加拿大魁北克省物理治疗技术人员在常见肩部疾病管理方面的知识与护理质量：一项调查结果
Knowledge and Care Quality of Physiotherapy Technologists in the Management of Common Shoulder Disorders: Results from a Survey in the Province of Quebec, Canada.
作者信息
Bélanger Annie, Lowry Véronique, Desmeules François
机构信息
From the: Maisonneuve-Rosemont Hospital Research Center, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, Montreal, Quebec, Canada.
School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.
出版信息
Physiother Can. 2024 Aug;76(3):247-258. doi: 10.3138/ptc-2023-0058. Epub 2024 Apr 11.
PURPOSE
In Québec, physiotherapy technologist (Phys.T.) scope of practice allows them to complete the evaluation and treat various musculoskeletal disorders, including shoulder disorders, after an initial assessment by a referring provider. They may need to re-evaluate and refer back to the providers if a patient does not progress in a satisfactory manner. Our purpose is to evaluate knowledge and care of practicing Phys.T. in identifying and managing overall care for common shoulder disorders.
METHOD
A survey presented four clinical vignettes featuring common shoulder disorders. Survey participants provided information regarding diagnosis, imaging recommendations, specialist referrals, medical and rehabilitation care, and their confidence in managing these clinical cases. Responses were compared to recommendations from selected clinical practice guidelines (CPGs).
RESULTS
43 Phys.T. completed the survey, with the majority accurately identifying common shoulder disorders across all vignettes (74%-94%). Compliance with CPGs was observed for rotator cuff tendinopathy (60%) and adhesive capsulitis (61%), with most Phys.T. refraining from initial imaging tests. However, a significant proportion recommended imaging for acute full-thickness rotator cuff tear (52%) and recurrent traumatic glenohumeral instability (80%), in line with CPGs. Education and exercises were prioritized in all vignettes as per CPGs, although a proportion favored passive physical modalities not endorsed by CPGs (13%-72%).
CONCLUSION
Most Phys.T. demonstrated adequate identification and management of shoulder disorders, reflecting their collaborative role in patient care. However, discrepancies existed in adherence to evidence-based recommendations, suggesting the need for additional training to optimize care pathways and inter-professional collaborations for shoulder and musculoskeletal disorders.
目的
在魁北克省，物理治疗技师（Phys.T.）的执业范围允许他们在转诊提供者进行初步评估后，完成对各种肌肉骨骼疾病的评估和治疗，包括肩部疾病。如果患者进展不令人满意，他们可能需要重新评估并将患者转回给提供者。我们的目的是评估执业物理治疗技师在识别和管理常见肩部疾病的整体护理方面的知识和护理情况。
方法
一项调查展示了四个以常见肩部疾病为特征的临床案例。调查参与者提供了有关诊断、影像学检查建议、专科转诊、医疗和康复护理以及他们处理这些临床病例的信心的信息。将回答与选定的临床实践指南（CPG）的建议进行比较。
结果
43名物理治疗技师完成了调查，大多数人在所有案例中都能准确识别常见肩部疾病（74%-94%）。对于肩袖肌腱病（60%）和粘连性关节囊炎（61%），观察到符合CPG的情况，大多数物理治疗技师避免进行初始影像学检查。然而，相当一部分人建议对急性全层肩袖撕裂（52%）和复发性创伤性肩肱关节不稳定（80%）进行影像学检查，这与CPG一致。根据CPG，在所有案例中都优先考虑教育和锻炼，尽管有一部分人倾向于CPG未认可的被动物理治疗方式（13%-72%）。
结论
大多数物理治疗技师在肩部疾病的识别和管理方面表现出足够的能力，反映了他们在患者护理中的协作作用。然而，在遵循循证建议方面存在差异，这表明需要额外的培训来优化护理路径以及肩部和肌肉骨骼疾病的跨专业协作。
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