Physiotherapy skills in the difference of years of therapists’ experience and affiliations

Article under review

This article is currently under peer review and has not yet been accepted for publication. While it may still be referenced at this web address, please bear in mind that amendments to the article may occur as a result of the review process.

Abstract

In Japan, physiotherapist is quantified ‘experienced’ as someone with sufficient time in the field, regardless of their level, efficacy or quality of training. However, this definition is insufficient in establishing quality and uniformity among physiotherapists in Japan. The purpose of this study is to establish groundwork for standardization in education and evaluation. Therefore, it was to clarify physiotherapy skills by means of a Weight Shifting (WS) practical assessment. Participants of this study were 10 physiotherapists from 2 institutions. The WS was repeated 3 times on a simulated patient. The ground reaction force (GRF) of the simulated patient was recorded during the task. The ratio of the center of pressure (COP) displacement was calculated by dividing COP displacement by the distance between the center of pressure of both feet of the simulated patient to normalize. Correlational statistical analysis was used to confirm whether years of experience changes the degree of WS. The obtained data was compared between their institutions. The results of this study confirm that the correlation between the data obtained and years of therapists’ experience is weak or absent. There were significant differences between each institution’s ratios for COP displacement as well as the maximum GRF. It was considered that years of therapists’ experience does not necessarily correlate with physiotherapy skill, especially if they have 6 or more years of experience. Greater differences were observed between institutions with regards to the characteristics of physiotherapy skill.

Reviews

Author: Kim Buchholtz
Review date: 9 November 2022
DOI: to be allocated
Permalink: Review - Physiotherapy skills in the difference of years of therapists’ experience and affiliations

Thank you for the opportunity to review this article. I appreciate the effort taken to perform these tests and to write this study, but have a few concerns that would need to be addressed before it is ready for publication.

  1. Complete, coherent, and well-organized presentation:

There are some small English grammar errors that need some attention, but they do not affect the understanding of the paper. A final English check would be good before publication. For example: In the 1st and 3rd paragraph there are 2 sentences starting with ‘And’… this should be corrected to be appropriate for scientific writing. This error also appears in the Discussion section. The paper is presented in a logical manner, but the content is missing some key information to understand the links between education and study selected.

  1. Sufficient explanation of the significance of the problem:

I think a little more context in the introduction would be helpful, for example, an explanation of what the undergraduate physio training in Japan consists of (how many years, clinical exposure, level of degree). Some information on how long physio has been accredited in Japan could also help to provide background on why there is a gap in this area. This will help the reader to understand why ‘education for novice physios is not enough in Japan’ as stated in the background. Can you provide some examples of possible post graduate studies? Which courses are available, are there masters degree to specialise? What do physios usually do to gain additional skills?

  1. Clear demonstration of the relevance to the field (beyond the case presented):
  2. Original contribution to the topic of physiotherapy education:

This has potential to be interesting if the link to physiotherapy education can be strengthened. It would be very interesting to understand more about the context of physiotherapy training, both undergraduate and postgraduate, in Japan.

  1. Compelling presentation of the problem within a theoretical framework (where appropriate):

 

6. Establishment of a relationship between the problem and other relevant literature:

It is difficult to understand why the WS has been selected as the technique measured. Based on the reference used, it doesn’t appear to be a validated assessment tool. It seems to have been used as a treatment technique in the article (Pizzi et al) which was on gait in hemiplegia rather than WS. To make it clear what specific items you are using to determine skill, it would be helpful to include in the methods exactly which components in the WS technique you are measuring and how they would indicate skill in the therapist. If you can clearly justify the link between the technique used and how experience could be detected using this technique then it will significantly increase the importance of this paper. It would also help to show whether the physios recruited were generally working on neuro patients, because this must also be considered in terms of experience. If they have been a physio for 10 years but only seen neuro patients for 2 years then maybe the experience is not accurate? I think it would also be helpful to discuss when this skill is usually taught at an undergrad or postgrad level as it is not something that I have seen taught in this manner on force plates at other English-speaking universities (in Europe and Africa) and it is possible that there are differences in the curricula across the continents. This would help greatly to understand the decision for using this assessment as a measure of skill.

  1. Appropriate research design and method:

The design of the study is appropriate, but a clear rationale for the use of the assessment is needed. It is not clear how the test is an indication of competence or skill. In the background you mention experienced defined as 5 years, but then in your analysis you have used 11 years, so this needs to be clearly explained in your methods section. Maybe remove the reference of 5 years from the background section to avoid confusion. Is it possible to get information from the participants on how much additional training they have had/which courses they have attended so that you can include information on both experience in terms of years, but also additional training which could influence skill?

