New Zealand Journal of Physiotherapy

A paradigm shift in sternal precautions and postoperative care after cardiac surgery: Are we there yet?

Emily Gray — 2024-12-03

What are possible reasons for the different choices of low back pain healthcare between European, Māori, and Pasifika for services funded by the Accident Compensation Corporation?

Nicola Saywell — 2024-12-03

Aotearoa New Zealand has a unique funding model in the Accident Compensation Corporation (ACC), for those who have an injury. The ACC funds a range of healthcare practitioners to treat low back pain from accidental causes and the costs continue to rise. However, there are clear ethnic differences in the services accessed. Data were obtained from ACC and analysed to observe trends in the number of claims and the cost per claim over an 11-year period. The three key findings were: (a) Māori and Pasifika have a lower number of claims than their European counterparts, proportional to population; (b) Māori have fewer claims, but a higher cost per claim than other ethnic groups; and (c) Māori and Pasifika use GP services most frequently, whereas Europeans use physiotherapy. Several factors are potential drivers of these differences, including cost of services leading to delay in seeking help, lack of culturally appropriate information about services, lack of culturally appropriate services, and disproportionately low numbers of Māori and Pasifika in the healthcare workforce. Possible solutions include earlier referral for physiotherapy, building connections with patients, and embracing principles of health models, Te Whare Tapa Whā (Māori) and Fonofale (Pasifika) (which describe the essential elements for health: spiritual, physical, mental and emotional, family, and social).

Aotearoa New Zealand Tongan residents’ attitudes to chronic cough and access to healthcare

Angela Upsdell — 2024-12-03

Little is known about the unique attitudes of Aotearoa New Zealand Tongan residents to chronic cough and healthcare access. Chronic cough is synonymous with respiratory conditions and delayed assessment and management may result in detrimental effects on quality of life, hospital admission, and mortality. Talanoa were undertaken with seven Tongan adults to explore attitudes to chronic cough and healthcare access that may facilitate or inhibit diagnosis and management. Three key themes were constructed representing disruption to dimensions of the Fonua model of health and an imbalance between the interconnectivity of life’s dimensions: (1) “feeling the cold” and the “warmth of remedies”; (2) the multidimensional impact of cough and action/inaction taken; and (3) discrepancies between understanding and accessing cough care, including respiratory physiotherapy. Study findings highlight the importance of increased community understanding of chronic cough and why and how to better access care pathways. Appreciation of the unique cultural nuances and health models of diverse patient populations, including Tongan, is essential to enhance engagement and ensure culturally responsive practice is provided. The promotion and marketing of respiratory physiotherapy in cough management is also required so that people understand, access, and engage with therapies to optimise their respiratory health.

Pasifika parents’ experiences of neonatal skin-to-skin: Insight into culturally responsive care

Cheree Taylor — 2024-12-03

Infants who survive prematurity have greater risk of neurodevelopmental impairments. Skin-to-skin during the neonatal period can improve infant outcomes. Greater understanding of Pasifika parents needs in implementing skin-to-skin could inform better implementation of skin-to-skin. This study explores Pasifika parents’ experiences of skin-to-skin with their preterm infants in New Zealand-based neonatal units to inform culturally responsive care and service delivery. Pasifika parents of preterm infants born less than 33 weeks gestation were eligible to take part in interviews. Recruitment and data collection occurred in neonatal units across Auckland. Interpretive Phenomenological analysis informed by Talanoa and Tui Kakala research methods informed the interview format and data analysis. Five themes were identified: “overcoming fear and anxiety”, “connection”, “words matter”, “actively managing racial bias”, and “spirituality and religious beliefs facilitate resilience”. Skin-to-skin promoted connection and strengthened all four pou of the Fonofale model. Communication styles of individual clinicians greatly influenced the Vā (relational space) experienced by families, which subsequently affected their experience of skin-to-skin. Findings indicate the need for Pasifika cultural competence training in order to provide culturally safe care when supporting an intervention like skin-to-skin. Intentionally encouraging and facilitating Pasifika parents’ spirituality within the neonatal intensive care unit could optimise skin-to-skin. Clinician communication has the potential to affect the initiation, uptake, and experience of skin-to-skin.

