Jason Chua

Physiotherapists in Aotearoa New Zealand, face challenges implementing evidence-based practice (EBP) for non-ambulatory children with cerebral palsy and intellectual disabilities (NACCPID) working within Hoffman’s model of EBP. Key challenges in the evidence component include limited NACCPID specific research. This project aims to review the literature on physiotherapy interventions for school-aged NACCPID to inform clinical practice and identify areas for future research within the Aotearoa New Zealand context. An integrative review was conducted, following Kutcher and LeBaron’s (2022) method. A systematic search, conducted in 2023, yielded 2,240 articles that were narrowed to 24 after applying inclusion criteria. Coding and thematic analysis were conducted in NVivo 12 following content analysis methods. Final codes were organised within the Te Whare Tapa Whā framework through collaborative review with a cultural advisor. This enabled a holistic view of health, addressing physical, mental, social, and spiritual wellbeing, incorporating Māori perspectives. Ten themes were generated relating to physiotherapy interventions for NACCPID: 1) individual needs; 2) self-esteem and positive emotions; 3) body systems; 4) optimising ability to move the body; 5) using the body to perform a task; 6) collaboration; 7) (in)dependence; 8) participation and inclusion; 9) resourcing; and, 10) accessible environments. Notably, power wheelchair training appears to have significant beneficial effects across all aspects of health, and it is important that the child and families’ individual needs, wants, likes, circumstances, and values are considered when choosing an intervention.

Background/Objectives: To identify the barriers and facilitators to accessing healthcare following intimate partner violence (IPV)-related brain injury (BI). Methods: Sixteen adult women participated in interviews about their experience of accessing healthcare following IPV-related BI. Interviews were transcribed verbatim and analyzed using the interpretative descriptive (ID) approach to identify themes and subthemes in the data. Results: Two themes, each with six subthemes related to healthcare seeking for IPV-related BI were identified: Theme 1—Deciding to seek and ability to access healthcare, comprising (a) severity of injury; (b) impact of injury; (c) ability to access medical services; (d) self-blame, fear, shame, and guilt; (e) contextual influences on healthcare seeking; and (f) previous negative interactions; and Theme 2—Complexity in identifying IPV-related BI, comprising (a) trauma can affect recall of events; (b) inability to distinguish IPV-related trauma or aging outcomes from BI sequelae; (c) the importance of trust in disclosure; (d) healthcare professionals need to ask the right questions and respond in the right way; (e) the complex nature of disclosure creates challenges for diagnosis; and (f) fear of being dismissed or judged. Conclusions: Many context-related factors influence whether women can seek treatment for IPV-related BIs. These factors need to be understood by first responders and medical professionals to improve the likelihood and speed of treatment seeking. Furthermore, challenges and fears associated with disclosure of IPV prevent women from seeking proper treatment. IPV training could be helpful in ensuring women feel safe with disclosure.

To explore how lived and care experiences of young people (aged 16-24 years) who experience chronic musculoskeletal pain (CMP) influence their choices about CMP care, and how and where a digital health solution (DHS) could support their care. A cross-sectional, exploratory qualitative study involving 20 young people (16-24 years) experiencing CMP. Eight focus groups were conducted, guided by a focus group schedule. Data were analyzed using thematic analysis. Three main themes emerged describing young people's experiences and CMP care choices. For each main theme we identified how a DHS could support their care: (1) "Experiences of living with and managing their CMP." A DHS could buffer self-care needs by providing timely support and creating a sense of community. (2) "Experiences with healthcare providers and healthcare services." An app-based DHS could potentially help to coordinate CMP care and support health services navigation. (3) "Young people's choices about their CMP care options." DHSs can support young people prioritize their CMP care options. Understanding young people's values, alongside their care needs is critical to delivering person-centred care. A tailored DHS can value-add to young people's CMP care by helping to minimize the burden of self-care, health service navigation and interactions with healthcare providers.

Objective: Australian evidence on lived and care experiences of chronic musculoskeletal shoulder pain (CMSP), irrespective of disorder classification or disease, is limited. However, such evidence is important for person‐centered care and informing local service pathways and care guidelines or standards. To address this gap, we explored the lived experiences of adults with CMSP across domains of the International Classification of Function, Disability and Health (ICF) framework, and their care experiences, preferences, and priorities for CMSP. Methods: This was a qualitative study that applied a phenomenological approach. Purposive sampling was conducted with adults experiencing CMSP. Individual semistructured interviews, informed by ICF domains, explored lived and care experiences/preferences of the participants. Data were analyzed using an inductive approach, by objective. Results: Twenty adults (50% female) with diverse CMSP conditions/diagnoses, clinical profiles, and age (21–78 years) participated. Five lived experience themes were identified: 1) impact on body functioning; 2) impact on sleep, energy, and drive; 3) impact on mental well‐being and evolving sense of self; 4) coping with CMSP; and 5) social support and participation. Four care experience themes were included: 1) care‐seeking choices; 2) interactions with health care professionals (HCPs); and 3) values and preferences for components of CMSP care. Conclusion: Adults with CMSP experience impacts across life stages in multiple domains of functioning (ICF categories) relating to personal and social dimensions. Clinical encounters, particularly interactions with HCPs, influence an individual's confidence and engagement in their CMSP care. Discussion, education, and goal setting through shared decision‐making are valued attributes of clinical encounters among people with CMSP.

