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

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

Peer review (Ben Ellis) – 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.

[jetpack-related-posts]

One Reply to “Peer review (Ben Ellis) – Physiotherapy skills in the difference of years of therapists’ experience and affiliations”

  1. Dear Ben Ellis

    Thank you very much for all your time and effort, we really appreciate it.
    We have corrected the areas you indicated. We also rechecked and corrected our English grammar. Areas of major revision are highlighted.

    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.
    →Thank you for your comments.
    We have changed the abstract along with the changes in the text.
    “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.”

    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.
    →We added an explanation about physical therapy education of Japan, including the training process in the Introduction.
    “In Japan, physiotherapist, who has approximately 5 years or 10 years of work experience, 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. In order to begin quantifying skill, it is first necessary to establish the feasibility of distinguishing between what the JPA considers ‘experienced’ from ‘novice’ based on basic physical therapy treatment technique and approach. The purpose of this study is to establish groundwork for standardization in education and evaluation.”

    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.
    →We have reexamined the statistical study of the method using correlation statistical analysis and we have accordingly revised our discussion.
    “Correlational statistical analysis was used to confirm whether years of experience changes the degree of WS.”

    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.
    →We changed the tables, and included which differences are significant and the level of significance.

    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.
    →We are thinking that undergraduate and clinical education are important for physiotherapy. Therefore, we believe that it is important to assess the practitioners as a preliminary step and the study provides an understanding of the current situation about it. In addition, if we can confirm it is possible to use force plates for technical evaluation, we expect that objective evaluation will be possible and can be used in undergraduate and clinical education. We added an explanation about our thinking in the Introduction.
    “This technique is a therapeutic technique and force plates are not used in therapeutic situations. However, if it becomes clear that force plates can be used to confirm the technique, it will be possible to objectively evaluate and improve the technique in future undergraduate and clinical education.”
    →We have revised our discussion.
    “The results of this study confirm that the correlation between the data obtained and years of therapists’ experience is weak or absent. Form the results, 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 skill evaluated in this study. However, the participants of this study had from 6 to 27 years of experience as therapists. Therefore, they all met the minimum of 5 years of therapists’ experience as per the clinical practice supervisor requirement in Japan. 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, it will need to get information from the participants on how much additional training they have had/which courses they have attended.”

    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.
    →The tasks we have done this time are part of the WS that will be done in treatment. Therefore, it was not performed while walking, and was performed in the resting standing position in the frontal plane.
    We added an explanation about reason of why the WS has been selected as the technique measured.
    “While there are many opportunities to practice ROM exercises, MMT, and muscle strengthening exercises in training school education, WS is a skill that is often learned after going into clinical practice. The influence of undergraduate education can be disregarded because it is learned post-graduation. For this reason, WS was chosen as the participant in this study. In addition, it was assumed to be a component until loading to the lower leg of one foot in the WS technique. This technique is a therapeutic technique and force plates are not used in therapeutic situations. However, if it becomes clear that force plates can be used to confirm the technique, it will be possible to objectively evaluate and improve the technique in future undergraduate and clinical education.”

    Best Regards,
    Yumi Okayama, PT, Ph.D.
    Department of Physical Therapy,
    Osaka University of Human Sciences,
    Osaka, Japan.
    Mail: [email protected]

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