Medical Education - Research Publications
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ItemOsteopathy Referrals to and from General Practitioners: Secondary Analysis of Practitioner Characteristics from an Australian Practice-Based Research Network(MDPI, 2024-01)Australian osteopaths engage in multidisciplinary care and referrals with other health professionals, including general practitioners (GPs), for musculoskeletal care. This secondary analysis compared characteristics of Australian osteopaths who refer to, and receive referrals from, GPs with osteopaths who do not refer. The analysis was undertaken to identify pertinent characteristics that could contribute to greater engagement between Australian osteopaths and GPs. Data were from the Australian osteopathy practice-based research network comprising responses from 992 osteopaths (48.1% response rate). Osteopaths completed a practice-based survey exploring their demographic, practice, and clinical management characteristics. Backward logistic regression identified significant characteristics associated with referrals. Osteopaths who reported sending referrals (n = 878, 88.5%) to GPs were more likely than their non-referring colleagues to receive referrals from GPs (aOR = 4.80, 95% CI [2.62-8.82]), send referrals to a podiatrist (aOR = 3.09, 95% CI [1.80-5.28]) and/or treat patients experiencing degenerative spinal complaints (aOR = 1.71, 95% CI [1.01-2.91]). Osteopaths reporting receiving referrals (n = 886, 89.3%) from GPs were more likely than their non-referring colleagues to send referrals to GPs (aOR = 4.62, 95% CI [2.48-8.63]) and use the Medicare EasyClaim system (aOR = 4.66, 95% CI [2.34-9.27]). Most Australian osteopaths who report engaging in referrals with GPs for patient care also refer to other health professionals. Referrals from GPs are likely through the Chronic Disease Management scheme. The clinical conditions resulting in referrals are unknown. Further research could explore the GP-osteopath referral network to strengthen collaborative musculoskeletal care. The outcomes of this study have the potential to inform Australian osteopaths participating in advocacy, public policy and engagement with Australian GPs.
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ItemNo gain without pain education: Improving knowledge and biopsychosocial attitudes and beliefs in a predominantly non-health-related undergraduate target audience(WILEY, 2022-09)OBJECTIVES: Chronic pain (CP) impacts individuals and society and is the leading cause of disability globally. Pain education interventions are often evaluated in patients and health professional students, but not in non-health student groups. Increasing knowledge of pain may facilitate shifts in attitudes and beliefs towards sufferers. We report on changes in pain knowledge, attitudes and beliefs of predominantly non-health-related tertiary degree students participating in online education. METHODS: Quantitative cohort study design. Students reported demographics and completed the Chronic Pain Myth Scale and 12-item Neurophysiology of Pain Questionnaire (NPQ) before (T1) and after (T2) the 7-week online module at The University of Sydney in 2020. RESULTS: Twenty-two students undertaking predominantly non-health-related bachelor's degrees (16.5% response rate, 90.9% female, mean = 19.5 years) participated. NPQ scores increased from 47.3% to 62.9%. Attitudes and beliefs towards biopsychosocial impact improved (p < 0.027) but not towards individuals suffering from CP or treatment of CP. A negative correlation was found between age and people suffering from CP (ρ = -0.437, p < 0.042) and age and towards treatment of CP; ρ = -0.556, p < 0.007) at T2. CONCLUSION: Completing the elective online module resulted in improved knowledge and biopsychosocial attitudes towards CP in this predominantly non-health cohort, as reported in health and patient cohorts.
