Farm house north of Carterton (near Masterton, NZ)
With the research rotation over, I spent most of my week on holiday in the lower North Island.
...the Nelson farm house (featured in an April 2016 post) has now been demolished.
My holiday in the Wairarapa took me to the southern most point of the South Island, Cape Palliser lighthouse!
Ocean Beach, near Lake Ferry
The Pinnacles, near Cape Palliser (looking down)
The Pinnacles (looking up)
Sealion pups playing in a pool, sheltered from the waves (near Cape Palliser)
White kiwi (difficult to photograph... bit dark!) at Pukaha Mt Bruce National Wildlife Centre
What would an adventure be without a few selfies?! So we did.
The final week of the research rotation is over. I'm once again on a one week break. This research rotation has been productive. Our group has completed a full draft copy of our research project, our supervisors are currently giving it a read over and then we will make some final adjustments before we submit the final copy later this year.
Our draft submission was about 38 pages long (not including 20-odd pages for one appendix, and references, cover page, or our research log, etc)... and no, we didn't use double line spacing. So there is much to show for our six weeks of research. But 'what about the content...', you say? '...is it of good quality and useful - did you make any discoveries?' Our research project hasn't yielded any Nobel Prize worthy discoveries, but it is a nice succinct review of the literature (with a number of limitations). Here's a brief overview of our drafted article (expect some level of self-plagiarism):
Falls self-management by people with long-term conditions and their support worker/s: An integrative review.
Research by Awesome research group that Phil's in, et al, 2016.
(We haven't yet decided on an order for our names to be published, knowing that the first person listed will be the famous one of the group if we ever get published e.g. Butler et al., 2016 if alphabetical order is chosen... and it'll likely be 2017 if it is going to be published).
Introduction
Currently falls prevention is popularised in community level healthcare for older persons. We problematise the narrow conception of falls, instead suggesting that 'fall prevention' should target a collective population of people that are at risk of falls. Falls affect people of different health statuses (long term illness / disability), as well as across the lifespan.
We then discuss the global and local burden of falls from an economic perspective - this seems to be the current language that is spoken at a political / policy level, so we have added this because falls prevention is important and we want to see improvements in healthcare. Furthermore, with reflection to the booming population, we foresee an increased burden of falls in NZ.
Did you know that a fall that incurs cost (not all falls directly cost our health system, but of the ones that do) on average cost $500 per fall. That cost is doubled when we exclusively look at the average cost of a fall for people older than 85 years of age!!
An argument is made that all healthcare
practitioners play a role in falls prevention, and physiotherapists are
particularly well placed to bring about meaningful change - to reduce
the risk of falls. Two New Zealand interventions (The Otago Exercise
Programme, and it's modified 'Steady as you go' programme) are two
economically viable means to reduce falls for older people at risk of
falls (n.b. the Otago Exercise Programme is no longer funded by the
government, instead they fund TaiChi). We know that a large number of people that would benefit from falls prevention information do not receive it - this includes information for informal caregivers. In summary, it is our opinion that falls prevention literacy should be improved in the country.
The purpose of our integrative review was to explore the literature for self-management and confidence strategies used for falls prevention ('common sense' strategies) by community-dwelling people with long term conditions (i.e. with greater falls risks) and the strategies used by the people who support these people (their informal caregivers e.g. family, friends, neighbours).
Methods
We searched for articles that fulfilled our research purpose (using keywords, MESH terms etc) then screened the results using the title / abstracts. Selected articles were then critically appraised (we used JBI, but there are other tools out there CASP, Pedro, QUADAS-2, STARD... depends on the type of study you're critically appraising e.g. qualitative vs quantitative. We pooled information (age, sex, country etc) from all of the studies into a table, then in another table we summarised the aims, results and limitations for each study. We described the process of extracting the data for another table in our results section - this table illustrates quotes and themes from each of these studies.
Results (Spoiler Alert!!!)
We presented self-management strategies used by individuals, and their informal caregivers separately.
We came up with the following categories (then described and illustrated each of these):
Discussion
We discuss the results with respect to our aim. A discussion about the current falls prevention climate (prevention policies and strategies pushed by policy makers around the world; the reach of falls information to people at falls risk; falls literacy and the general population). Etc.
A suggestion for future research, limitations, strengths of our study and implications of our study for rehabilitation were then made.
Conclusion
We conclude, as all good research studies inevitably do, that falls is a problem and we should do something about it. Lets stand up to falls!! p.s. Stand up to falls is a campaign to increase awareness of falls - it's not specifically mentioned in our study.
...And that, my friends, is what research looks like! There is plenty of fall prevention information online - health professionals will find these three links useful...
As with all of our rotations, we have to write a reflective statement. The reflective statement for the research rotation had to integrate working as a team and the University of Otago graduate attributes. These graduate attributes include: a global perspective, interdisciplinary perspective, lifelong learning, scholarship, communication, critical thinking, cultural understanding, ethics, environmental literacy, information literacy, research, self-motivation and of course teamwork.
