Experiences of Australian podiatrists working through the 2020 coronavirus (COVID-19) pandemic: an online survey

Allied health service delivery in residential aged care and the impact of the coronavirus (COVID-19) pandemic: a survey of the allied health workforce

Objectives Industry reports suggest that routine and essential care in Australian residential aged care (RAC), including allied health (AH) services, were disrupted during the coronavirus diseas 2019 (COVID-19) pandemic. This study aimed to explore whether AH services in RAC were paused during the pandemic, factors associated with a pause in care delivery, and qualitative details on how COVID-19 impacted AH service delivery. Methods A 26-question survey was distributed via social media, health service providers, and AH networks between February and April 2022. Participation was restricted to AH professionals and assistants with experience in RAC during the pandemic. A mix of closed and open-ended response questions was used to collect demographic data and experiences of delivering care during the pandemic. Quantitative responses were analysed with descriptive statistics and a probit model. Content analysis was performed on open-ended questions. Results One hundred and four AH professionals and assistants responded to the survey. Fifty-five percent of participants (n  = 51) were contractually or casually employed. AH services were negatively impacted by the pandemic with 52% of respondents experiencing a pause in service delivery and 78% reporting poorer AH care quality. In a probit model, contracted/casually employed respondents were more likely to experience a pause in care delivery (1.03, P  < 0.05) compared to permanently employed AH professionals. Conclusion Insecure work arrangements may have exacerbated inconsistent care during the pandemic (impacting residents) and may have negative implications on the RAC AH workforce. In the future, an AH inclusive workforce policy including data collection and research is required to monitor and plan the RAC workforce.

The effect of COVID-19 lockdowns on exercise and the role of online exercise in Australians with multiple sclerosis

INTRODUCTION

Regular exercise is beneficial for people with Multiple Sclerosis (MS), regardless of disability level. The previously reported differential effect of COVID-19-related lockdowns on exercise levels in this population remains unexplained. We examined effects of lockdowns on exercise in Australians with MS according to disability levels, lockdown severity and health technology use.

METHODS

A cross-sectional survey of people with MS in Australia (22 April-23 September 2021) collected demographic and clinical information as well as exercise patterns before and during lockdowns. Mann-Whitney was used to compare ordinal data and Likelihood Ratio to compare dichotomous data.

RESULTS

151 people completed the survey. 72.2% had mild disability and 25.2% moderate disability. Extended lockdowns were associated with significantly decreased sedentary behaviour (31.5% to 25.9%) but also with decreased exercise frequency in frequent exercisers (≥3 times/week; 53.7% to 22.2%). The latter occurred significantly more in those with mild disability (-22.7%) than with moderate disability (-3.5%). More people with mild disability walked for exercise pre-pandemic (LR 8.6, p=.004) and during lockdowns (LR 6.6, p=.010). Walking during lockdowns was positively associated with working from home. People with moderate disability were more likely to engage in home exercise both pre-pandemic (LR 5.5, p=.019) and during lockdown (LR 5.2, p=.023). Engagement in home exercise rose for both groups during lockdowns and was facilitated by on-line exercise classes.

CONCLUSION

Lockdowns differentially affected exercise patterns according to disability level. The proportion of people achieving exercise recommendations decreased more in those with mild but not moderate disability. Incidental physical activity was disproportionately impacted in people with moderate disability.

The indirect impact of COVID-19 pandemic on limb preservation care- a retrospective analysis of trends in lower limb revascularisation

BACKGROUND

Disruptions caused by COVID-19 pandemic have profoundly influenced the management of many conditions, especially vascular pathologies including limb preservation care. The aim of this study is to evaluate the impact of the pandemic on patients with peripheral arterial disease (PAD) focusing on lower limb revascularisation procedure volume, their indication and urgency of surgery.

METHODS

The Australian Vascular Audit (AVA) was used to capture data on revascularisation procedures before and after the onset of the pandemic in Victoria, Australia. Information on patient demographics, procedures performed, their indication and urgency of surgery were collected.