Chronic musculoskeletal pain (CMP) and coexisting mental health conditions impact young people; however, little is known about their lived and care experiences. In a prospectively registered systematic review with qualitative evidence synthesis (PROSPERO: CRD42022369914), we explored the following: (1) lived physical, psychological, and social experiences; and (2) care experiences/preferences of young people living with CMP and mental health conditions. Inclusion criteria: studies using qualitative methods; participants aged 16 to 24 years with CMP and coexisting mental health condition(s); phenomenon explored included lived and/or care experiences. Seven databases were searched (inception to 19-May-2024), study quality was assessed, data were extracted and analysed thematically, and GRADE-CERQual was used to assess confidence in findings. Twenty-two studies (23 reports) were included (>239 participants, 82% women). Lived experiences yielded 4 themes (9 findings): 2-way relationship between CMP and mental health (2 findings, low to moderate confidence); psychosocial implications of CMP (3 findings, very low-moderate confidence); uncertainty about future (2 findings, low-moderate confidence); coping with CMP and mental health conditions (2 findings, low-moderate confidence). Care experiences/preferences yielded 3 themes (8 findings): navigating healthcare systems (2 findings, moderate confidence); receiving appropriate care (3 findings, very low-moderate confidence); point-of-care experiences and care preferences (3 findings, very low-moderate confidence). Chronic musculoskeletal pain and mental health conditions are interconnected, significantly impacting young people's lives, identities, and socialisation, yet services for CMP and mental health are often inadequate and poorly integrated. The mechanisms and interplay of CMP and mental health require deeper exploration, including how young people may be better supported with personalised, holistic, developmentally and/or life-stage-appropriate integrated care.

Following a mild traumatic brain injury (mTBI; also known as concussion), physiotherapists may be involved in injury identification, assessment and rehabilitation. However, how people perceive and experience the physiotherapist’s role is not well understood. Semistructured interviews were undertaken with patients who saw a physiotherapist individually or as part of a multidisciplinary team following mTBI in New Zealand. Interviews were recorded, transcribed verbatim and analysed using the interpretive descriptive approach. A total of 12 interviews were held with participants aged 19–67 (50% female; mean age 37 (SD=14.8) years) who had a mTBI on average 9 (SD=8) months ago. Thematic coding of interviews generated four themes, each supported by three to five categories representing their experiences: (1) ‘How physiotherapy could help me’—representing how the interventions were delivered; (2) ‘Empower me to manage my mTBI’—representing participants learnings to self-manage; (3) ‘Set me up to get the most out of treatment’—representing considerations needed before, during and after practice to maximise engagement and (4) ‘Get to know me and what’s important to me’—representing the importance of considering the person as a whole, and preferences for assessment, intervention, communication and culture throughout service delivery. Overall, participants reported variable mTBI care experiences yet perceived the physiotherapist as having a key role in supporting self-management and treating headaches, neck pain and balance issues. mTBI physiotherapy care needs to be more attuned to patients’ preferences and circumstances and delivered in a way that maximises rehabilitation outcomes. Building effective therapeutic connections with patients may be key to addressing these concerns simultaneously in practice.

Concussions (mild traumatic head injury) have received increasing attention in clinical practice, research, and the public press. A range of healthcare providers engage with patients presenting with concussion, and physiotherapists are often at the front line of these consultations, especially on the sports field. We explored physiotherapists’ perspectives of their scope of practice and actual clinical practice within the sports-related concussion diagnosis and return-to-sport context. A qualitative approach with interviews and focus groups was used, including 18 physiotherapists. Three themes were derived: (a) delayed access to concussiontrained general practitioners; (b) navigating concussion care in a strained healthcare system; and (c) proposed expanded role for physiotherapists. Delayed patient access to medical doctors often delayed a formal concussion diagnosis, initiation of specific concussion care, or medical sports clearance. Yet the participants were regularly identifying and managing concussions, and most felt confident to do so. Some participants, particularly those working with high-performance athletes or in multidisciplinary teams, suggested that concussion diagnosis and clearance for return to work or play should remain the medical doctors’ responsibilities. Yet participants working at community level suggested that, with relevant training and mentored experience, diagnosis, triaging, and clearance for sport could be within their scope of practice.

Background: Post-mild traumatic brain injury (mTBI) symptoms are not specific to mTBI and are experienced in populations without brain injury. Understanding how people without brain injury experience mTBI-like symptoms and factors influencing symptom reporting is important to determine how symptom experience differs following an mTBI. Methods: To understand how people without a history of brain injury experience mTBI-like symptoms, we conducted a cross-sectional survey comprising sociodemographic characteristics, the Brain Injury Screening Tool symptom scale, general health rating, Illness Attitude Scale, Positive and Negative Affect Scale and Perceived Stress Scale. The mean total symptom score and proportion of people experiencing moderate or severe symptoms (=4) were reported. Associations between sociodemographic variables, stress, negative affect, illness attitudes, health status and symptoms were examined using regression models. Results: One-hundred and seventy-three people completed the survey with a mean age of 40 years (s.d. = 15.8; n = 82, 47.4% male). The mean total symptom score was 34.5( ± 26.6). Commonly experienced symptoms were tiredness (n = 73, 42.2%), poor sleep (n = 64, 37.0%) and headaches (n = 56, 32.4%). Regression analysis revealed that on average higher levels of worry about illness and negative affect were associated with higher symptoms (ß = 0.5, P = 0.027 and ß = 0.9, P = 0.020 respectively) but there were no significant associations with other variables. Conclusions: Cognitive and vestibular-ocular symptoms occur much less frequently than physical symptoms in the general population and may be more specific to mTBI. However, there is a need to consider vestibular-ocular symptoms alongside illness attitudes due to greater concerns about these symptoms by patients.