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ItemNo Preview AvailableUtilisation of pain counselling in osteopathic practice: secondary analysis of a nationally representative sample of Australian osteopaths(WALTER DE GRUYTER GMBH, 2021)OBJECTIVES: Advice, reassurance and education are recommended as first line treatments for musculoskeletal pain conditions such as low back pain. Osteopaths are registered primary contact allied health professionals in the Australian healthcare system who primarily manage acute and chronic musculoskeletal pain conditions. This study aimed to investigate the proportion of Australian osteopaths who do and do not utilise advice, reassurance and education (pain counselling) in their clinical practice, and determine the characteristics associated with the frequency of using pain counselling in clinical practice. METHODS: A secondary analysis of practice characteristics from a nationally representative sample of Australian osteopaths was undertaken. Participants completed a 27-item practice characteristics questionnaire between July-December 2016. Bivariate analyses were used to identify significant variables for inclusion in a backward multiple logistic regression model. Adjusted odds ratios (OR) were calculated for significant variables. RESULTS: Responses were received from 991 Australian osteopaths, representing 49% of the profession. Of these 264 (26.64%) indicated often utilising pain counselling, and 727 (73.36%) reported not often utilising pain counselling. Those who utilised pain counselling were more than twice as likely to report research evidence had a high impact on their clinical practice (OR 2.11), and nearly twice as likely to discuss physical activity with their patients (OR 1.84). CONCLUSIONS: Pain counselling is under-utilised by nearly three quarters of the Australian osteopathic profession as a management strategy. Future studies are required to explore the reasons why most in the profession comprised in this sample are infrequently utilising this guideline recommendation. Given the frequency of chronic musculoskeletal pain conditions presenting to Australian osteopaths, strategies appear to be needed to advance the profession via professional development in accessing and using evidence-based care for pain conditions.
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ItemDemographic, practice and clinical management characteristics of osteopaths referring to podiatrists: secondary analysis of a nationally representative sample of Australian osteopaths(BMC, 2022-02-18)BACKGROUND: Interprofessional care is paramount in contemporary healthcare practice. How different professions interact, and the characteristics of those practitioners who practice in an interprofessional way are rarely described in the literature. The aim of the current work was to identify the demographic, practice and clinical management characteristics of Australian osteopaths who report referring to podiatrists. METHODS: The study was a secondary analysis of data from the Osteopathy Research and Innovation Network (ORION). Inferential statistics were generated to identify statistically significant demographic, practice and clinical management characteristics associated with referrals to podiatrists by Australian osteopaths. RESULTS: Nine-hundred and ninety-two Australian osteopaths responded to the questionnaire. Sending referrals to a podiatrist was reported by 651 participants (65.6%). Female Australian osteopaths were less likely to report referring to podiatrists compared to male osteopaths (OR 0.76, 95%CI 0.59-0.99). Australian osteopaths who reported referring to podiatrists were more likely to report receiving referrals from podiatrists (OR 9.75, 95%CI 6.98-13.61), use orthopaedic testing in patient assessment (OR 7.62, 95%CI 2.82-20.60), and often treat patients with postural disorders (OR 1.71, 95%CI 1.03-2.26), compared to osteopaths who do not refer to podiatrists. CONCLUSION: This study provides initial evidence for the referral relationship between Australian osteopaths and podiatrists. Further work could explore the nature of these referrals, including the complaints resulting in referral and outcomes of care. This information will be useful to those involved in health policy development and the professions advocating for their role in the wider healthcare system.
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ItemInsights into the complexity of presentation and management of patients: the Sport and Exercise Physician's perspective(BMJ PUBLISHING GROUP, 2021-11)OBJECTIVES: Sport and Exercise Physicians represent a relatively new specialty focusing on exercise in complex diseases including musculoskeletal diseases. Our objective was to describe the characteristics, type and complexity of patient presentations, their management strategies and referral information in Australian practice. METHODS: A cross-sectional study including a cohort of 11 senior Sport and Exercise Physicians in Australia studied all new patient consultations within an 8-week period. Data were analysed relating to presentation, referral source, follow-up referrals, and patient management strategies. RESULTS: Data from 419 patients were recorded. The majority, 97% (n=406), had musculoskeletal conditions, 53% (n=222) had one or more associated comorbidities and 47% (n=195) had ongoing symptoms for >12 months. Most patients, 82% (n=355), were referred by general practitioners. Prior consultations included physiotherapy 72% (n=301) and orthopaedic 20% (n=85). A multidisciplinary network of referrals from Sport and Exercise Physicians was observed, including 210 referrals to 9 allied health specialities and 61 referrals to 17 medical specialities. Over 74% (n=311) of patients received exercise-based intervention as part of the treatment plan, including 57% (n=240) physician managed exercise interventions. CONCLUSION: Our work shines a light on the nature and complexity of the role of Sport and Exercise Physicians in an Australian practice context. Findings will assist in implementing measures to promote patient care at the community level in managing musculoskeletal conditions. Sport and exercise medicine stakeholders and government policy makers can use this information in developing appropriate programmes to support patients and create integrated sport and exercise medicine services for the community.