RESULTS

There was a significant 22.7% increase in revascularisations for PAD during the COVID-19 pandemic, driven solely by a 31.9% increase in endovascular revascularisation procedures. Revascularisation procedures for all indications of PAD, namely claudication, rest pain and tissue loss, increased by 14.8%, 39.2% and 27.4% respectively, during the pandemic compared to pre-pandemic times. Open procedures declined by 10.2% during the pandemic. There were significant 13.9% and 62.2% increases in elective and semi-urgent revascularisations respectively during the pandemic while emergency revascularisations for PAD fell by 4.2%. There were no significant increases in toe, forefoot or below knee amputations during the pandemic compared to pre-pandemic times.

CONCLUSIONS

This study found that the volume of revascularisation for PAD increased significantly during the pandemic indicating that patients with PAD had significant deterioration of their condition during the pandemic. This is likely multifactorial; due to disruptions to standard provision of podiatry, vascular surgery and endocrinology services to these patients, a decline in overall health and changes in health-related behaviours due to restrictions and infection control methods imposed during the pandemic. The number of elective and semi-urgent procedures also increased during the pandemic which reflects the significant deterioration of PAD patients during the pandemic. This study highlights a concerning trend of worsening PAD when routine care of these patients is disrupted. Such data should be instrumental in contingency planning and resource allocation for managing the ongoing pandemic.

Australian podiatry workforce: findings from the PAIGE cross-sectional study of Australian podiatrists

BACKGROUND

Understanding the dynamics of the podiatry workforce is essential for the sustainability of the profession. This study aimed to describe the podiatry workforce characteristics and identify factors associated with rural practice location.

METHODS

We used an exploratory descriptive design from data obtained during cross sectional study: Podiatrists in Australia: Investigating Graduate Employment through four online surveys (2017-2020). Demographic and workplace characteristics including career development were described. Univariate logistic regressions were used to determine associations with rural or metropolitan practice location.

RESULTS

Data were included from 1, 135 podiatrists (21% of n = 5,429). There were 716 (69% of n = 1,042) females, 724 (65% of n = 1,118) worked in the public health service and 574 (51% of 1,129) were salaried employees. There were 706 (87% of n = 816) podiatrists with access to paid annual leave and 592 (72% of n = 816) to paid sick leave. There were 87 (32% of n = 276) podiatrists who reported 51-75% of workload involved Medicare bulk-billed Chronic Disease Management plans, and 324 (74% of n = 436) not utilising telehealth. The majority of podiatrists (57% of n = 1,048) indicated their average consultation length was 21 -30 min, and patients typically waited < 3 days for an appointment (41% of n = 1,043). Univariate logistic regression identified podiatrists working in metropolitan settings have less years working in current location (OR = 0.98, 95% CI = 0.96, 0.99), less working locations (OR = 0.91, 95% CI = 0.86, 0.97), were less likely to have access to paid annual leave (OR = 0.65, 95% CI = 0.43, 0.98), and paid sick leave (OR = 0.65, 95% CI = 0.46, 0.95), shorter waiting periods for appointments (OR = 0.44, 95% CI 0.30, 0.64) and more likely to utilise telehealth within their practice (OR = 2.03, 95% CI 1.19, 3.50) than those in rural locations.

CONCLUSION

These results provide insight into the profession uncommonly captured in workforce planning data. This included the number of working locations, billing practices and wait lists. This also highlights opportunities to promote rural training pathways, service integration to build attractive podiatry positions that are tailored to meet the needs of rural communities and solutions to make telehealth more accessible to podiatrists.

