Evidence-based practice for rehabilitation professionals: concepts and controversies

Understanding North American yoga therapists' attitudes, skills and use of evidence-based practice: A cross-national survey

INTRODUCTION

Little is known about the adoption of evidence-based practice (EBP) by yoga therapists (YTs).

OBJECTIVE

To determine the attitudes, skills, training, use, barriers and facilitators to the use of EBP amongst North American YTs DESIGN: Cross-sectional, descriptive survey METHODS: Self-identified YTs practicing in North America were invited to participate in an online survey. YT attitudes, skills, training, utilisation, barriers to use, and facilitators of EBP use were measured using the 84-item Evidence-Based practice Attitude and utilization SurvEy (EBASE).

RESULTS

367 members responded (∼20% of eligible participants). Attitudes towards EBP were generally positive with 88% agreeing that professional literature and research findings were useful for the practice of yoga therapy. Most (80%) were interested in improving their skills and the majority agreed that EBP improves the quality of care (68%), assists in making decisions (74%) and takes into account the YTs clinical experience when making clinical decisions (59%). Moderate to moderately-high levels of perceived skill in EBP were reported mostly utilizing online search engines (51%). Lack of clinical evidence was the only notable barrier to uptake reported by YTs (48%). Facilitators to EBP included access to online EBP education materials (70.6%), ability to download full-text journal articles and access to free online databases in the workplace (67.3%).

CONCLUSION

North American YTs report positive attitudes, moderate to moderately-high levels of perceived skill and moderate uptake of EBP. This aligns them with other complementary and integrative health practitioners. Initiatives to support the adoption of EBP are proposed as a means of improving best practice in yoga therapy.

Does somatosensation change with age in children and adolescents? A systematic review

BACKGROUND

Somatosensory modalities, such as touch, proprioception and haptic ability, greatly influence the achievement of developmental milestones for children. Describing somatosensory impairment, natural variability and typical or expected developmental changes across age groups will help establish frameworks for intervention in clinical populations. This systematic review aimed to determine how different somatosensory modalities develop across childhood into adolescence to use as a point of reference for children at risk of somatosensory impairment.

METHODS

Searches of five electronic databases were undertaken through EBSCO-host (MEDLINE, CINAHL, PsycINFO, SPORTDiscus and ERIC) for studies measuring at least one somatosensory modality in typically developing individuals between birth and 18 years and analysed by age. Characteristics of studies were collected including country of origin, sample size, demographics and outcome measure used. Quality assessment and data extraction were performed by two independent reviewers.

RESULTS

Twenty three cross-sectional studies were included from a total of 188 articles retrieved: 8 examined aspects of touch, 5 proprioception and 10 haptic ability. Variability of study designs and variation in assessment tools precluded any formal meta-analysis.

CONCLUSIONS

Somatosensation matures through childhood into adolescence; however, the present review found the pattern of somatosensory development varied depending on the assessment tool used and the aspect of somatosensation being measured, making it difficult to describe typical performance. There is a need for comprehensive assessment batteries to measure the somatosensation, including touch, proprioception and haptic ability, of children at risk of somatosensory impairment to aid in the development of effective interventions.

Building capacity for knowledge translation in occupational therapy: learning through participatory action research

BACKGROUND

There has been widespread acknowledgement of the need to build capacity in knowledge translation however much of the existing work focuses on building capacity amongst researchers rather than with clinicians directly. This paper's aim is to describe a research project for developing a knowledge translation capacity building program for occupational therapy clinicians.

METHODS

Participatory action research methods were used to both develop and evaluate the knowledge translation capacity-building program. Participants were occupational therapists from a large metropolitan hospital in Australia. Researchers and clinicians worked together to use the action cycle of the Knowledge to Action Framework to increase use of knowledge translation itself within the department in general, within their clinical teams, and to facilitate knowledge translation becoming part of the department's culture. Barriers and enablers to using knowledge translation were identified through a survey based on the Theoretical Domains Framework and through focus groups. Multiple interventions were used to develop a knowledge translation capacity-building program.