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ItemNo Preview AvailableClinical characteristics of Australian osteopaths who teach: A national sample(AUSTRALIAN NZ ASSOC HEALTH PROFESSIONAL EDUCATORS-ANZAHPE, 2021)Background: Health professionals involved in teaching future practitioners have been studied to some extent, but our knowledge of their clinical characteristics is variable. Our study sought to profile the clinical characteristics of osteopaths who teach in the three Australian universities delivering pre-professional osteopathy education.Materials: This study is a secondary analysis of data collected via the Australian Osteopathy Research and Innovation Network (ORION) project. Descriptive statistics were generated for each of the 27-item questionnaire variables. For binary responses, unadjusted odds ratios were calculated, and for continuous variables, independent t-tests were used. Backward step-wise regression modelling was used to identify significant characteristics associated with university teaching in osteopathy. Results: The survey demonstrated 9.9% of Australian osteopaths reported being involved in university teaching. Compared to non-teaching survey respondents, the osteopaths involved in university teaching were more likely to be female (OR 1.56), older (p 0.01) and in clinical practice for longer (p 0.01) but report fewer patient care hours (p 0.01) and patient visits per week (p 0.01). Osteopaths involved in university teaching were also more likely to be involved in research (OR 18.54) and clinical supervision (OR 12.39). They also reported a broader range of patient presentations and therapeutic modalities than their counterparts.Conclusions: This nationally representative survey demonstrates a small percentage of the Australian osteopathy profession are engaged in university teaching. Our secondary analysis has highlighted several characteristics associated with involvement in university teaching that begin to shed light on the composition of the Australian osteopathy teaching workforce. This data may inform development of a skilled and experienced teaching workforce.
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ItemNo Preview AvailableMultiple feedback sources in learning clinical history-taking skills: Developing evaluative judgement(AUSTRALIAN NZ ASSOC HEALTH PROFESSIONAL EDUCATORS-ANZAHPE, 2021)Introduction: Contemporary feedback models emphasise the value of multiple feedback opportunities. Effective feedback participation requires evaluative judgement—the ability to discern the quality of one’s own and others’ work. Self and peer assessment may enable repeated practice and feedback for developing evaluative judgement. However, attitudes to self and peer assessment may present a barrier to effective implementation. This study explored whether congruence between marks from self and peer assessment improved with assessment task participation. Participants’ attitudes towards self and peer assessment and approaches to learning were also evaluated.Methods: Participants undertook simulated history-taking tasks in semester 2, 2018. Group 1 undertook formative and summative assessments and participated in self and peer assessment . Group 2 undertook formative and summative assessment. Group 3 undertook only summative assessment. All groups received faculty feedback for each submitted assessment. Participants completed the modified Study Process Questionnaire (mSPQ) and the Peer Perception of Assessment (PPA) before (T1) and after the formative task (T2) and after the summative task (T3).Results: Summative task scores improved for group 1 (n = 9, p 0.01) and group 2 (n = 26, p 0.01). Within-group (p = 0.02) and between-group differences (p = 0.01) were identified for surface learning approaches. All groups’ perceptions of peer assessment decreased significantly (p 0.01) across all three time periods.Conclusions: Participants receiving self and peer assessment and faculty feedback improved performance and increased congruence of their self- and peer-assessment marks, potentially developing their evaluative judgment skills. Peer assessment perception became less positive, while surface learning approaches increased. Future research should assess the role of self and peer assessment in developing evaluative judgment.