Another week, the same friendly smiles! Our research project is coming along (a bit slower this week - we will need to find some momentum for our last week of research). What have we achieved? We've got a very very rough results section completed. I'll do a big reveal next week and summarise the research rotation (next week is the last week of the research rotation!!).
Interesting website targeted at physicians, but it has some good info and newsletters that students may find interesting --> http://www.bpac.org.nz/
Michael Monaghan. Physiotherapy's fourth 'M' (alongside Mackenzie, Mulligan, Maitland) in the field of manual therapy. Monaghan has integrated osteopathic and physiotherapy manual therapy techniques for the cervical spine. His book 'Spinal Manipulation: A Manual for Physiotherapists' has been a key text in his post-graduate teaching. Monaghan is widely known for his contribution to teaching manual therapy in New Zealand, and particularly to undergraduates placed in Nelson. He is a major draw card for choosing your fourth year placement in Nelson. Here's an article you should look in to:
Hing, W. A., Reid, D. A., Monaghan, M. (2003). Manipulation of the cervical spine. Manual Therapy. 8(1), 2-9.
Our tutorial with Michael Monaghan on Friday morning was extraordinary. We started with a list of case studies to work through - how we would apply manual therapy techniques to correct a problem (some cases had sneaky red flags). Monaghan's style is very biomechanically focused and requires reliable and accurate palpation skills, strong arthrokinematic knowledge and clinical reasoning. Monaghan's manual handling and ability to perform manual therapy in a range of positions, using various locking/stabilising techniques (or using alternative manual therapy techniques - mainly high velocity, low amplitude mobilisations) is incredible. Furthermore, he is a great teacher. We were shown how to assess and mobilise spinal segments C0-3, with an emphasis on C0 (occipitoatlantal). Other than fine-tuning our pistol manip and lumbar manip, Monaghan showed us a transverse gapping HVLA technique for the upper thoracic / C-T junction, and the pistol manip performed on a person in sitting.
Hot tip!
Here's one really basic aspect of the physical assessment that is often overlooked by clinicians. When assessing neck range of motion, in particular side flexion, the clinician must remember that the upper cervical joints function quite differently to that of the lower cervical joints. We typically remember that the C1-2 joint can flex whilst the other Cx joints extend (i.e. the double chin), or all segments can flex (i.e. the 'did I spill tomato sauce down my front'). Clinicians often ask their clients to side flex (bring your ear to your shoulder) and commonly believe that only one movement is occurring in the neck (side-flexion). Wrong! Sure, side flexion is occurring in the lower cervical spine, but there is a slight rotation at C0 to the opposite direction (to keep the head forward, eyes as level as possible), that is forgotten about. I.e. if you side bend your neck to the left, there will be compensatory right rotation at C0. Why is this important? Say your client has a headache that is brought on by neck rotation and side-flexing the neck in the physical examination, the clinician is probably going to get confused about where the problem lies - is it in the upper, lower, or a more global cervical neck problem? Well, the answer probably lies in the subjective assessment, but you will confuse yourself in the physical assessment if you forget about these movement couplings. It's always good to assess the upper and lower cervical spine, in particular manually assessing C0 in a physical examination of the neck.
Physio Matters!
It was an exciting week - I got to feature
(albeit, a cut-down version of what I had written) in the physiotherapy
magazine 'Physio Matters'. I had comments over my Skype research meeting on Tuesday, a tweet from @LeonMabire and a request to promote the NZ Physiotherapy Board's new summer scholarship for 3rd year student (see the end of this post). So there we go, this week I was famous in the small world of New Zealand physiotherapy. Here is the full exert that I had written for
the magazine:
Social
media is wonderful (mostly). We simply cannot get enough of it, and there is a
lot of it out there. It’s our daily addiction. Between all the weird and
wonderful content online, I can imagine (with some certainty) that we’ve all experienced physiotherapy
on social media. Facebook ads, physiotherapy memes and infamous physiotherapy
legends on Twitter and bloggers like @AdamMeakins ‘The Sports Physio’. Informative,
thought provoking, entertaining, interactive, great!
I’m a fourth year physiotherapy student from the University
of Otago and I have been using social media too. It has become apparent that
Physiotherapy New Zealand keeps tabs on social media, and has miraculously stumbled upon my blog. Now,
having been welcomed to write a short article for Physio Matters magazine, I
thought I would take this opportunity to share a little bit about my blogging
experience and my undergraduate experience of fourth year.
