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A pain competencies framework: development, dissemination and next steps
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1238–eS1642
Special Interest Report Poster Presentation Number: SI-PO-18-05-Mon Monday 4 May 2015 12:15 Exhibit halls 401–403 A PAIN COMPETENCIES FRAMEWORK: DEVELOPMENT, DISSEMINATION AND NEXT STEPS G. Sowden 1,2 , S. Wilson 3 , E. Bartlett 4 , H. Cameron 5 , P. Cameron 6 , Z. Hansen 7 , M. Hey 8 , L. Knott 9 , G. Owen 10 1 Staffordshire
and Stoke-on-Trent NHS Partnership Trust, IMPACT, Stoke-on-Trent, United Kingdom; 2 Keele University, Arthritis Research UK Primary Care Centre, Stoke-on-Trent, United Kingdom; 3 Bath Centre for Pain Services, Royal National Hospital for Rheumatic Diseases, Bath, United Kingdom; 4 Solent NHS Trust, Physiotherapy, Southampton, United Kingdom; 5 NHS Greater Glasgow & Clyde, Physiotherapy, Glasgow, United Kingdom; 6 NHS Fife, Pain Service, Edinburgh, United Kingdom; 7 University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, United Kingdom; 8 The Mid-Yorkshire Hospitals NHS Trust, Pain Management, Dewsbury, United Kingdom; 9 Torbay Hospital, Pain Management, Torquay, United Kingdom; 10 The Chartered Society of Physiotherapy, Practice & Development, London, United Kingdom Background: Pain is frequently associated with substantial emotional distress, disrupted physical and social functioning, reduced quality of life and costs in terms of healthcare utilization and lost productivity. Pain continues to pose substantial challenges for clinical management, however, understanding and clinical practice, have improved dramatically over the last 30 years. At the same time, the knowledge and skills required by physiotherapists treating people with pain have continued to evolve. It is essential therefore, for the safety of patients and the protection of clinicians that physiotherapists working with people in pain receive appropriate training, support and clinical supervision in order to practice competently. A project was therefore commenced, with the aim of developing a competency framework (CF) for physiotherapists working with people in pain. Purpose: The purpose of this project was to develop a CF for physiotherapists, which describes the values, knowledge and skills of physiotherapists working with people in pain, from entry level graduate to expert level. It is envisaged that the CF will be used to: • deconstruct practice to recognise & celebrate personal strengths & highlight potential learning/development needs. • recognise how specific sets of behaviours, knowledge & skills transfer from one area of practice to another.
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• build a picture of individual/departmental/organisational profile of the physiotherapy workforce. • Inform the commissioning of services and workforce planning. • Inform curriculum development. The CF is a robust first step in the process of developing a number of related projects and products (see Vii for details). Methods: January 2013: Expert committee established – Physiotherapy Pain Association and Chartered Society of Physiotherapy (CSP), UK. Focused on the qualified practice levels of the CSP’s Physiotherapy Framework and applied them to describe the values, behaviours, knowledge & skills used by physiotherapists working with people in pain. Developed a draft Competencies Framework. October 2013: UK physiotherapy consultation launched. Consultation workshop held in Birmingham at PhysioUK. January 2014: CF modified in light of feedback. April 2014: UK professionals consultation launched in workshop at British Pain Society Annual Scientific Meeting. Parallel international physiotherapy consultation. June 2014: CF modified in light of the feedback. October 2014: Final CF launched at PhysioUK. October 2014: Dissemination. Results: A CF for physiotherapists working with people in pain has been developed. The CF is divided into 3 sections: 1. Definition of physiotherapy & physiotherapy practice with people in pain. 2. Structure of the framework: This section explains how the domains & descriptors within the framework work together to describe physiotherapy practice. 3. Physiotherapy values, behaviours, knowledge & skills for physiotherapists working with people in pain. Conclusion(s): The CF development committee (CFDC) plan to develop: • executive summaries; • descriptors of competence and identification/development of methods/tools to evaluate competence; • job descriptions; • a career structure; • pain curricula; and • training materials. Implications: The CF is comprehensive yet nonprescriptive, it therefore has utility in different systems and by different stakeholders. It is freely available online. The CFDC have developed a dissemination strategy and welcome the opportunity to collaborate. Keywords: Competencies; Pain; Education Funding acknowledgements: None.