RESULTS

Fifty-two occupational therapists participated initially, but only 20 across the first 18 months of the project. Barriers and enablers were identified across all domains of the Theoretical Domains Framework. Interventions selected to address these barriers or facilitate enablers were categorised into ten different categories: educational outreach; teams working on clinical knowledge translation case studies; identifying time blocks for knowledge translation; mentoring; leadership strategies; communication strategies; documentation and resources to support knowledge translation; funding a knowledge translation champion one day per week; setting goals for knowledge translation; and knowledge translation reporting strategies. Use of these strategies was, and continues to be monitored. Participants continue to be actively involved in learning and shaping the knowledge translation program across the department and within their specific clinical areas.

CONCLUSION

To build capacity for knowledge translation, it is important to involve clinicians. The action cycle of the Knowledge to Action framework is a useful guide to introduce the knowledge translation process to clinicians. It may be used to engage the department as a whole, and facilitate the learning and application of knowledge translation within specific clinical areas. Research evaluating this knowledge translation program is being conducted.

What influences the implementation of the New Zealand stroke guidelines for physiotherapists and occupational therapists?

Purpose To explore perceived barriers and facilitators to the use of the New Zealand (NZ) stroke guidelines by occupational therapists and physiotherapists. Methods A qualitative descriptive methodology was used. Eligible physiotherapists and occupational therapists (NZ registered, working in one of two hospitals, treating at least 10 patients with stroke in the previous year) were invited to participate in semi-structured interviews to elicit their perceptions of the utility and feasibility of the NZ stroke guidelines and identify barriers and facilitators to their implementation. All interviews were audio-recorded and transcribed. Conventional content analysis with constant comparative methods was used for coding and analysis. Results The main themes influencing guideline implementation were resources and characteristics of the guidelines, the organization, the patient and family and the therapist. Insufficient resources were a major barrier that crossed many of the themes. Participants suggested a range of strategies relating to the organization to improve therapists' alignment to the guidelines. Conclusion Alignment to the guidelines in NZ is influenced both positively and negatively by a range of interacting factors, consistent with other studies. Alignment might be improved by the introduction of some relatively simple strategies, such as ring-fencing time for access to resources and training in the use of the guidelines. Many of the barriers and related interventions are likely to be more complex. Implications for rehabilitation Alignment with stroke guidelines has been shown to improve patient outcomes. Therapist alignment with the implementation of the New Zealand stroke guidelines is influenced by guideline characteristics, organizational characteristics, resources, patient and family characteristics and therapist characteristics. Frequently encountered barriers related to limited resources, particularly time. Ring-fencing regular time for access to resources and training in the use of guidelines are examples of simple strategies that may reduce barriers.

Reliability and validity of the Lower Limb Function Questionnaire when completed by young adult orthotic and prosthetic device users

Purpose The Lower Limb Function Questionnaire (LLFQ) was developed as a self-report assessment of lower-limb functional ability for orthotic and prosthetic (O&P) device users to be suitable for a wide range of conditions, cultures, and ages. The measure aims to address an existing gap in tools for the assessment of functional ability in this population. The purpose of this study is to evaluate LLFQ reliability and validity in a sample of young adult O&P users. Methods Adolescents from a secondary school in Kenya completed the LLFQ twice, 6 d apart, and test-retest reliability was assessed using intra-class correlation coefficients. Validity evaluations involved Timed Up-and-Go, 6-min walk, 6-min obstacle course, and/or spatiotemporal gait assessments. Oxygen consumption was measured during walk tests. Associations between the LLFQ and each measure were evaluated using Pearson correlation coefficients for construct validity. Results LLFQ reliability was acceptable (ICC = 0.79, 95% CIs 0.64-0.89). Construct validity was demonstrated via moderate correlation (r  >  0.60) with obstacle course distance, gait velocity, stride length, and stance/single support/double support percent of gait cycle. Conclusions Both LLFQ reliability and validity were acceptable in the sample of youth in Kenya. Further testing is required to determine applicability in other cultural contexts. Implications for Rehabilitation The LLFQ may be clinically useful across a variety of cultures and conditions to provide feedback on the effectiveness of rehabilitative treatment or assistive devices for youth with lower limb impairments. The LLFQ may enable specific strengths and challenges to lower limb function to be identified to enable planning of well-targeted rehabilitation.