I write a weekly recount of my physiotherapy experiences in
a blog. I started writing my
blog in 2014 and have subsequently
covered every academic week in
a post… Unfortunately
it’s not an original idea. There’s not a lot of detail in each of my blog posts; just enough detail for my
friends and family to keep up-to-date
with my undergraduate experiences – this was the purpose of writing the
blog. I have since used it to reflect upon the journey I’ve had so far. Others might recognise it
as a promotional resource for studying physiotherapy in New Zealand – it is, after all, online and open
for everybody to view. I don’t claim to have written anything masterful,
but it is my personal little project and I am enjoying it.
As mentioned, I am currently a fourth year student. My peers
are placed around the South Island and mid-lower North Island. For the students who made Dunedin their
home, they will feel quite separated from friends, possibly family and a little lost for finding an equivalent
local ice cream parlour to Dunedin’s Rob Roy. This is the great
adventure of fourth year but settling into a new location for the year can be a
challenge. This is a challenge that I face. Luckily I’m placed in sunny Nelson. I'll take this moment to brag. Nelson
and the surrounding area is stunning and the weather is a bonus. Don’t be
jealous, just come and visit – bring your tramping boots.
Blogging
whilst away from my family and friends has become quite useful for letting them
know that I'm alive and well, but I've recently discovered that being in a new
location away from the people you usually hang-out with will leave you feeling quite
isolated. Social media does not replace having a catch-up in person or over the
phone. Chatting about the experiences had by your peers is very necessary for
both your mental health and being effective on your placement – the placement
itself can be quite stressful too. My clinical educator kindly reminded me of
this, but some things you've got to learn the hard way.
I have had
many great moments over my first placement this year, lots of laughs with
clients and made to feel like one of the team by physiotherapists and other
healthcare staff. Luckily for me I will have more placements in Nelson
Hospital. Social media is wonderful (mostly) and I shall continue my weekly
blog updates for the year, amongst more person-to-person interactions (I think
I’ve learned that lesson now). Fourth year is great, but not without its
challenges. Embrace these challenges with the company and wisdom of others.
Written by
Phil Butler, 4th Year Physiotherapy Student.
Also in social media, as alluded to by Leon Mabire, the School of Physiotherapy was looking good on YouTube - the promotional video for the school was released to the public this week, and what a fantastic video it is.
A friend and I went on a mission to find some more DOC huts around Nelson. The three huts that we visited would be three of the easiest huts there are around the region - so no excuses not to look these up online and get out to walk them (@LeonMabire, you'll be pleased about all this walking I'm advocating). The huts are Bushline Hut (Nelson lakes national park), Flora Hut and Mt Arthur Hut (Kahurangi national park). Both starts of the walking tracks are about 1h drive from Nelson and the loop tracks can be done within 4h (thereabouts).
Mt Arthur Hut, Kahurangi National Park
Flora Hut, Kahurangi National Park
Bushline Hut, Nelson Lakes National Park
Back to the topic of research! You'll be quite aware that there is a research module in the 4th year of physiotherapy (unless you've mistaken it for a tramping module - I can see how that might happen). The NZ Physiotherapy Board (the team that will issue you with your licence to touch / registration as a physiotherapist at the end of your degree... not to be confused with Physiotherapy New Zealand who I've mentioned earlier in the post about Physio Matters magazine) are offering 3rd year physiotherapy students a summer research opportunity to the tune of $5000 (you'll like the sound of that). What better way to get some paid practice for 4th year! But to trump that, you will also be doing a great service to Physiotherapy in New Zealand. All the details you need are online.
Sunrise at John Reid Hut, Kahurangi National Park (near Nelson)
Another week, another weekend tramp before winter sets in. I made my way under the cover of nightfall (headlamp and torch beaming) to John Reid Hut. Excellent overnight adventure! I then popped down to Waimate to spend a few days with my parents.
"Fear of falling was reported as a debilitating condition that brought on feelings of
worthlessness due to limiting activities of daily living, and feelings of being
a burden on their family" (Honaker & Kretschmer, 2014).
This week, my research group really got down to business. I ended up fairly sick on Wednesday-Thursday, so wasn't able to contribute much. Here are some things that we did get done:
Extracting quote by quote, statement by statement, categorising them and analysing them (using an inductive analysis method). On Friday, we began our search for themes... we printed and cut out each of the quotes/statements and began sorting them into piles.
Writing a first full draft of the introduction & methods.
I've grouped our included studies (the ones we will be analysing) into EndNote. EndNote is a citation / bibliography software which allows you to create your own library of articles (and attach .pdf copies of the articles). We can send these libraries to other EndNote users, insert citations and bibliographies directly into Microsoft Word. It's all pretty useful stuff. Here's what it looks like!
Endnote in use!
Only two weeks of research to go! Where has this time gone?!
References
Honaker, J. A. & Kretschmer, L. W. (2014). Impact of fear of falling for patients and caregivers: Perceptions before and after participation in vestibular and balance rehabilitation. American Journal of Audiology, 23, 20-33. doi: 10.1044/1059-0889(2013/12-0074)