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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1238–eS1642
Ethics approval: Ethics approval was not required. http://dx.doi.org/10.1016/j.physio.2015.03.1384 Research Report Poster Presentation Number: RR-PO-11-22-Sat Saturday 2 May 2015 13:00 Exhibit halls 401–403 FUNCTIONAL OUTCOMES AFTER FLEXOR TENDON REPAIR OF THE HAND: PRELIMINARY RESULTS OF A SOWETAN POPULATION IN SOUTH AFRICA T. Spark 1 , V. Ntsiea 2 , L. Godlwana 2 1 Chris
Hani Baragwanath Academic Hospital, Soweto, South Africa; 2 University of the Witwatersrand, Johannesburg, South Africa Background: Flexor tendon injuries are common hand injuries for which optimal surgical and post-operative treatment has not yet been established. The variability in results is great, with good outcomes being achieved in specialised hands units in developed countries. Minimal research has been undertaken in developing countries, in particular South Africa, regarding flexor tendon repair (FTR) and the outcomes thereof. Purpose: The objectives of this study are to establish the range of movement (ROM), grip strength and hand function at six months post FTR. Methods: The study was conducted at Chris Hani Baragwanath Academic Hospital, Soweto, South Africa. 23 participants were recruited consecutively post FTR. At one, three and six months post FTR the ROM of the injured and contralateral finger(s) were measured using a metal finger goniometer. The Total Active Motion (TAM) classification system was applied to each affected digit and the average TAM determined for the participants’ affected hand. At three and six months post FTR the participants’ bilateral power and pinch grip strength were measured using a Jamar dynamometer and a Jamar pinch gauge respectively. The power and pinch grip strengths were calculated as a percentage of the unaffected hand. A QuickDASH questionnaire was administered in an interview format at three and six months. All assessments were done by the first author. Data were analysed used SPSS version 22. Data are presented as percentages, means and standard deviations. Results: 23 participants completed six months follow up, 18 males and 5 females aged 31 ± 12SD. Out of 23 participants none had an excellent outcome, 39% (n = 9) had a good outcome, 26% (n = 6) had a fair outcome and 35% (n = 8) had a poor outcome with regards to TAM. At six months post FTR the average power grip was 58% ± 23%SD of the unaffected hand while the average pinch grip was 45% ± 30%SD of the unaffected hand. The average score on the QuickDASH questionnaire was 23.83 ± 20.45SD at six months. All 12
patients who were employed prior to injury had returned to work by six months post surgery and scored an average of 24.48 ± 30.56SD on the QuickDASH work module. 83% (n = 19) of patients had post operative complications: 16% (n = 3) had infection, 53% (n = 10) had tenodesis and 32% (n = 6) had contractures. Five participants (22%) underwent further surgery. Conclusion(s): Although there were some promising outcomes, during this period, participants did not consistently achieve the good or excellent functional outcomes that are achieved in developed countries. Implications: More research needs to be done into the factors that affect the functional outcome of patients post FTR in the developing world. Once these factors are known, risk factors for poor outcome can be identified which will allow interventions to be put into place in order to address those risk factors before complications occur. Keywords: Flexor tendon repair; Outcomes; Johannesburg Funding acknowledgements: Individual research grant received from University of the Witwatersrand Faculty Research Committee. Ethics approval: Ethical clearance obtained from University of the Witwatersrand Human Research Ethics Committee (Medical) and from CHBAH Ethics Committee. http://dx.doi.org/10.1016/j.physio.2015.03.1385 Research Report Platform Presentation Number: RR-PL-4019 Monday 4 May 2015 11:51 Rooms 334–335 TREATMENT OF ORAL CANCER STILL REDUCE MASTICATORY EFFECTIVENESS: AN OPPORTUNITY FOR THE OROFACIAL PHYSICAL THERAPIST C.M. Speksnijder 1,2 , R. Koole 1 , T. Merkx 2 , A. van der Bilt 1 1 UMC
Utrecht, Oral and Maxillofacial Surgery and Special Dental Care, Utrecht, Netherlands; 2 Radboudumc, Oral and Maxillofacial Surgery, Nijmegen, Netherlands Background: Masticatory performance is highly at risk in persons confronted with oral cancer. The main objective to treat oral cancer is to maximize the patients’ survival and to avoid reappearance in the treated area. However, ablative surgery in the mouth results in defects of soft tissues, and possibly also in defects of bone and skin, which can result in disabling alterations of functional components of occlusion causing impairment of the ability to chew. Radiotherapy related to oral cancer causes xerostomia, tissue fibrosis, osteoradionecrosis, and may accelerate dental caries. Purpose: The aim of this study was to prospectively follow the time-course of masticatory performance in 143