Clinical decision making for using electro-physical agents by physiotherapists, an Israeli survey

Background

Electro-physical agents (EPAs) are fundamental components in the management arsenal of physiotherapy. The objective of this study was to provide a comprehensive understanding of the factors affecting the decisions made by Physiotherapists (PTs) when choosing to apply EPAs as a treatment modality.

Methods

A purpose-designed questionnaire was developed to investigate the contribution of 13 factors on the decision to use EPAs. Two hundred questionnaires were randomly distributed to PTs attending the annual conference of the Israeli Physiotherapy Society, 2014. The factors were grouped into six categories and Wilcoxon Sign Rank tests were applied to compare their impact on decision making.

Results

In total, 144 (72%) questionnaires were completed. Good internal consistency was found for the 13 component of the decisions factors (Cronbach’s coefficient alpha = 0.77) with unequal distribution of answers in each question (p < 0.01).

Eighty-one percent of the participants reported past experience, and 55 % mentioned research evidence as strong or very strong factors which influence their decision to use of EPAs. However, only 38% of the participants reported patients’ preferences as a strong or very strong factor. Comparisons between the six categories of the decision factors determined three levels of impact (rank scores) which were significantly different from each other (p < 0.01). Availability of equipment ranked the highest. The lowest level of impact included two categories, technology related issues and patients’ and physicians’ preferences.

Conclusion

The participating PTs were likely to make decisions which were strongly impacted by availability of equipment and operational factors. This research can be used to provide practicing PTs with a basis for a critical appraisal of their decision making regarding the application of EAPs. In addition, due to the strong impact of availability of equipment, health policy makers should verify that the available equipment is up to date with the best research evidence.

Facilitating interprofessional evidence-based practice in paediatric rehabilitation: development, implementation and evaluation of an online toolkit for health professionals

PURPOSE

Lack of time, competencies, resources and supports are documented as barriers to evidence-based practice (EBP). This paper introduces a recently developed web-based toolkit designed to assist interprofessional clinicians in implementing EBP within a paediatric rehabilitation setting.

METHODS

EBP theory, models, frameworks and tools were applied or adapted in the development of the online resources, which formed the basis of a larger support strategy incorporating interactive workshops, knowledge broker facilitation and mentoring.

RESULTS

The highly accessed toolkit contains flowcharts with embedded information sheets, resources and templates to streamline, quantify and document outcomes throughout the EBP process. Case examples relevance to occupational therapy and physical therapy highlight the utility and application of the toolkit in a clinical paediatric setting. Workshops were highly rated by learners for clinical relevance, presentation level and effectiveness. Eight evidence syntheses have been created and 79 interventions have been evaluated since the strategy's inception in January 2011.

CONCLUSIONS

The toolkit resources streamlined and supported EBP processes, promoting consistency in quality and presentation of outputs. The online toolkit can be a useful tool to facilitate clinicians' use of EBP in order to meet the needs of the clients and families whom they support. Implications for Rehabilitation A comprehensive online EBP toolkit for interprofessional clinicians is available to streamline the EBP process and to support learning needs regardless of competency level. Multi-method facilitation support, including interactive education, e-learning, clinical librarian services and knowledge brokering, is a valued but cost-restrictive supplement to the implementation of online EBP resources. EBP resources are not one-size-fits-all; targeted appraisal tools, models and frameworks may be integrated to improve their utility for specific sectors, which may limit them for others.

