when comparing physiotherapist-led injection therapy to traditional care. Pharmacology knowledge was variable and unmet training needs identified. Conclusion:Medicines management practices were identified in physiotherapy and positive outcomes of extended scope physiotherapy. There was a lack of evidence regarding podiatric practice. Review of educational preparation for medicines management is recommended along with evaluation of medicines management practice.
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Training programmes to improve evidence uptake and utilisation by physiotherapists: a systematic scoping review.
Background: Research training programmes are a knowledge translation (KT) intervention which aim to improve research evidence uptake by clinicians. Whilst KT training programmes have been reported to significantly improve evidence uptake by physiotherapists, it is unclear which aspects of training optimally assist KT into physiotherapy practice. The purpose of the review was to establish the body of evidence regarding KT training programmes to improve physiotherapists' use of evidence-based practice (EBP) and clinical practice guidelines (CPG). Methods: A systematic scoping review was undertaken in line with the adapted Arksey and O'Malley framework. Nine electronic databases (CINAHL, BIOMED CENTRAL, Cochrane, Web of Science, PROQUEST, PUBMED, OTseeker, Scopus, ERIC) were searched. Targeted keywords identified primary research articles of any hierarchy, that described the nature and impact of KT training programmes for physiotherapists. Where systematic reviews were identified, the component primary studies were considered individually for relevance. Critical appraisal was not undertaken due to the nature of a scoping review, and data was reported descriptively. Results: Ten systematic reviews were identified (yielding four relevant primary studies). Five additional primary studies were identified (two randomised controlled trials, two non-randomised controlled trials and one pre-post study) which were not included in the original systematic reviews. This provided nine eligible primary research studies for review. The KT strategies were all multi-faceted. Interactive sessions, didactic sessions, printed material and discussion and feedback were consistently associated with effective outcomes. When KT strategies addressed local barriers to EBP utilisation, there were better success rates for EBP and CPG uptake, irrespective of the outcome measures used. There were no consistent ways of measuring outcome. Conclusion: Multi-faceted KT strategies designed to address local barriers to knowledge translation were most effective in improving EBP/ CPG uptake among physiotherapists.
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Systematic review and meta-analysis in cardiac surgery: a primer.
Purpose of review: The purpose of this article is to review the strengths and weaknesses of systematic reviews and meta-analyses to inform our current understanding of cardiac surgery. Recent findings: A systematic review and meta-analysis of a focused topic can provide a quantitative estimate for the effect of a treatment intervention or exposure. In cardiac surgery, observational studies and small, single-center prospective trials provide most of the clinical outcomes that form the evidence base for patient management and guideline recommendations. As such, meta-analyses can be particularly valuable in synthesizing the literature for a particular focused surgical question. Since the year 2000, there are over 800 meta-analysis-related publications in our field. There are some limitations to this technique, including clinical, methodological and statistical heterogeneity, among other challenges. Despite these caveats, results of meta-analyses have been useful in forming treatment recommendations or in providing guidance in the design of future clinical trials. Summary: There is a growing number of meta-analyses in the field of cardiac surgery. Knowledge translation via meta-analyses will continue to guide and inform cardiac surgical practice and our practice guidelines.
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The effectiveness of physiotherapist-delivered group education and exercise interventions to promote self-management for people with osteoarthritis and chronic low back pain: A rapid review Part I
Background: Osteoarthritis (OA) and chronic low back pain (CLBP) are two of the most common and costly musculoskeletal conditions globally. Healthcare service demands mean that multiple condition group-based interventions are of increasing clinical interest, but no reviews have evaluated the effectiveness of group-based physiotherapy-led self-management interventions (GPSMI) for both conditions. Objectives: This rapid review aimed to evaluate the effectiveness of GPSMI for OA and CLBP. Design: Rapid reviews are an increasingly valid means of expediting knowledge dissemination and are particularly useful for addressing focused research questions. Method: The electronic databases MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Register of Controlled Trials were searched. Structured group-based interventions that aimed to promote self-management delivered by health-care professionals (including at least one physiotherapist) involving adults' with OA and/or CLBP were included. The screening and selection of studies, data extraction and risk of bias assessment were conducted independently by two reviewers. Results: 22 Studies were found (10 OA, 12 CLBP). No significant difference was found between the effectiveness of GPSMI and individual physiotherapy or usual medical management for any outcome. Conclusions: GPSMI is as clinically effective as individual physiotherapy or usual medical management, but the best methods of measuring clinical effectiveness warrant further investigation. Further research is also needed to determine the cost-effectiveness of GPSMI and its implications. (C) 2014 Elsevier Ltd. All rights reserved.
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The effectiveness of physiotherapist-delivered group education and exercise interventions to promote self-management for people with osteoarthritis and chronic low back pain: a rapid review part I.
Background: Osteoarthritis (OA) and chronic low back pain (CLBP) are two of the most common and costly musculoskeletal conditions globally. Healthcare service demands mean that multiple condition group-based interventions are of increasing clinical interest, but no reviews have evaluated the effectiveness of group-based physiotherapy-led self-management interventions (GPSMI) for both conditions. Objectives: This rapid review aimed to evaluate the effectiveness of GPSMI for OA and CLBP. Design: Rapid reviews are an increasingly valid means of expediting knowledge dissemination and are particularly useful for addressing focused research questions. Method: The electronic databases MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Register of Controlled Trials were searched. Structured group-based interventions that aimed to promote self-management delivered by health-care professionals (including at least one physiotherapist) involving adults' with OA and/or CLBP were included. The screening and selection of studies, data extraction and risk of bias assessment were conducted independently by two reviewers. Results: 22 Studies were found (10 OA, 12 CLBP). No significant difference was found between the effectiveness of GPSMI and individual physiotherapy or usual medical management for any outcome. Conclusions: GPSMI is as clinically effective as individual physiotherapy or usual medical management, but the best methods of measuring clinical effectiveness warrant further investigation. Further research is also needed to determine the cost-effectiveness of GPSMI and its implications.
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