Special Interest Report Poster Presentation Number: SI-PO-18-05-Mon Monday 4 May 2015 12:15 Exhibit halls 401–403 A PAIN COMPETENCIES FRAMEWORK: DEVELOPMENT, DISSEMINATION AND NEXT STEPS G. Sowden 1,2 , S. Wilson 3 , E. Bartlett 4 , H. Cameron 5 , P. Cameron 6 , Z. Hansen 7 , M. Hey 8 , L. Knott 9 , G. Owen 10 1 Staffordshire
and Stoke-on-Trent NHS Partnership Trust, IMPACT, Stoke-on-Trent, United Kingdom; 2 Keele University, Arthritis Research UK Primary Care Centre, Stoke-on-Trent, United Kingdom; 3 Bath Centre for Pain Services, Royal National Hospital for Rheumatic Diseases, Bath, United Kingdom; 4 Solent NHS Trust, Physiotherapy, Southampton, United Kingdom; 5 NHS Greater Glasgow & Clyde, Physiotherapy, Glasgow, United Kingdom; 6 NHS Fife, Pain Service, Edinburgh, United Kingdom; 7 University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, United Kingdom; 8 The Mid-Yorkshire Hospitals NHS Trust, Pain Management, Dewsbury, United Kingdom; 9 Torbay Hospital, Pain Management, Torquay, United Kingdom; 10 The Chartered Society of Physiotherapy, Practice & Development, London, United Kingdom Background: Pain is frequently associated with substantial emotional distress, disrupted physical and social functioning, reduced quality of life and costs in terms of healthcare utilization and lost productivity. Pain continues to pose substantial challenges for clinical management, however, understanding and clinical practice, have improved dramatically over the last 30 years. At the same time, the knowledge and skills required by physiotherapists treating people with pain have continued to evolve. It is essential therefore, for the safety of patients and the protection of clinicians that physiotherapists working with people in pain receive appropriate training, support and clinical supervision in order to practice competently. A project was therefore commenced, with the aim of developing a competency framework (CF) for physiotherapists working with people in pain. Purpose: The purpose of this project was to develop a CF for physiotherapists, which describes the values, knowledge and skills of physiotherapists working with people in pain, from entry level graduate to expert level. It is envisaged that the CF will be used to: • deconstruct practice to recognise & celebrate personal strengths & highlight potential learning/development needs. • recognise how specific sets of behaviours, knowledge & skills transfer from one area of practice to another.
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• build a picture of individual/departmental/organisational profile of the physiotherapy workforce. • Inform the commissioning of services and workforce planning. • Inform curriculum development. The CF is a robust first step in the process of developing a number of related projects and products (see Vii for details). Methods: January 2013: Expert committee established – Physiotherapy Pain Association and Chartered Society of Physiotherapy (CSP), UK. Focused on the qualified practice levels of the CSP’s Physiotherapy Framework and applied them to describe the values, behaviours, knowledge & skills used by physiotherapists working with people in pain. Developed a draft Competencies Framework. October 2013: UK physiotherapy consultation launched. Consultation workshop held in Birmingham at PhysioUK. January 2014: CF modified in light of feedback. April 2014: UK professionals consultation launched in workshop at British Pain Society Annual Scientific Meeting. Parallel international physiotherapy consultation. June 2014: CF modified in light of the feedback. October 2014: Final CF launched at PhysioUK. October 2014: Dissemination. Results: A CF for physiotherapists working with people in pain has been developed. The CF is divided into 3 sections: 1. Definition of physiotherapy & physiotherapy practice with people in pain. 2. Structure of the framework: This section explains how the domains & descriptors within the framework work together to describe physiotherapy practice. 3. Physiotherapy values, behaviours, knowledge & skills for physiotherapists working with people in pain. Conclusion(s): The CF development committee (CFDC) plan to develop: • executive summaries; • descriptors of competence and identification/development of methods/tools to evaluate competence; • job descriptions; • a career structure; • pain curricula; and • training materials. Implications: The CF is comprehensive yet nonprescriptive, it therefore has utility in different systems and by different stakeholders. It is freely available online. The CFDC have developed a dissemination strategy and welcome the opportunity to collaborate. Keywords: Competencies; Pain; Education Funding acknowledgements: None.
