Background

In recent years, education for novice physiotherapists is not enough in Japan because the number of new physiotherapists is increasing rapidly. In addition, it is difficult to objectively evaluate their skills. Therefore, the education of physiotherapy skills for physiotherapists and their students are often performed based on individual therapists’ experience. For that reason, physiotherapy education depends on the way of thinking of staff at each institution at the time of graduation. In physiotherapy education, it is important to differentiate between experienced and novice, but firstly, it is necessary to define ‘experienced’. And, these differences tended to be distinguished by years of therapists’ experience (5 years of practical experience permits the teaching of other physiotherapy students, with the approval of a governing association board) (Ministry of health, Labour and Welfare, 2019).

On the other hand, in Japan, both experienced and new physiotherapists charge for physiotherapy at the same fee/rate under the public insurance system. Due to the aforementioned points, it is challenging to secure a minimum quality of physiotherapy services. For that reason, it is important to objectively evaluate the teaching methods in undergraduate training, as well as physiotherapy skills pre- and post-education.

There are the basic physiotherapy skills: range of motion (ROM) exercise (Cleland et al., 2010), manual muscle testing (MMT) (Florence et al., 1992), muscle strengthening exercise (Fowler et al., 2001), weight-bearing (Suchak et al., 2008), weight-shifting (WS) (Pizzi et al., 2007) and others. It is considered that these basic physiotherapies are major components of the quality of physiotherapy. And, these are skills that are frequently used by physiotherapists. Therefore, it is considered that helping to standardise knowledge in physiotherapy skills by quantifying the influence (positive and/or negative effect) on the patient during the treatment by a physiotherapist is necessary.

It is meaningful to establish objective evaluation and instruction of physiotherapy skills in the training and post-institutional education of physiotherapists. As a preliminary step, the purpose of this study was to clarify the characteristics of physiotherapy skill from the center of pressure (COP) and ground reaction force (GRF) of the simulated patient during WS of one of the basic physiotherapy skills was analyzed, as well as differences according to years of therapists’ experience and to which institution they were affiliated with.

Methods

Participants were 10 physiotherapists (6 clinical physiotherapists and 4 physiotherapy educators) from two institutions: average years of therapists’ experience of 14.5 ± 6.9 years (see Table 1).

The WS while standing (with the therapist guiding from behind) was repeated three times on a simulated patient where the speed of movement was at the discretion of the therapist (see Figure 1). All participants tried the task with the same simulated patient. Then, participants guided the simulated patient using bilateral manipulation from the posterior side at the lateral part of the pelvis. And, participants guided WS to the right without the contralateral lower extremity lifting off the floor. First, participants shifted the weight of the simulated patient to the right direction from the pelvis. Second, participants shifted them left again, back to the upright standing position, and performed this three times.

The GRF of the simulated patient was recorded during the task using force plates (AMTI). The COP was calculated from the GRF. The ratio of COP displacement was calculated by dividing COP displacement by the distance between both foot pressure centres of the simulated patient at the time to normalise.

Starting position of a simulated patient was upright. Participants shifted the ‘patient’ from upright standing to the right (a) and back to upright (b). This was repeated three times.The mean and standard deviation were calculated for the ratio of COP displacement and the maximum GRF. Normality was tested using a Shapiro-Wilk test (this method tests whether the data are normally distributed). The obtained data was compared by a non-paired t-test for statistical examination between experienced and novice participants. It was also compared by a non-paired t-test for statistical examination between their institutions. For the data analysis, SPSS software version 27.0 was used. The significance level was determined at 0.05.

Results

The therapists’ years of experience for a ‘novice’ was categorised as less than 11 (mean: 7.5 (5.5-10.5)) years, and for ‘experienced’ as more than 11 (mean: 19.2 (12.5-27.5)) years.

