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

Article: Physiotherapy students promoting health and well-being of school-aged children and adolescents in North Karelia, Finland
Article status: accepted
Author: Ralph Hammond
Review date: 12 January 2022
DOI: 10.14426/opj/rrh20220609

Peer review (Ralph Hammond) – Physiotherapy students promoting health and well-being of school-aged children and adolescents in North Karelia, Finland

1. Complete, coherent, and well-organized presentation

Thank you for submitting this article. I think this is an interesting idea and pilot study. I want to encourage you to continue with this work because I think it is of value. I certainly like the idea of the profession increasing its deployment of staff beyond traditional healthcare settings (i.e., hospitals and homes).

Currently, I think it is incomplete, because it omits to report on important governance arrangements that I would anticipate the physiotherapy school and the education school would have put in place.

It sounds like a good idea, and something that is superficially of value – but if you are to report on what you did, then it would help to provide more details, otherwise you raise more questions than you answer. I will try to give examples of what I mean, below.

I think your paper reports on a service improvement project rather than a research study. If you want this to be a research study report, you will need to add much more detail about the background thinking, research methodology and methods, evaluation measures, and points of measurement, etc, to strengthen the credibility and trustworthiness of your report. However, I don’t think this is really what you are seeking to do or report on.

If I’m right and it is a service improvement project, I still think it would help to add in more details of your thinking, the options you faced, and therefore the decisions you made; more information about governance arrangements; how you have evaluated the pilot; and, therefore, why you consider it a success. I’m sure you are, but you don’t currently demonstrate this.

I appreciate this is meant to be a short report. I like the idea and intentions of the work. I want to encourage you to re-read this report and add more details of what you were thinking about as you planned it: what decisions did you make, what safeguards did you put in place, how have you worked out that it was a success.

2. Sufficient explanation of the significance of the problem

I am not sure. You provide details of the importance of physical activity for this age group. You explain that many do not achieve it. You then suggest that physiotherapists can provide this. As this is an international journal, I did wonder if you could supply more details about the nature of physical education provision in Finland – is this provided by sports teachers or schoolteachers who have been volunteered to run physical activity sessions. As such, is this a gap in local school curriculum provision, or have you identified a gap in national level?

3. Clear demonstration of the relevance to the field (beyond the case presented)

I suggest this is implied and that physiotherapists might understand your perspective. However, policy makers and educationalists may need a sentence or two to understand why student physiotherapists can do this safely and effectively.

4. Original contribution to the topic of physiotherapy education

Yes. I think so, though I am not familiar with the literature of physical activity in primary school children, or education provision in Finland. I can see, and would agree, that physiotherapists, or the physiotherapy profession in Finland, could expand its service offer by offering a more comprehensive physical activity service in the community, beyond healthcare services, by providing primary prevention public health services. I think it would help your case, were you to say this.

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

I think this needs expanding. See my previous point.

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

More would strengthen the paper. For example, what specifically were you hoping to achieve? Is this about expanding the placement provision for student physiotherapists, filling a gap in the school’s curriculum that has been identified, or supplementing or strengthening what is already provided?

7. Appropriate research design and method

I suspect this is a service improvement project rather than a research study. If it is the latter, then much more detail about the theoretical perspective, research methodology, and research methods, including measures, are needed.

If it is a service improvement project,, it would still benefit from describing in more detail the governance arrangements, and measures of activity, to give a stronger sense of what happened, and what improvements the pilot showed. As it is, the report seems to suggest that getting physiotherapy students to run a physical activity session “works”: what is it that “worked”? Do you have any independent feedback: from students, from parents, from the teachers – to strengthen your evaluation?

For example, in the School physiotherapy pilot section you say:

“Students organized physical activity groups, e.g., exercise, motor skills training and relaxation groups”.

What sort of exercise, what motor skills training, what relaxation groups? Was this individualised, or group work? How did the students manage students with diverse needs, abilities, and motivation?

“According to students, these groups were popular amongst the pupils.”

Can you provide more evidence? If you can’t, it may be worth saying so, and suggesting that you would do so, as you roll out the pilot. Were these groups popular with literally everyone, or a large majority? Did they prefer some forms of physical activity over others? Did some just like the relaxation classes?

“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.”

I think more detail would make this more powerful: how often did the teachers get involved, and why? Was this to help a student who was struggling with a given child, or because the teachers enjoyed the activity? Were teachers learning new skills that they planned to take on themselves? What was the incidence of children with special needs, what type of special needs, and how did the students manage this? Answers to these questions strengthen your evaluation and report.

“Students were involved in health evaluations, where they provided health-promoting advice especially to overweight, obese and inactive pupils.”

Can you describe how this was undertaken, and what governance arrangements were in place to prevent the student, with the best of intentions, from delving into personal problems? I can imagine this requires a great deal of sensitivity and could open all sorts of issues: which are worth opening up for the child but would need great care to do so safely.

“Students with school nurses also performed spinal assessments for scoliosis and if necessary, gave physiotherapeutic guidance and advice for exercises.”

This potentially expands the pilot from offering physical activity opportunities, to much more individualised and bespoke work; it might also stray into national public health schemes: all potentially worthwhile, but complex.

“Physiotherapy students also gave individual targeted advice to pupils who had musculoskeletal pain.”

Again, this might be useful opportunistic health care, but strays into becoming a specific healthcare episode of care: so, how was this managed: what governance arrangements, record keeping, etc were in place. How was the student supervised to ensure they conducted an appropriate examination and assessment, and gave appropriate advice, and were able to refer on, when necessary?

8. Accurate and useful interpretation

Limited: needs development. In the section, Results of the school physiotherapy pilot, you do not actually provide any results. Rather you say what will happen next.

9. Sound argument and analysis

Needs more reflection on the outcomes and what you think it means.

10. Effective conclusion about the implications for physiotherapy education, research, and/or practice



One Reply to “Peer review (Ralph Hammond) – Physiotherapy students promoting health and well-being of school-aged children and adolescents in North Karelia, Finland”

  1. Thank you for very valuable advice and collegial discussion of issues brought up in this paper.

    We have made changes as we feel is appropriate and possible based on this work. Our work is a service improvement project as you expected and because of that we weren’t able to show results of pilot. We clarified the context of the paper by adding details to the requested questions. For example we added details about the physical education and school health care system in Finland. We described the project more specific and added references to feedback from students, pupils and the teachers.

    We are encouraged by your interest and valuable comments, and are hoping to continue the development of this project.

    We are very grateful for your time and advice and look forward to further discussion and further work on this important and continuing change and challenge of educational provision for all of us.
    The authors.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.