Background: Rising healthcare costs, an increasing general practitioner shortage and an aging population have made healthcare organization transformation a priority. To meet these challenges, traditional roles of non-medical members have been reconsidered. Within the domain of physiotherapy, there has been significant interest in Extended Scope Physiotherapy (ESP). Although studies have focused on the perceptions of different stakeholders in relation to ESP, there is a large variety in the interpretation of ESP. Aim: To identify a paradigm of ESP incorporating goals, roles and tasks, to provide a consistent approach for the implementation of ESP in primary care. Methods: An exploratory, qualitative multi-step design was used containing a scoping review, focus groups and semi-structured interviews. The study population consisted of patients, physiotherapists, general practitioners and indirect stakeholders such as lecturers, health insurers and policymakers related to primary care physiotherapy. The main topics discussed in the focus groups and semi-structured interviews were the goals, skills and roles affiliated with ESP. The ‘framework’ method, developed by Ritchie & Spencer, was used as analytical approach to refine the framework. Results: Two focus groups and twelve semi-structured interviews were conducted to explore stakeholder perspectives on ESP in Dutch primary care. A total of 11 physiotherapists, six general practitioners, five patients and four indirect stakeholders participated in the study. There was a lot of support for ‘decreasing healthcare costs’, ‘tackling increased health demand’ and ‘improving healthcare effectiveness’ as main goals of ESP. The most agreement was reached on ‘triaging’, ‘referring to specialists’ and ‘ordering diagnostic imaging’ as tasks fitting for ESP. Most stakeholders also supported ‘working in a multidisciplinary team’, ‘working as a consultant’ and ‘an ESP role separated from a physiotherapist role’ as roles of ESP. Conclusions: Based on the scoping review, focus groups and interviews with direct and indirect stakeholders, it appears that there is sufficient support for ESP in the Netherlands. This study provides a clear presentation of how ESP can be conceptualized in primary care. A pilot focused on determining the feasibility of ESP in Dutch primary care will be the next step.
BACKGROUND: Chronic musculoskeletal pain (CMP), Generalized Joint Hypermobility (GJH) and pain-related fear have influence on physical functioning in adolescents.AIM: to evaluate differences in physical functioning between adolescents with CMP, GJH or the combination of both, and in addition evaluate the potential contribution of pain-related fear.DESIGN: The design of this study was observational and cross-sectional.SETTING: The adolescents with CMP were recruited by a physician in rehabilitation medicine and measured in the university outpatient rehabilitation clinic (Adelante/Maastricht University Medical Center+, the Netherlands). The adolescents without CMP were recruited in the Southern area of the Netherlands and measured in the university outpatient rehabilitation clinic (Adelante/Maastricht University Medical Center+, the Netherlands).POPULATION: Four subgroups of adolescents were included; 21 adolescents with CMP without GJH, 9 adolescents with CMP and GJH, 51 adolescents without CMP without GJH, and 11 adolescents without CMP with GJH.METHODS: Outcome measures were muscle strength and endurance, motor performance, physical activity level, and pain-related fear. Hierarchical regression analyses were used to study differences in physical functioning and the contribution of pain-related fear in adolescents with/without CMP as well as with/without GJH.RESULTS: Adolescents with CMP had decreased muscle strength (P=0.01), endurance (P=0.02), and lower motor performance (P<0.01) compared to adolescents without CMP. Higher levels of pain-related fear were related to decreased muscle strength (P=0.01), endurance (P<0.01), and motor performance (P<0.01). No differences in physical functioning and pain-related fear between hypermobile and non-hypermobile adolescents with CMP were found.CONCLUSIONS: Adolescents with CMP had decreased muscle strength and motor performance associated with increased levels of pain-related fear compared to adolescents without CMP. The association of being hypermobile with physical functioning is not more pronounced in adolescents with CMP.CLINICAL REHABILITATION IMPACT: No differences were found in physical functioning and pain-related fear between hypermobile adolescents with CMP compared to non-hypermobile adolescents with CMP. Future rehabilitation treatment in hypermobile adolescents with CMP should also focus on psychological components, such as pain-related fear.