  1. Accurate and useful interpretation:

As the initial justification of the study is not clear, it is difficult to fully review whether the interpretation is accurate. In your discussion you mention that ‘there may be no difference in therapists command of the basic physiotherapy skills past their 6th year’… I think this is a very large assumption. You do later explain that it may be specific to this skill, but it might not be an appropriate to state this assumption at all.

  1. Sound argument and analysis:
  2. Effective conclusion about the implications for physiotherapy education, research, and/or practice:

The link between education and the technique used to assess the practitioners is not clear. This needs to be explained in greater detail so that the reader can clearly understand the implications in education of physio and how this research can be used to develop further skill training for physios.

Author: Ben Ellis
Review date: 5 August 2022
DOI: to be allocated
Permalink: Review - Physiotherapy skills in the difference of years of therapists’ experience and affiliations

Thank you for submitting this article. Overall your article addresses a potentially interesting topic, however there are some areas in which I think the article would benefit from some significant revision, particularly in relation to establishing the relevance and rationale of the research question.

The article has a clear overall structure and is organised appropriately for this type of study. However the key issue that I struggled with was understanding the premise for your research project in relation to how clinical skill was being evaluated using the study methodology. In order to provide sufficient explanation of the problem and demonstrate the relevance of your research it would be helpful to clarify and provide evidence to support what skilled performance of the weight shift task looks like and how your chosen outcome measures can therefore demonstrate differences in skill between groups of participants. It is not inherently clear to me that greater or lesser displacement of COP or ground reaction force during this task would be associated with different levels of clinical skill. My presumption would be that when looking to support a patient to shift weight, that either too much movement of the COP or conversely not enough would both be less effective (and potentially less safe), and that skilled clinicians may be more likely to adapt the amount and direction of weight shift in response to an individual patient. Establishing the rationale for using these measures as a proxy for clinical skill in your introduction is necessary to link the background that you present to your study methodology in order to show that this was an appropriate research design to answer your question.

In addition I would question the definition of novice and experienced clinicians used in the study given that all clinicians had over 5 years practice experience. The definition of experience as over 11 years needed justification as this appeared arbitrary. This distinction needs to be more clearly based on a theoretical framework for expertise development linked to this skill.

The methods are clearly described and repeatable, including appropriate  justification and selection of statistical analysis. Results are clearly presented. However the interpretation and analysis of results is unclear when these are discussed in the context of skill development and expertise. This relates back to the need to establish the premise for using these measures as a proxy for skill performance. The difference between institutions is not clearly relevant. The sample size is too small to draw any firm conclusions from as to the relevance of this finding and more data relating to training or other variables would be needed to support the assertion that any difference may be associated with educational differences between institutions.

The study conclusions are not clearly related to the findings. I wasn’t clear whether the implication was that using this methodology to quantify weight shift had potential utility in physiotherapy education, but this is not supported by the study findings.

Bearing in mind these overall comments, please find below further comments relating to each section:

Abstract:

This provides a concise overview. It would benefit from more clearly stating the research aims and briefly establishing why the methodology is appropriate to answer the question as discussed above, which would also help focus the conclusions.

Introduction/background

The introduction provides some broad background, but as discussed above, does not currently provide sufficient clarity on the research objectives or rationale for the methodology as a means to achieve them. This section would benefit from greater use of literature in developing the rationale for the study including considering a theoretical framework of development of expertise to explain why greater expertise may result in different application of the practical skill, and to provide a link to physiotherapy education to justify why understanding differences in skill performance between different groups of clinicians may be relevant to physiotherapy educational practice.

Methods

The methods themselves are clearly described and repeatable. The participant demographic information should come at the start of the results section rather than in the methods. There could be an argument for using correlational statistical analysis to see whether years of experience changes the degree of weight shift rather than comparison of means given the arbitrary cut-off between novice and experienced clinician.

Results

The results are clearly presented. The tables would benefit from including which differences are significant and the level of significance. Some of the wording to describe groups could be reviewed for clarity – eg “at each year of experience” suggests that the groups are more stratified than they are.

Discussion

In line with the previous recommendations, clearer establishment of why your data is a useful proxy for clinical skill in the introduction would help to support your discussion. Currently the discussion is based on your perceptions of the findings and does not place your findings in the context of other literature. Relating your findings to theoretical frameworks of skill development and other empirical findings of skill development will strengthen the critical analysis of your results. In addition, considering the strengths and limitations of your own study methodology in this section would add critical appraisal and help to consider more specific implications for future research.

Conclusions:

The concluding paragraph does not currently clearly relate to the study aims and objectives. Having a clearer rationale for how your study is attempting to answer the it’s questions in the introduction will allow you to draw your discussion together towards addressing those aims. More specific implications for practice and future research, that consider the validity of your findings will strengthen this section.

Thank you again for submitting this article. I would be interested to see a future iteration of it and happy to continue the discourse.

Conflict of interest statement

There are no conflicts of interest to declare.

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