The contribution of conceptual frameworks to knowledge translation interventions in physical therapy

There is growing recognition of the importance of knowledge translation activities in physical therapy to ensure that research findings are integrated into clinical practice, and increasing numbers of knowledge translation interventions are being conducted. Although various frameworks have been developed to guide and facilitate the process of translating knowledge into practice, these tools have been infrequently used in physical therapy knowledge translation studies to date. Knowledge translation in physical therapy implicates multiple stakeholders and environments and involves numerous steps. In light of this complexity, the use of explicit conceptual frameworks by clinicians and researchers conducting knowledge translation interventions is associated with a range of potential benefits. This perspective article argues that such frameworks are important resources to promote the uptake of new evidence in physical therapist practice settings. Four key benefits associated with the use of conceptual frameworks in designing and implementing knowledge translation interventions are identified, and limits related to their use are considered. A sample of 5 conceptual frameworks is evaluated, and how they address common barriers to knowledge translation in physical therapy is assessed. The goal of this analysis is to provide guidance to physical therapists seeking to identify a framework to support the design and implementation of a knowledge translation intervention. Finally, the use of a conceptual framework is illustrated through a case example. Increased use of conceptual frameworks can have a positive impact on the field of knowledge translation in physical therapy and support the development and implementation of robust and effective knowledge translation interventions that help span the research-practice gap.

Turning evidence into practice: Barriers to research use among occupational therapists

Introduction

Research has demonstrated that occupational therapists generally have a positive attitude regarding the use of evidence in their daily practice and decision-making. In addition, occupational therapists are expected to implement evidence-based practice, which is often understood as equivalent to research. However, evidence-based practice might be difficult to reconcile with occupational therapy from a client-centred focus. This study examines what occupational therapists perceive as barriers to research use and discusses the challenge of clinical implementation.

Method

This study uses a descriptive cross-sectional design. The Barriers to Research Utilization Scale questionnaire was mailed to 807 randomly selected Swedish occupational therapists. The response rate was 59%.

Findings

The occupational therapists identified three main barriers to the use of research: insufficient facilities (82%); lack of time to read research (77%); difficulty understanding statistical analyses (75%). Degree of education was shown to affect results; occupational therapists with higher education levels indicated a higher use of research.

Conclusion

Implementing research in clinical practice is a challenge. Occupational therapists are interested but they lack the optimal prerequisites and time.

Knowledge Translation of the Gross Motor Function Classification System Among Pediatric Physical Therapists

PURPOSE

To learn where pediatric physical therapists in the United States are in the process of knowledge translation of the Gross Motor Function Classification System (GMFCS).

METHODS

Links to an online survey were distributed electronically.

RESULTS

All 283 respondents reported hearing about the GMFCS, 95% agreed it was useful, 81% reported they were confident in their ability to use it, 77% reported they use it, and 42% reported they use it consistently. Therapists primarily used the GMFCS to predict gross motor function, set realistic goals, and anticipate need for assistive technology. The American Physical Therapy Association Section on Pediatrics members were more likely than nonmembers to agree the GMFCS is useful, they are able to use it, that they use it, and that they use it consistently.

CONCLUSIONS

The majority of therapists responding use the GMFCS, but not consistently.

VIDEO ABSTRACT

For more insights from the authors, see Supplemental Digital Content 1, available at http://links.lww.com/PPT/A91.

Postacute rehabilitation quality of care: toward a shared conceptual framework

There is substantial interest in mechanisms for measuring, reporting, and improving the quality of health care, including postacute care (PAC) and rehabilitation. Unfortunately, current activities generally are either too narrow or too poorly specified to reflect PAC rehabilitation quality of care. In part, this is caused by a lack of a shared conceptual understanding of what construes quality of care in PAC rehabilitation. This article presents the PAC-rehab quality framework: an evidence-based conceptual framework articulating elements specifically pertaining to PAC rehabilitation quality of care. The widely recognized Donabedian structure, process, and outcomes (SPO) model furnished the underlying structure for the PAC-rehab quality framework, and the International Classification of Functioning, Disability and Health (ICF) framed the functional outcomes. A comprehensive literature review provided the evidence base to specify elements within the SPO model and ICF-derived framework. A set of macrolevel-outcomes (functional performance, quality of life of patient and caregivers, consumers' experience, place of discharge, health care utilization) were defined for PAC rehabilitation and then related to their (1) immediate and intermediate outcomes, (2) underpinning care processes, (3) supportive team functioning and improvement processes, and (4) underlying care structures. The role of environmental factors and centrality of patients in the framework are explicated as well. Finally, we discuss why outcomes may best measure and reflect the quality of PAC rehabilitation. The PAC-rehab quality framework provides a conceptually sound, evidence-based framework appropriate for quality of care activities across the PAC rehabilitation continuum.