Investigation of concussion knowledge and attitudes of Chinese amateur adolescent soccer athletes

Concussions are a common traumatic brain injury in soccer games but are often ignored by coaches and athletes. The purpose of our study is to assess the concussion knowledge and attitudes among amateur adolescent soccer athletes in China. Data was collected from questionnaire surveying (Rosenbaum Concussion Knowledge and Attitudes Survey (Student Version)) and semi-structured interviews completed by 69 amateur adolescent soccer athletes who participated in the U17 and U15 male groups of the 2022 China Youth Soccer League. The study followed a mixed methodology cross sectional study design. The concussion knowledge index (0-25) and concussion attitude index (15-75) scores were derived from the questionnaire and descriptive statistics were used for data analysis. The mean score of concussion knowledge is 16.8 ± 2.4 (range 10-22), and the mean score of concussion attitude is 61.3 ± 8.8 (range 45-77). Thematic analysis was used to categorize the participant's responses of the semi-structured interview and the results were compared with their survey answers of questionnaire. Interestingly, the interviews revealed the inconsistencies between the questionnaire responses and intended behaviors, and multiple factors (injury severity, the importance of the game and substitution rules) influencing concussion-reporting behaviors were identified. In addition, athletes hope to acquire concussion knowledge through formal education. Our study lay the foundation for educational interventions to potentially improve concussion-reporting behaviors among amateur adolescent soccer athletes.

Clinical supervision in podiatry in Australia and New Zealand: supervisor challenges in this role

BACKGROUND

Clinical supervisors play an integral role in preparing podiatry graduates for clinical practice. Not enough is, however, known about how prepared podiatry clinical supervisors are for this role, in terms of training received and the challenges they face in the role. Informed by previous qualitative research, this study extends our understanding of what it means to be a clinical supervisor in podiatry.

METHODS

An online survey comprising closed and open-ended questions gathered data from 67 registered podiatrists who were also clinical supervisors. Descriptive analysis was undertaken. Chi-square analysis was used to test independence between preparedness for supervision and variables of interest (e.g. training received). Item analysis was assessed using Cronbach's alpha coefficients and Kendall's Tau to determine whether statistically significant associations existed across the broad challenges previously identified (i.e. supervisor-specific, curriculum and students). Open-ended comments were analysed using content analysis.

RESULTS

Generally, most supervisors (64%, 43/67) initially felt " prepared" to supervise, despite the majority (58%, 39/67) not having received any training or educational support. Overwhelming, supervisors (97%, 65/67) considered universities responsible for ensuring quality clinical supervision. They perceived many of the previously identified supervisor-specific challenges (e.g. time-consuming), curriculum issues (e.g. limited hands-on patient contact in private practice placements) and student deficiencies (e.g. poor time management). Positive correlations were found across the three sets of challenges, with the strongest measure of association found between overall student deficiencies and overall curriculum issues (p < .001).

CONCLUSION

These findings contribute to a deeper understanding of clinical supervision in podiatry. The study identified inconsistent support for clinical supervisors from partner universities. This study found a clear desire and need for supervisor training. A partnership approach is recommended in which universities work with clinical supervisors to address their overall challenges in terms of supervisor professional development, paying attention to curriculum issues, and improving student preparedness during placements.

Describing the factors related to rural podiatry work and retention in the podiatry workforce: a national survey

BACKGROUND

Maldistribution of podiatrists limits capacity to address the footcare needs of the population. Understanding factors that impact recruitment and retention of Australian podiatrists is a key solution. The primary aim of this study was to describe factors related to rural podiatry work, and overall professional retention amongst Australian podiatrists.

METHODS

We used data collected from the most recent relevant response of a cohort of Australian podiatrists between 2017 and 2020 of four online surveys. Person and job role variables known to impact current work and retention were collected. Logistic regression models were used to determine factors associated with rural work and intent to leave direct patient care or the profession entirely.

RESULTS

There were 1129 podiatrists (21% of 5429) who participated in at least one of the survey waves. Podiatrists who had a rural background (30%) were less likely to work in a metropolitan location (OR = 0.20, 95%CI = 0.11,0.37). Podiatrists who undertook a regional/rural placement during their undergraduate education (43%) were more likely to work in a metropolitan location (OR = 1.86, 95%CI = 1.38,2.51). Podiatrists who indicated they were planning to leave direct patient care within 5 years (n = 282, 26%), were less satisfied with working conditions (OR = 0.77, 95% CI = 0.66, 0.92), less satisfied with opportunities to use their abilities (OR = 0.83, 95% CI = 0.69, 0.99), perceived less personal accomplishment (OR = 0.94, 95% CI 0.86, 0.94) and less job satisfaction (OR = 0.92, 95% CI = 0.91, 0.98). Podiatrists who indicated that they were planning to leave podiatry work entirely within 5 years (n = 223, 21%), were less satisfied with opportunities to use their abilities (OR = 0.74, 95% CI = 0.62, 0.88), agreed they had a poor support network from other podiatrists (OR = 1.35, 95% CI = 1.13, 1.61), had less job satisfaction (OR = 0.89, 95% CI = 0.86, 0.94), and did not have access to paid annual leave (OR = 0.62, 95% CI = 0.38, 0.99).

