Physiotherapy students promoting health and well-being of school-aged children and adolescents in North Karelia, Finland

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Abstract

Background: Physical activity is important for health and well-being for all ages. The recommendation for children and adolescents is at least 60 minutes moderate- to vigorous- intensity physical activity daily and two third of Finnish children achieve these recommendations. Schools have an important role in children’s physical activity and physiotherapists as experts in motor development, movement and mobility could contribute largely in this respect to children's health and wellbeing in school healthcare system. This article describes, how school physiotherapy was developed and organized in North Karelia in cooperation with Karelia University of Applied Sciences (Karelia), schools in the Joensuu region and the Siun sote- Joint municipal authority for North Karelia social and health services. Aim: The aim of the pilot project was to promote the health, well-being, and functional capacity of children and adolescent. The purpose of the school physiotherapy pilot was to build a school physiotherapy model for schools in the North Karelia region. Results: As a result of the school physiotherapy pilot, a model for school physiotherapy practice was created. Conclusion: School physiotherapy pilot was shown to be helpful in improving the activity levels and motor development of school-aged children and adolescents. It is hoped that school physiotherapy will develop further to promote the health and well-being, motor skills and functional capacity of children and adolescents through physical activity.

Physiotherapy students promoting health and well-being of school-aged children and adolescents in North Karelia, Finland

Introduction

Physical activity is important for health and well-being of children and adolescents and is associated with improved physical outcomes (e.g. cardiorespiratory fitness, muscle mass and body composition. Physical activity is also linked with mental and cognitive health outcomes, such as brain health and cognition (Physical Activity Guidelines for Americans 2018.) The recommendation for children and adolescents is at least 60 minutes of moderate- to vigorous-intensity daily physical activity (Bull et al. 2020). Studies have found that only a proportion of children and adolescents achieve these recommendations (Hallal et al. 2012, Katzmarzyk et al. 2017). In Finland two thirds of children achieved the recommended level of daily physical activity in 2018 (Kokko & Martin 2019).

Schools have an important role in pupils’ physical activity, because children and adolescents spent majority of their time at schools (SHAPE America 2013, Vazou et al. 2020). According to World Physiotherapy (2019) one of the physiotherapists’ role is to guide and facilitate people of all ages to develop, maintain and restore their maximum movement and functional ability and improve their quality of life. Physiotherapists are experts in motor development and skills acquisition, movement and mobility, which are particularly important for school aged children and adolescents. Physiotherapists have knowledge and skills to promote and implement physical activities for people of different ages. Currently physiotherapists’ knowledge and expertise are underused in school healthcare system. (Lindqvist 2017, The Nordic Physiotherapy Associations 2017.)

The Nordic Physiotherapy Associations (2017) recommends that physiotherapists should be a part of school healthcare system. Also, Finnish Association of Physiotherapists in 2019 published a recommendation of school physiotherapy to Finland. According to the recommendations, the goal of school physiotherapist is to organize activities that promote health and well-being and prevent musculoskeletal problems in children. Preventing and treating musculoskeletal problems are also important part of school physiotherapist‘s work. It has been shown that one third of adolescents report musculoskeletal (MSK) pain monthly and prevalence of MSK pain increases from childhood to adolescence. There is also evidence that persistent MSK pain in children or adolescent may be a risk factor for chronic pain in adulthood (Kamper et al. 2015). Exercise interventions have been found to be promising at least to treating low back pain in children and adolescents (Michaleff et al. 2014). When physiotherapists work in schools, it is possible to support children’s and adolescents’ social, mental and physical functioning through appropriate physical activity and movement during the school day. (The Nordic Physiotherapy Associations 2017, Finnish Association of Physiotherapists 2019.)

This article describes a pilot project on how school physiotherapy was developed and organized in North Karelia in cooperation with Karelia University of Applied Sciences (Karelia), schools in the Joensuu region and the Siun sote- Joint municipal authority for North Karelia social and health services.

School physiotherapy pilot

A school physiotherapy pilot was launched in North Karelia in the spring of 2020and completed in the autumn of 2021. The aim of the pilot was to promote the health and well-being, motor skills and functional capacity of children and adolescent. The purpose of the school physiotherapy pilot was to build a school physiotherapy model for schools in the North Karelia region. The pilot was designed and implemented in cooperation with Karelia physiotherapy education, the Joensuu region’s primary schools and Siun sote – Joint municipal authority for North Karelia social and health services. Karelia in eastern Finland, founded in 1992, is a small University of Applied Sciences offering 21 degree programmes, 16 bachelors, and five at the master level, in seven study fields that accommodate about 4000 students. The 3.5 year bachelor degree program in physiotherapy has two intakes in a year, 20-30 students each time. The total annual physiotherapy student population is approximately 200 (Karelia 2021). The program includes five practice education periods, total 1107 hours from second and final year of the studies (Karelia 2019).

During the school physiotherapy pilot, the physiotherapy students from Karelia worked in pairs with school nurses in the selected schools in the Joensuu region for eight weeks at the beginning of the school semester. The students also collaborated closely with the teachers and other school staff during their practice. Physiotherapy students, who participated in this pilot , were at the end of their studies and this practice was at least their third placement. To date, a total of 11 school health care units have been involved in the pilot. Physiotherapists and school nurses from Siun sote and the teachers of physiotherapy program were responsible for supervising the students’ practice. Physiotherapists and physiotherapy teachers met each student once in a week in schools or remotely during the COVID19-pandemic. In addition to this, students and physiotherapy teachers had common weekly reflection session, where it was possible to discuss about students’ experiences and learning. Shared reflection was perceived important for students.

During the pilot, physiotherapy students’ work tasks followed the recommendations of school physiotherapy by The Nordic Physiotherapist Associations (2017) and Finnish Association of Physiotherapists (2019). Students organized physical activity groups, e.g. exercise, motor skills training and relaxation groups. According to students, these groups were popular amongst the pupils. Students were also involved in exercise classes with teachers, where they organized activities which developed motor skills and helped the pupils who had special needs.

Students were involved in health evaluations, where they provided health-promoting advice especially to overweight, obese and inactive pupils. Students with school nurses also performed spinal assessments for scoliosis and if necessary, gave physiotherapeutic guidance and advice for exercises. Physiotherapy students also gave individual targeted advice to pupils who had musculoskeletal pain.

During the pilot, students also conducted ergonomic evaluation and advice in classrooms and planned together with the pupils, how school-environment could facilitate exercise and moving during the school day.

Results of the school physiotherapy pilot

As a result of the this pilot project, a model for school physiotherapy practice was created. In the future, school physiotherapy will be included as one of the practice education periods for all physiotherapy students at Karelia. The practice in the schools will last 12 weeks in both school semesters and students will be in the schools two days a week during the practice. Practice also includes four hours of reflection weekly and the rest of the week students will have other studies of the curriculum. The practice will be undertaken in pairs, with two students completing the practice at the same school, allowing students to support each other and reflect their learning together during the week.

Conclusion

School physiotherapy pilot was necessary for improving physiotherapy for school-aged children and adolescents. Physiotherapy students’ working tasks were diverse and they followed the recommendations of school physiotherapy by The Nordic Physiotherapist Associations and Finnish Association of Physiotherapists. In future, school physiotherapy should be continued and developed for promoting the health and well-being, motor development and functional capacity of school aged children and adolescents.


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