Are Established Methods of Physiotherapeutic Management for Long-term Neurological Conditions Applicable to 'Orphan' Conditions such as Syringomyelia?

BACKGROUND AND PURPOSE

Syringomyelia is a rare or 'orphan' condition with the potential to cause significant disability and detrimental effects to quality of life. Syringomyelia shares similar symptoms to those common in other long-term neurological conditions, including spinal cord injury and multiple sclerosis. In these more prevalent conditions, physiotherapy is utilized widely and is effective in optimizing physical, psychological and social parameters. Therefore, we theorized that physiotherapy might be transferable to, and beneficial to syringomyelia patients. As a paucity of literature exists in this area, we aimed to evaluate the existing uptake and perceived efficacy of physiotherapy.

METHODS

An exploratory, mixed methodology was selected to derive sufficient qualitative data for analysis. Specifically designed questionnaires and semi-structured interviews yielded data on uptake and perceived physiotherapy efficacy. One hundred patients from a National Health Service tertiary syringomyelia service were invited to participate.

RESULTS

The questionnaire and interviews were completed by 49 and 20 patients, respectively. Of the small number of patients receiving physiotherapy, the majority reported beneficial effects on pain modulation and quality of life. Stretching and hydrotherapy were deemed effective for relief of pain and stiffness. Additionally, physiotherapy was reported to provide similar benefits to surgical intervention.

DISCUSSION

Syringomyelia patients report physiotherapy to provide benefits for symptom management and quality of life. Such findings suggest that established rehabilitation techniques in more common conditions may be transferable to those less prevalent. Uptake of physiotherapy was limited, seemingly because of inadequate information, knowledge and resources. To address these deficiencies, further studies should be planned investigating the effectiveness of physiotherapy modalities, such as hydrotherapy, in parallel or in conjunction with surgery and/or pharmacology. Additionally, syringomyelia could be represented alongside similar pathologies in research trials to initiate further research questions and drivers for funding.

A case for the implementation of cognitive-communication screenings in acute stroke

PURPOSE

The purpose of this article was to illustrate the importance of the implementation of cognitive-communication screenings in acute stroke and to discuss the need for further research on whether and how these screenings are implemented. Cognitive-communication screenings after stroke are the subject of existing practice guidelines and are supported by accumulated evidence.

METHOD

The author uses an autoethnographic narrative--a tool founded in phenomenology--to provide an in-depth description of the experiences of a family in which one member experienced right-hemispheric stroke. She uses systematic introspection to produce a narrative using literary techniques.

RESULTS

The narrative illustrates the experiences of one family when one of their members has a right-hemisphere stroke, and cognitive-communication impairments are never formally identified by professionals involved in the patient's care.

CONCLUSIONS

The narrative is linked to the published literature and the importance of identifying and managing cognitive-communication impairments after stroke. A model of implementation science is presented as one way to consider the challenges clinicians face when attempting to implement evidence-based practices. The model and examples from other fields show avenues for further research.

Development and outcomes of a program to translate the evidence for spinal manipulation into physical therapy practice

OBJECTIVES

To describe a program to translate evidence into practice for the use of manipulation with a sub-group of patients with low back pain and report the program's outcomes following implementation. We compared outcomes based on appropriate inclusion in the program and compliance with the evidence being translated.