CONCLUSION

Findings suggest ways to promote rural work, including selecting university students with rural backgrounds, and optimising the experience of rural placements which currently predict metropolitan practice. To retain podiatrists, it is important to ensure access to leave, professional support, and appropriate physical working conditions. Further research is required to understand why intention to leave is so high.

Impact of COVID-19 pandemic on foot care services in Ontario, Canada

BACKGROUND

The COVID-19 pandemic has directly affected the delivery of health care services in Canada, including foot care. The goal of this descriptive study was to understand the impact of the early COVID-19 pandemic (March 2020 to April 2021) on chiropodists' and podiatrists' clinical practices and foot care service delivery in Ontario, Canada.

METHODS

A web-survey was completed by participating chiropodists and podiatrists registered with the College of Chiropodists of Ontario. The survey consisted of 31 multiple choice and open-ended items on clinical practice characteristics, foot care service delivery changes, perceived barriers during the pandemic, and its impact on clinicians. Descriptive statistics were used to characterize the sample and examine clinicians' responses, and qualitative content analysis was used to explore opened-ended items.

RESULTS

Of the 773 eligible clinicians, 279 participated for a response rate of 36.1%. Most respondents reported a decline in patient volume, an increase in urgent foot health problems, a financial impact on their clinical practices, an emotional impact, and substantial changes to how they provided foot care services, such as incorporating telehealth/virtual care into patient care. Factors that impact clinicians' perception of future pandemic preparedness are identified.

CONCLUSION

This study describes foot care service delivery in Ontario, Canada during the COVID-19 pandemic. The COVID-19 pandemic saw an increase in urgent foot health problems, decline in patient volume, and impacted clinicians' mental health and emotional well-being. Future studies should examine patients' experiences of foot care service delivery and maintaining their foot health during the pandemic, and further examination of factors that impact clinicians' perception of pandemic preparedness.

Health care workers' experiences during the COVID-19 pandemic: a scoping review

BACKGROUND

COVID-19 has challenged health systems worldwide, especially the health workforce, a pillar crucial for health systems resilience. Therefore, strengthening health system resilience can be informed by analyzing health care workers' (HCWs) experiences and needs during pandemics. This review synthesizes qualitative studies published during the first year of the COVID-19 pandemic to identify factors affecting HCWs' experiences and their support needs during the pandemic. This review was conducted using the Joanna Briggs Institute methodology for scoping reviews. A systematic search on PubMed was applied using controlled vocabularies. Only original studies presenting primary qualitative data were included.

RESULTS

161 papers that were published from the beginning of COVID-19 pandemic up until 28th March 2021 were included in the review. Findings were presented using the socio-ecological model as an analytical framework. At the individual level, the impact of the pandemic manifested on HCWs' well-being, daily routine, professional and personal identity. At the interpersonal level, HCWs' personal and professional relationships were identified as crucial. At the institutional level, decision-making processes, organizational aspects and availability of support emerged as important factors affecting HCWs' experiences. At community level, community morale, norms, and public knowledge were of importance. Finally, at policy level, governmental support and response measures shaped HCWs' experiences. The review identified a lack of studies which investigate other HCWs than doctors and nurses, HCWs in non-hospital settings, and HCWs in low- and lower middle income countries.

DISCUSSION

This review shows that the COVID-19 pandemic has challenged HCWs, with multiple contextual factors impacting their experiences and needs. To better understand HCWs' experiences, comparative investigations are needed which analyze differences across as well as within countries, including differences at institutional, community, interpersonal and individual levels. Similarly, interventions aimed at supporting HCWs prior to, during and after pandemics need to consider HCWs' circumstances.