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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1238–eS1642
Ethics approval: Ethics approval was not required. http://dx.doi.org/10.1016/j.physio.2015.03.1384 Research Report Poster Presentation Number: RR-PO-11-22-Sat Saturday 2 May 2015 13:00 Exhibit halls 401–403 FUNCTIONAL OUTCOMES AFTER FLEXOR TENDON REPAIR OF THE HAND: PRELIMINARY RESULTS OF A SOWETAN POPULATION IN SOUTH AFRICA T. Spark 1 , V. Ntsiea 2 , L. Godlwana 2 1 Chris
Hani Baragwanath Academic Hospital, Soweto, South Africa; 2 University of the Witwatersrand, Johannesburg, South Africa Background: Flexor tendon injuries are common hand injuries for which optimal surgical and post-operative treatment has not yet been established. The variability in results is great, with good outcomes being achieved in specialised hands units in developed countries. Minimal research has been undertaken in developing countries, in particular South Africa, regarding flexor tendon repair (FTR) and the outcomes thereof. Purpose: The objectives of this study are to establish the range of movement (ROM), grip strength and hand function at six months post FTR. Methods: The study was conducted at Chris Hani Baragwanath Academic Hospital, Soweto, South Africa. 23 participants were recruited consecutively post FTR. At one, three and six months post FTR the ROM of the injured and contralateral finger(s) were measured using a metal finger goniometer. The Total Active Motion (TAM) classification system was applied to each affected digit and the average TAM determined for the participants’ affected hand. At three and six months post FTR the participants’ bilateral power and pinch grip strength were measured using a Jamar dynamometer and a Jamar pinch gauge respectively. The power and pinch grip strengths were calculated as a percentage of the unaffected hand. A QuickDASH questionnaire was administered in an interview format at three and six months. All assessments were done by the first author. Data were analysed used SPSS version 22. Data are presented as percentages, means and standard deviations. Results: 23 participants completed six months follow up, 18 males and 5 females aged 31 ± 12SD. Out of 23 participants none had an excellent outcome, 39% (n = 9) had a good outcome, 26% (n = 6) had a fair outcome and 35% (n = 8) had a poor outcome with regards to TAM. At six months post FTR the average power grip was 58% ± 23%SD of the unaffected hand while the average pinch grip was 45% ± 30%SD of the unaffected hand. The average score on the QuickDASH questionnaire was 23.83 ± 20.45SD at six months. All 12
patients who were employed prior to injury had returned to work by six months post surgery and scored an average of 24.48 ± 30.56SD on the QuickDASH work module. 83% (n = 19) of patients had post operative complications: 16% (n = 3) had infection, 53% (n = 10) had tenodesis and 32% (n = 6) had contractures. Five participants (22%) underwent further surgery. Conclusion(s): Although there were some promising outcomes, during this period, participants did not consistently achieve the good or excellent functional outcomes that are achieved in developed countries. Implications: More research needs to be done into the factors that affect the functional outcome of patients post FTR in the developing world. Once these factors are known, risk factors for poor outcome can be identified which will allow interventions to be put into place in order to address those risk factors before complications occur. Keywords: Flexor tendon repair; Outcomes; Johannesburg Funding acknowledgements: Individual research grant received from University of the Witwatersrand Faculty Research Committee. Ethics approval: Ethical clearance obtained from University of the Witwatersrand Human Research Ethics Committee (Medical) and from CHBAH Ethics Committee. http://dx.doi.org/10.1016/j.physio.2015.03.1385 Research Report Platform Presentation Number: RR-PL-4019 Monday 4 May 2015 11:51 Rooms 334–335 TREATMENT OF ORAL CANCER STILL REDUCE MASTICATORY EFFECTIVENESS: AN OPPORTUNITY FOR THE OROFACIAL PHYSICAL THERAPIST C.M. Speksnijder 1,2 , R. Koole 1 , T. Merkx 2 , A. van der Bilt 1 1 UMC
Utrecht, Oral and Maxillofacial Surgery and Special Dental Care, Utrecht, Netherlands; 2 Radboudumc, Oral and Maxillofacial Surgery, Nijmegen, Netherlands Background: Masticatory performance is highly at risk in persons confronted with oral cancer. The main objective to treat oral cancer is to maximize the patients’ survival and to avoid reappearance in the treated area. However, ablative surgery in the mouth results in defects of soft tissues, and possibly also in defects of bone and skin, which can result in disabling alterations of functional components of occlusion causing impairment of the ability to chew. Radiotherapy related to oral cancer causes xerostomia, tissue fibrosis, osteoradionecrosis, and may accelerate dental caries. Purpose: The aim of this study was to prospectively follow the time-course of masticatory performance in 143