BackgroundIn 2015, Amsterdam became part of the WHO Age Friendly City community, thereby accepting the responsibility to work towards a more age friendly Amsterdam. To study senior citizens’ needs and wishes concerning the age friendliness of their neighbourhood, the municipality asked the Amsterdam University of Applied Science to set up two pilot projects in two neighbourhoods. Aim was to 1) gain insight in seniors’ views and wishes regarding an age friendly city, and 2) reflect on the experiences with working with senior co-researchers. MethodologyThe study followed a Participatory Action Research approach with research teams consisting of seniors as co-researchers and professional researchers. We chose two neighbourhoods with distinct characteristics: the Indische Buurt which is centrally located, vibrant, multicultural, and strongly gentrifying, and Buitenveldert, a suburban and spacious neighbourhood, with less facilities and a dominance of well-to-do senior citizens. In both areas, we recruited senior co-researchers to form the research teams. They generally lived in, or close to, the pilot neighbourhood, and varied in age and ethnical background. The aim was to put the co-researchers in the lead during the entire research process. However, it differed between the neighbourhoods which type of researcher was in the lead. As a team, they formulated the main research question, constructed a topic list for interviews with older citizens, convened the interviews, analysed the data, wrote the report, and presented the results. During the entire process, they were supported by professional researchers.Both research teams interviewed 40 senior citizens, who were recruited through the co-researchers’ networks, professional care organisations, neighbourhood communities, and local media. We intended to gather a sample representative for the neighbourhood population. In the Indische Buurt, this proved to be difficult, since the relatively large Turkish and Moroccan communities were difficult to get into contact with, and it was hard to find co-researchers from those communities who could have provided a way in. Process and outcomesWe will share some of the results, but we will mainly reflect on the research process. ProcessRegarding the process, we found some differences between the two neighbourhoods. In the Indische Buurt, it took much effort to find co-researchers, since the seniors we encountered said to be too busy with other neighbourhood activities. We did recruit a small group of four co-researchers of different ethnical background, but sadly lacking Turkish and Moroccan seniors. They started with a very limited research experience and experienced ownership, which greatly increased during the process. At the finalisation of the project, the group ceased to be, but the outcomes were followed up by existing groups and organisations in the neighbourhood.In Buitenveldert, a large group of co-researchers was recruited in no-time, bearing more resemblance to an action group than a research group. They were generally highly educated and some already had research experience. The group proved to be pro-active, had a strong feeling of ownership, and worked in constant collaboration with the ‘professional’ researchers, respecting each other’s knowledge and skills. At the finalisation of the project, the group remained active as partner of the local government. OutcomesConcerning the content of the outcomes, we found some expected differences and unexpected similarities. For instance, we expected to find different outcomes concerning housing and facilities between the neighbourhoods. Indeed, in Buitenveldert, housing was already age friendly whereas facilities were scarce and geographically far apart. Yet, in the Indische Buurt, housing was poorly equipped for physically impaired seniors, but facilities were abundant and close by.We also found that, in both neighbourhoods, senior citizens were reluctant to share their limitations and ask for support, despite differences in neighbourhood, ethnicity, age etc. Of course, this can be expected of seniors from the ‘silent generation’. However, they seemingly shared these emotions more easily with their peers than with professional researchers. ConclusionThe social-cultural context of the neighbourhood impacts the research process. Overall, co-research appears to be a fruitful method to involve senior citizens in decisions concerning the improvement of their neighbourhood. Aims and content of the workshopWe aim to:• present our reflections on the participative process of working with senior co-researchers in Amsterdam• exchange and discuss with the participants of the workshop the lessons learned on how to facilitate citizens’ participation in the community• discuss similar and future projects and possibilities for collaboration among the participants of the workshopContent of the workshop• Presentation• Exchange and discussion in small groups • Plenary discussion on possible collaboration projects aiming to enhance citizens’ participation in the community