Inpatient stroke rehabilitation activity: Barriers, enablers, and changes in activity behaviour with diary use

Georgia Manning — 2024-12-03

The Australian Stroke Foundation guidelines recommend participation in at least 3 hours of physical and occupational therapy daily during stroke rehabilitation. The majority of services in Australia do not currently meet this guideline. This study explored the usefulness of activity diary implementation in increasing activity during inpatient stroke rehabilitation and identified barriers and enablers to activity level guideline adherence, as perceived by clinicians. Using a mixed-methods, longitudinal embedded-design study, two participant cohorts were recruited: people undergoing inpatient stroke rehabilitation and stroke rehabilitation clinicians. Behaviour mapping pre- and post-implementation of activity diaries measured inpatient activity levels. Clinician surveys assessed enablers and barriers to inpatient activity level guideline adherence, both pre- and post-implementation. Twelve adults undergoing inpatient stroke rehabilitation were included. Trends toward reduced time spent sedentary (d = –0.797, 95% confidence interval (CI) [–1.811, 0.217]), increased independent ADL practice (d = 0.861, 95% CI [–0.159, 1.88]), and lower limb active practice were noted after diary implementation (d = 0.778, 95% CI [–0.234, 1.791]). Sixteen clinicians completed 14 pre-diary implementation and nine post-implementation surveys. The main themes identified as clinician-perceived barriers to activity level guideline adherence included de-prioritisation of activity, staff shortages, caseload demands, lack of family and patient-friendly resources, and stroke-related factors. The facilitators included activity diaries, behaviour change, and multidisciplinary communication. Active time among people undergoing inpatient stroke rehabilitation increased after implementation of the diaries. Despite the identified institutional barriers to inpatient activity engagement, activity diaries may assist in promoting an increase in activity among people undergoing inpatient stroke rehabilitation.

The effect of menstrual cycle phase-based rehabilitation for females following anterior cruciate ligament reconstruction: A randomised controlled trial

Emma O'Loughlin — 2024-12-03

Research reports that follicular phase-based resistance training, where females predominantly perform resistance training in the first half of their menstrual cycle (MC), appears to result in better responses than regular training. The objective of this study was to compare the effects of MC phase-based rehabilitation (MCPBR) versus usual care (UC), following anterior cruciate ligament reconstruction (ACLR). Forty-three females participated in a 12-week intervention commencing six weeks post-ACLR. The primary outcome was knee extension strength limb symmetry index (LSI), and the secondary outcome was self-reported function (measured using the Knee Injury and Osteoarthritis Outcome Score, International Knee Documentation Committee Questionnaire, and Knee Self Efficacy Scale), measured at baseline and endpoint. Participants were randomly assigned to MCPBR (n = 21) or UC (n = 22). Participants’ MCs were monitored using calendar tracking, basal body temperature tracking, and urinary ovulation testing. Thirty-six females provided data for the final analysis. The M (SD) knee extension LSI for participants following MCPBR was 81.2% (13.2%), compared to 73.5% (21.8%) for those following UC (p = 0.17). The M (SD) one repetition maximum knee extension of the injured leg was 38.8 kg (14.1 kg) following MCPBR and 30.4 kg (11.7 kg) following UC (p = 0.06). Self-reported function was similar between groups. The findings of this study show that MCPBR and UC result in similar knee extension LSI and function and therefore do not support the recommendation of MCPBR for ACL rehabilitation in a New Zealand context. Future research should investigate females’ experience of MCPBR following ACLR.

Development of an entrustable professional activities framework for physiotherapists working in orthopaedic triage and assessment roles in New Zealand

Angela Cadogan — 2024-12-03

In New Zealand, an increasing number of physiotherapists have been engaged in orthopaedic triage and assessment (OTA) roles within elective orthopaedic departments to help optimise surgeon clinic time and improve timely access to diagnostic assessment and treatment planning for people with musculoskeletal conditions. To date no framework has been available to guide physiotherapists and surgeons in developing these roles. This commentary describes the development of an Entrustable Professional Activity (EPA) framework for physiotherapists in OTA roles in which five key clinical activities were identified. The framework defines the context, limitations, knowledge, skills, attributes, and behaviours needed for each activity. The EPAs were mapped to existing New Zealand physiotherapy competencies and key competencies identified that are needed for safe and effective practice with minimal or no supervision. This EPA framework is intended for use in elective orthopaedic departments, to support the development of physiotherapists working in orthopaedic triage and assessment roles in clinical subspecialty areas.

Collaborative goal setting for children with disability within education: A scoping review

Leanne Robinson — 2024-12-03

Successful collaborative goal setting for disabled children is an essential part of family-centred practice (FCP). There is a paucity of research that collates concepts or approaches to collaborative goal setting. This scoping review aimed to explore key features and the application of collaborative goal setting frameworks and approaches used in an educational context for disabled children and their families. Ten databases were systematically searched using the keywords and synonyms of collaboration, goal setting, children, and disability from 2000 to January 2023. Data were collated and analysed thematically. Twenty-four studies were included for review and four key elements were identified as supporting collaborative FCP: (a) adopting a child-centred approach to enhance the child’s strengths and dreams; (b) using goal-setting tools to identify the child’s current ability; (c) applying structured processes to achieve collaborative family-centred practice; and (d) accessing external support during collaborative goal setting. A new working model was developed from the findings, which describes collaborative constructs and practical strategies for child-centred goal setting. Exploration and use of this model may support professionals to enhance collaborative family-centred goal-setting practice.