The ratio of COP displacement is shown in Table 2. Experienced (n=6) was 0.34±0.16 and novice (n=4) was 0.29±0.10, and there were no significant differences between experienced and novice. On the other hand, institution A (n=3) was 0.49±0.07 and institution B (n=7) was 0.25±0.10, and there were significant differences between each institution’s ratios (p < 0.05).

The maximum GRF is shown in Table 3. Experienced (n=6) was 477.25±54.52N and novice (n=4) was 453.88±58.94N, and there were not any significant differences between experienced and novice. Conversely, institution A (n=3) was 508.71±1.53N and institution B (n=7) was 440.25±50.62N, and there were significant differences in the maximum GRF between institutions (p < 0.05).

Discussion and Conclusion

In this study, the ratio of COP displacement and the maximum GRF of a simulated patient was examined by means of WS, which is one of the basic physiotherapy skills. And the differences according to years of therapists’ experience as well as their institution to clarify the characteristics of physiotherapy skill. As a result, there were no significant differences in the ratio of COP displacement and the maximum GRF of simulated patients when performed by either experienced therapists or novices. However there were significant differences in the ratio of COP displacement and the maximum GRF during WS when compared between institutions.

The participants of this study had from 6 to 27 years of experience as therapists, and they all met the minimum of 5 years of therapy experience as per the clinical practice supervisor requirement in Japan. Due to this, for the purpose of this study it was established that greater than 10 years of experience could be considered ‘experienced’ (Median experience for participants). Then it was clear that there was a possibility that there were no significant differences in the ratio of COP displacement and the maximum GRF between experienced and novice. And, the results of this study suggest that there may be no difference in therapist’s command of the basic physiotherapy skills past their 6th year. Therefore, it was considered that the duration of years of therapists’ experience was not necessarily related to physiotherapy skill, at least in the performance of the specific skill evaluated in this study. 

In the future, it will be necessary to include physiotherapy students, clinical physiotherapists and physiotherapy educators in their first to fifth year, and increase the number of participants to examine the differences in skill regarding the basic physiotherapy principles between different years of therapists’ experience.

In addition, especially in WS which is not often seen in post-graduate skill training in the basic physiotherapy skills, it is possible that they may not recognize the difference in years of therapists’ experience. For that reason, it is necessary to verify physiotherapy skills of all other basic physiotherapy principles by means of a practical evaluation or examination.

On the other hand, it was hypothesised that the factor that showed significant differences in the ratio of COP displacement and the maximum GRF between institutions was postgraduate education. WS is rarely taught at training schools of physiotherapy unlike ROM exercises and MMT. Additionally WS is not often taught even in clinical skill training at institutions as mentioned above. In addition, some institutions are planning the education for new physiotherapists, due to the number of new physiotherapists increasing rapidly. But other institutions are unable to perform education, as a result of the number of physiotherapy educators being too low. Consequently physiotherapist skills of these institutions are low too, because experienced educators are not present. This has a knock-on effect year after year.

Based on the above, it was clear that there were differences based on each institution regarding the characteristics of physiotherapy skill from the COP and GRF of the simulated patient during WS (one of the basic physiotherapy skills). And, it was considered that the duration of years of therapists’ experience does not necessarily correlate with their physiotherapy skills when they have greater than 6 or more years of therapists’ experience. In the future, it is necessary to verify that physiotherapy skills and teaching methods are dependent on individual therapists’ experience (within a specific institution) as this in turn affects physiotherapy education.

It is considered that helping to gain knowledge in physiotherapy skills by quantifying and standardising the aspects of physical movement during treatment by a physiotherapist or physiotherapy student as well as teaching methods for educators. This in turn will influence  patient care. And, this study will help to transform experiential knowledge into formal knowledge.

References

Ministry of health, Labour and Welfare. (2019). Guidelines for guidance of physiotherapist and occupational therapist training facilities. Retrieved on 10 April 2022 from https://www.japanpt.or.jp/assets/pdf/info/20181009_02/02_Guideline_hikakuhyo_181005.pdf​

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