CONCLUSIONS

Following a context-sensitive approach to empowering HCWs that accounts for the multitude of aspects which influence their experiences could contribute to building a sustainable health workforce and strengthening health systems for future pandemics.

Development and use of the PodEssential and Paeds-PodEssential triage tools to define "essential" podiatry services. A Delphi survey, scoping review, and face validity testing study

BACKGROUND

The coronavirus pandemic resulted in unique challenges for podiatrists in Australia. Podiatrists were tasked with having to make triage decisions about face-to-face care without clear guidelines. This research aimed to develop podiatry triage tools to understand individual risk for adults and children, and explore the face validity of both tools.

METHODS

An online three-round modified Delphi technique was used to elicit podiatrists' opinions on conditions, assessments and social factors that elevate risk. Additional elements of known foot and/or leg risk were informed by a synchronous scoping review. Australian podiatrists who held a clinical role treating patients or directly managing podiatrists treating patients within the past six months were recruited. Where 70% of participants reported the same or similar theme in Round 1, statements were accepted with consensus. Where 50-69% of participants reported a similar theme, these were returned to participants to rate agreement using a four-point Likert agreement scale. Statements identified in the scoping review were added at Round 2, if not already identified by participants. The final round presented participants with triage tools, and a series of mock patient scenarios.. Participants were asked to indicate if they would or would not provide face to face podiatry service based on these scenarios.

RESULTS

There were 40 participants who responded to Round 1 (Adult presentations), of these, 23 participants also provided paediatric presentation responses. Participants developed and agreed upon 20 statements about risk in podiatry service delivery for both adults and children across Rounds 1 and 2. The PodEssential and Paed-PodEssential were developed based on these statements indicating stand-alone condition risk (tier 1), elements that should elevate risk (in the absence of a stand-alone condition) (tier 2), and assessments results identifiying a limb at risk (tier 3) in adults and children respectively. Participants utilising these tools in Round 3 more frequently indicated face-to-face service when mock patient scenarios included a greater number elements, suggesting the tool can be useful in making triage decisions.

CONCLUSION

The PodEssential and Paeds-PodEssential tools direct conditions requiring urgent attention as well as providing considered elements to a person's health status to assist in making triage decisions.

Prevalence of musculoskeletal injury and pain of UK-based podiatrists and the impact of enforced altered working practices

Background

Occupational musculoskeletal injuries are prevalent in healthcare workers and are reported to be profession-specific. There is, however, a paucity of information around the injuries sustained from working as a podiatrist. This paper looks at the incidence of injury from working as a podiatrist, the aggravating factors to sustain these injuries and whether the changes in workload due to the COVID-19 pandemic altered the incidence.

Methods

A modified work based musculoskeletal injury questionnaire was distributed in the UK via podiatry led social media platforms. Open and Closed questions explored the demographics of the sample, perceived injury 12 months prior to the COVID-19 pandemic and then 6 months into the lockdown. Pre and post COVID-19 data were analysed for differences and thematic analysis was included to categorise reported experiences.

Results

148 podiatrists representing 3 % of HCPC registered practitioners responded to the questionnaire. Employment status altered as a result of the COVID-19 pandemic with a 13 % reduction in those working full time. Environments also changed with domiciliary and telehealth significantly increasing (p > 0.00) and non-clinical roles being extended (p > 0.002). Pain frequency and intensity significantly (p > 0.04) increased as a result of the pandemic with shoulder pain being most frequent before lockdown altering to the neck during the lockdown. Two main themes were identified that were attributed to the causes of pain including physical demands and working in awkward spaces.

Conclusions

Work-related musculoskeletal pain in podiatrists is common with the shoulder and neck being the most frequently affected. Changes in work practices due to the restrictions enforced from the COVID-19 pandemic increased the frequency and intensity of pain mostly associated with increased domiciliary and telehealth working environments.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13047-021-00491-7.