METHODS

The evidence translation program was based on evidence that patients meeting two criteria (duration of symptoms <16 days, no symptoms distal to knee) were likely to respond to a physical therapy that included manipulation in the first two visits. Implementation addressed potential barriers with referring physicians, physical therapists, and scheduling staff to this evidence. Outcomes for patients in the program were tracked following implementation. Process outcomes were appropriateness of inclusion (met both criteria), compliance with evidence for providing thrust manipulation in the first two visits, and number of physical therapy visits. Clinical outcomes were based on Oswestry scores from the first, interim (after two to three visits), and final visit.

RESULTS

A total of 577 patients entered the evidence translation program (mean age  =  43.0, 56.8% female); 79.5% were appropriate inclusions and 83.0% received manipulation. The use of manipulation was associated with fewer visits (mean difference  =  0.54 visits, 95% CI: 0.037, 1.04, P  =  0.035), and appropriate inclusion was associated with greater Oswestry change (mean difference at the final visit  =  6.6 points, 95% CI: 1.6, 11.6; P  =  0.010).

DISCUSSION

Implementing evidence into practice is difficult; however, barriers can be anticipated and overcome. Tracking the outcomes of an implementation program is critical to evaluating its benefit to patients. Additional research using experimental designs are necessary to evaluate the effectiveness of various treatments implemented in physical therapy practice.

Attitudes toward evidence-based clinical practice among doctors of chiropractic with diplomate-level training in orthopedics

Background

Evidence-based clinical practice (EBCP) is a practice model gaining prominence within healthcare, including the chiropractic profession. The status of EBCP has been evaluated in a variety of healthcare disciplines, but little is known regarding the attitudes doctors of chiropractic (DCs) hold toward this model of healthcare. This project examines the attitudes toward EBCP within a specialty discipline of DCs.

Methods

We identified a survey questionnaire previously used to evaluate EBCP among non-chiropractic complementary and alternative practitioners. We adapted this questionnaire for use among DCs and pretested it in 5 chiropractic college faculty. The final version was administered to DCs with diplomate-level training in orthopedics. The survey was emailed to 299 potential participants; descriptive results were calculated.

Results

144 surveys were returned, resulting in a 48% response rate. The majority of respondents perceived EBCP as an important aspect of chiropractic practice. Respondents also believed themselves to have an above average skill level in EBCP, reported that training originated from their diplomate education, and based the majority of their practice on clinical research.

Conclusion

Doctors of chiropractic with an orthopedic diplomate appear to have favorable attitudes toward EBCP. Further study will help understand EBCP perceptions among general field DCs. A logical next step includes validation of this questionnaire.

Measuring up to speech intelligibility

Improvement or maintenance of speech intelligibility is a central aim in a whole range of conditions in speech-language therapy, both developmental and acquired. Best clinical practice and pursuance of the evidence base for interventions would suggest measurement of intelligibility forms a vital role in clinical decision-making and monitoring. However, what should be measured to gauge intelligibility and how this is achieved and relates to clinical planning continues to be a topic of debate. This review considers the strengths and weaknesses of selected clinical approaches to intelligibility assessment, stressing the importance of explanatory, diagnostic testing as both a more sensitive and a clinically informative method. The worth of this, and any approach, is predicated, though, on awareness and control of key design, elicitation, transcription and listening/listener variables to maximize validity and reliability of assessments. These are discussed. A distinction is drawn between signal-dependent and -independent factors in intelligibility evaluation. Discussion broaches how these different perspectives might be reconciled to deliver comprehensive insights into intelligibility levels and their clinical/educational significance. The paper ends with a call for wider implementation of best practice around intelligibility assessment.

Developing a framework to generate evidence of health outcomes from social media use in chronic disease management

Background

While there is an abundance of evidence-based practice (EBP) recommendations guiding management of various chronic diseases, evidence suggesting best practice for using social media to improve health outcomes is inadequate. The variety of social media platforms, multiple potential uses, inconsistent definitions, and paucity of rigorous studies, make it difficult to measure health outcomes reliably in chronic disease management. Most published investigations report on an earlier generation of online tools, which are not as user-centered, participatory, engaging, or collaborative, and thus may work differently for health self-management.

