Università degli studi di Modena e Reggio Emilia

Background: Chronic Low Back Pain (CLBP) is currently considered a biopsychosocial syndrome, where individual, physical, occupational, psychological and social risk factors coexist. The available research indicates that physiotherapists (PTs) theoretically endorse the proposed biopsychosocial approach to treatment, yet very few are adopting this approach in clinical practice. Aim: The purpose of this exploratory survey is to obtain a detailed view of physiotherapists’ perceptions in their local setting, with specific reference to the operators’ kind of approach and professional skills in the treatment of CLBP. Methods: The survey tool was a focus group, based on a simulated clinical case conducted with expert operators selected on a voluntary basis. The results of the interview were analyzed using a qualitative-inductive method. Results: The analysis shows results related to three interconnected macro areas: the physiotherapists’ professional skills/training, evaluation tools, and organizational structure. Physiotherapists’ skills should be reinforced with training dedicated to communication-relational aspects and supported by assessment tools necessary to screen and evaluate psychosocial factors. As regards organizational structure, it takes the opportunity to design a clinical path or structure specialized in outpatient services for patients with chronic low back pain (CLBP). Conclusion: Some results are aligned with the literature. In particular, the need to reinforce physiotherapists’ inter-relational skills and to support them with the intervention of other specialists (multidisciplinary team) in the case of problems not strictly of their competence. The role of management is to identify organizational solutions to creating clinical pathways to reduce dispersion and to reinforce the professionals’ expertise.

BACKGROUND:Falls are a common adverse event in both elderly inpatients and patients admitted to rehabilitation units. The Hendrich Fall Risk Model II (HIIFRM) has been already tested in all hospital wards with high fall rates, with the exception of the rehabilitation setting. This study's aim is to address the feasibility and predictive performances of HIIFRM in a hospital rehabilitation department. METHODS: A 6 months prospective study in a Italian rehabilitation department with patients from orthopaedic, pulmonary, and neurological rehabilitation wards. All admitted patients were enrolled and assessed within 24 h of admission by means of the HIIFRM. The occurrence of falls was checked and recorded daily. HIIFRM feasibility was assessed as the percentage of successful administrations at admission. HIIFRM predictive performance was determined in terms of area under the Receiver Operating Characteristic (ROC) curve (AUC), best cutoff, sensitivity, specificity, positive and negative predictive values, along with their asymptotic 95% confidence intervals (95% CI). RESULTS: One hundred ninety-one patents were admitted. HIIFRM was feasible in 147 cases (77%), 11 of which suffered a fall (7.5%). Failures in administration were mainly due to bedridden patients (e.g. minimally conscious state, vegetative state). AUC was 0.779(0.685-0.873). The original HIIFRM cutoff of 5 led to a sensitivity of 100% with a mere specificity of 49%(40-57%), thus suggesting using higher cutoffs. Moreover, the median score for non-fallers at rehabilitation units was higher than that reported in literature for geriatric non fallers. The best trade-off between sensitivity and specificity was obtained by using a cutoff of 8. This lead to sensitivity = 73%(46-99%), specificity = 72%(65-80%), positive predictive value = 17% and negative predictive value = 97%. These results support the use of the HIIFRM as a predictive tool. CONCLUSIONS: The HIIFRM showed satisfactory feasibility and predictive performances in rehabilitation wards. Based on both available literature and these results, the prediction of falls among all hospital wards, with high risk of falling, could be achieved by means of a unique tool and two different cutoffs: a standard cutoff of 5 in geriatric wards and an adjusted higher cutoff in rehabilitation units, with predictive performances similar to those of the best-preforming pathology specific tools for fall-risk assessment