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ItemBreast size, bra fit and thoracic pain in young women: a correlational study.(Springer Science and Business Media LLC, 2008-03-13)INTRODUCTION: A single sample study was undertaken to determine the strength and direction of correlations between: a) breast size and thoracic spine or posterior chest wall pain; b) bra fit and thoracic spine or posterior chest wall pain and; c) breast size and bra fit, in thirty nulliparous women (18-26 years), with thoracic spine or posterior chest wall pain, who wore bras during daytime. MEASURES: Pain (Short Form McGill Pain Questionnaire), bra size (Triumph International), bra fit (Triumph International). RESULTS: Most (80%) women wore incorrectly sized bras: 70% wore bras that were too small, 10% wore bras that were too large. Breast size was negatively correlated with both bra size (r = -0.78) and bra fit (r = -0.50). These results together indicate that large breasted women were particularly likely to be wearing incorrectly sized and fitted bras. Negligible relationships were found between pain and bra fit, and breast size and pain. Menstrual cycle stage was moderately positively correlated with bra fit (r = 0.32). CONCLUSION: In young, nulliparous women, thoracic pain appears unrelated to breast size. Bra fit is moderately related to stage of menstrual cycle suggesting that this research may be somewhat confounded by hormonal changes or reproductive stage. Further research is needed to clarify whether there is a relationship between breast size or bra fit and thoracic pain in women during times of hormonal change.
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ItemCharacteristics of Australian Osteopaths Managing Tendinopathies: Analysis of a Nationally Representative Survey of 989 Practitioners(EDRA SPA, 2021-01-01)Background. Tendinopathies are a common complaint presenting to health professionals, including osteopaths. Evidence supports the use of exercise rehabilitation, with a potential role for manual therapy. This study sought to profile the practice and clinical management characteristics of Australian osteopaths who often treat tendinopathies. Methods. The study was designed as a cross-sectional survey of Australian osteopaths. Participants were Australian osteopaths who were members of the Osteopathy Research and Innovation Network (ORION) – the Australian professions’ practice-based research network. Participants were invited to complete a 27-item practice and clinical management characteristic questionnaire. The questionnaire asked participants to identify demographic, practice and clinical management characteristics associated with their practice. Regression modelling was used to identify significant characteristics associated with often treating tendinopathies. Results. Nine hundred and eighty-nine osteopaths responded and over 41% (n = 410) reported often treating tendinopathies. This group were more likely to be female (ORa 1.5), often treat patients with chronic pain (ORa 3.8) and sports injury (ORa 2.5) and often use exercise prescription (ORa 1.6) in patient care. Conclusions. Australian osteopaths who often treat tendinopathies demonstrate different clinical practice and management characteristics compared to their colleagues who do not often treat this complaint. Research into patient outcomes and cost-effectiveness of osteopathy care for the management of tendinopathies is now required.
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ItemPROMIS® General Life Satisfaction scale: construct validity in musculoskeletal pain patients(Springer Science and Business Media LLC, 2020-12)Background: Life satisfaction is part of subjective well-being. Measurement of life satisfaction is undertaken using self-report measures. This study aimed to evaluate the structural validity, concurrent validity, and internal structure of the PROMIS® General Life Satisfaction Scale (GLSS) in a musculoskeletal pain cohort. Method: Consecutive new patients attending the Victoria University Osteopathy Clinic (Melbourne, Australia) were invited to complete the GLSS prior to their initial consultation. Structural validity and internal structure were explored using confirmatory factor analysis and Mokken scale analysis. Concurrent validity was evaluated against a single-item measure of life satisfaction. Results: The PROMIS® GLSS comprised a single factor and formed an acceptable Mokken scale in this population. No differential item functioning was observed. A large positive correlation (r = 0.70) was observed between the General Life Satisfaction scale and a single-item measure of life satisfaction. Conclusions: The PROMIS® General Life Satisfaction scale demonstrated acceptable internal structure and structural validity in a musculoskeletal pain population. Additional research is required to explore concurrent validity and other measurement properties, however initial data suggests the measure could be a feasible screen of life satisfaction for Australian osteopathic patients.