Objective

The challenge to establish a sound evidence base for social media use in chronic disease starts with the need to define criteria and methods to generate and evaluate evidence. The authors’ key objective is to develop a framework for research and practice that addresses this challenge.

Methods

This paper forms part of a larger research project that presents a conceptual framework of how evidence of health outcomes can be generated from social media use, allowing social media to be utilized in chronic disease management more effectively. Using mixed methods incorporating a qualitative literature review, a survey and a pilot intervention, the research closely examines the therapeutic affordances of social media, people with chronic pain (PWCP) as a subset of chronic disease management, valid outcome measurement of patient-reported (health) outcomes (PRO), the individual needs of people living with chronic disease, and finally translation of the combined results to improve evidence-based decision making about social media use in this context.

Results

Extensive review highlights various affordances of social media that may prove valuable to understanding social media’s effect on individual health outcomes. However, without standardized PRO instruments, we are unable to definitively investigate these effects. The proposed framework that we offer outlines how therapeutic affordances of social media coupled with valid and reliable PRO measurement may be used to generate evidence of improvements in health outcomes, as well as guide evidence-based decision making in the future about social media use as part of chronic disease self-management.

Conclusions

The results will (1) inform a framework for conducting research into health outcomes from social media use in chronic disease, as well as support translating the findings into evidence of improved health outcomes, and (2) inform a set of recommendations for evidence-based decision making about social media use as part of chronic disease self-management. These outcomes will fill a gap in the knowledge and resources available to individuals managing a chronic disease, their clinicians and other researchers in chronic disease and the field of medicine 2.0.

Community-university partnerships in occupational therapy education: a preliminary exploration of practice in a European context

AIM

To explore community-university partnerships in occupational therapy education in Europe.

METHOD

Educators from Europe were invited to participate in the study. Data were collected using a questionnaire designed for the study. Eleven completed questionnaires were included. Descriptive statistics were generated from quantitative data while qualitative data were analyzed using inductive content analysis.

RESULTS

The majority of participants reported that community-university partnerships were part of the third year of undergraduate occupational therapy studies. Partners were from a broad range of sectors. The activities undertaken were typically focused on specific target groups within the community. Three main themes emerged from the qualitative analysis (i) instigating community-university partnerships, (ii) processes of creating and sustaining partnerships and (iii) perceived outcomes of community-university partnerships.

CONCLUSIONS

This is the first study of community-university partnerships in Europe generating some useful findings. Clarification is needed regarding the use of the term community-university partnership. Educators are called upon to consider how partnerships are embedded into curricula and to address issues of sustainability.

IMPLICATIONS FOR REHABILITATION

Healthcare education should prepare rehabilitation professionals to collaborate with diverse communities. Community--university collaborations appear to offer opportunities to support students to develop competences for future community orientated practice. Key issues to be considered include choice of pedagogical approach, issues of reciprocity and sustainability.

Sports and exercise-related tendinopathies: a review of selected topical issues by participants of the second International Scientific Tendinopathy Symposium (ISTS) Vancouver 2012

In September 2010, the first International Scientific Tendinopathy Symposium (ISTS) was held in Umeå, Sweden, to establish a forum for original scientific and clinical insights in this growing field of clinical research and practice. The second ISTS was organised by the same group and held in Vancouver, Canada, in September 2012. This symposium was preceded by a round-table meeting in which the participants engaged in focused discussions, resulting in the following overview of tendinopathy clinical and research issues. This paper is a narrative review and summary developed during and after the second ISTS. The document is designed to highlight some key issues raised at ISTS 2012, and to integrate them into a shared conceptual framework. It should be considered an update and a signposting document rather than a comprehensive review. The document is developed for use by physiotherapists, physicians, athletic trainers, massage therapists and other health professionals as well as team coaches and strength/conditioning managers involved in care of sportspeople or workers with tendinopathy.