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Qualitative Investigation of Occupational Therapy andPhysiotherapy Practice in a Community Rehabilitation Setting –In order to identify areas of professional commonality, difference and overlap

Sue Smith, P Roberts, N OldhamManchester School of PhysiotherapyIntroduction Traditional assumptions about professionalroles in the National Health Service are being challenged(Allen, 2000). The NHS Plan (2000) has increased the drivefor change ‘where the old hierarchal ways of working aregiving way to more flexible team working between differentclinical professionals’.

Current professional groupings may not be sustainable intheir current form and new groups and ways of workingmay have to emerge to meet user-led needs. This qualitativestudy, driven by the need to recognise the users’ per-spectives, captured current practice within a communityrehabilitation setting to investigate areas of role difference,skill sharing and commonality between communityoccupational therapy and physiotherapy staff.

Method Focus groups with users (n = 4), clinicians (n = 11)and rehabilitation service managers (n = 9) wereundertaken in two community trusts. 1:1 interviews were

also undertaken. Discussions were taped, transcribed andanalysed using thematic content analysis.

Results 1. Professional tribalism exists and hampers effective team

working.2. Service users are frequently unable to identify the

differences between the two professional groups.3. Skill sharing, the sharing of common terminology and

the blurring of professional boundaries occur on a dailybasis.

4. Clinicians and managers felt the underpinningphilosophy taught separately to each profession at pre-registration level was the key factor that differentiatedbetween the two professions.

5. Increased shared learning and joint modules betweenthe professions at as early a stage in pre-registrationtraining as possible was regarded as beneficial.

Ergonomic MicroscopesCan They Reduce the Risks of Work-Related Musculoskeletal Disorders?

MISCELLANEOUS

Heather Gray, F MacMillanGlasgow Caledonian UniversityIntroduction Microscopy work places a high level ofmusculoskeletal stress on the body of the user. Indeed,there are certain types of neck-shoulder disordersassociated with microscope operation, especially duringcytology work. This field study was carried out to investigatethe differences in upper trapezius muscle activity, posture,pain and perceived exertion in cytologists while scanningcervical screening slides using both standard andergonomic microscopes.

Method This field study employed a two-period crossoverexperimental design. Thirteen cytologists (mean age 36.1 ±8.8 years) from one acute NHS trust consented to part-icipate. Subjects screened eight slides with each micro-scope while four different measurements were taken:

� Bilateral upper trapezius electromyography.� Posture, using a rapid upper limb assessment. � Pain, using a body part discomfort diagram and visual

analogue scale.� Rating of perceived exertion (Borg CR-10 RPE scale).

Results The results demonstrated that when operating theergonomic microscope, there was significantly less uppertrapezius activity for both the right (p = 0.015) and left (p =0.000) shoulders, signifying reductions of 64% and 62%respectively. However, there was not a statistically significantdifference in postures adopted between the microscopes,using RULA (p = 0.173). Neither were there any statisticallysignificant differences in neck (p = 0.084), upper back (p =0.098) or lower back (p = 0.625) pain when using theergonomic microscope, although a statistically significantreduction in shoulder pain was reported (p = 0.043).Finally, the results revealed that the ergonomic microscoperequired significantly less perceived exertion to operatethan the standard microscope (p = 0.009).

Discussion This study indicated that the ergonomicmicroscope was preferable to the standard microscope interms of upper trapezius muscle activity, shoulder pain andperceived exertion. These findings have importantimplications for cytologists, of whom the majority arecurrently using standard microscopes, in terms of reducingpotential risk factors for the development of work-relatedmusculoskeletal disorders.

Physiotherapy January 2003/vol 89/no 1

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Deborah Bancroft, N TowersPennine Acute Hospitals NHS Trust, BuryIntroduction The prevalence of urinary incontinence in females is high (RCP, 1995). Prior to publication of the Chartered Society of Physiotherapy guidelines,documentation of assessment and treatment methods wasvariable. This study evaluates treatment outcomes based onthe recommendations for management as specified in theguidelines, using the Urinary Incontinence AssessmentForm (Laycock et al, 2001).

Method Twenty-one female patients were referred bygeneral practitioners and gynaecologists to the physio-therapy outpatient department at Fair field General

Hospital, Bury, from October 2001 to February 2002, andassessed by a senior I physiotherapist specialising incontinence management. Three (14%) of these wereexcluded from the study, being outside the age limitspecified in the guidelines. Referral diagnoses includedgenuine stress incontinence, stress incontinence andprolapse; some were confirmed by urodynamic studies.Pelvic floor strength, severity of incontinence, and a qualityof life assessment were recorded before and after treatment.

Findings/analysis Results are available for the 7/18 (39%)patients who finished treatment. The remaining 11/18(61%) will become available as their treatment is comp-leted over the subsequent three months. Of those who had

Use of the Chartered Society of Physiotherapy Guidelines in thePhysiotherapy Management of Stress Urinary Incontinence inFemales

Comparison of Two Clinically Used Positions to Investigate Which Is Most Effective at Facilitating the Muscles InternalOblique and Transverse Abdominus during the AbdominalDrawing-in ManoeuvreRachel HuntDudley Group of Hospitals NHS TrustIntroduction Clinicians are increasingly advocatingexercise programmes designed to improve abdominalmuscle function as a way to address low back pain. Theeffectiveness of the abdominal drawing-in manoeuvre infacilitating stabilising muscle activity in patients with lowback pain has been identified by research. However, there isno existing evidence to suggest which position is mosteffective for teaching it. The aim of this study was tocompare two clinically used positions to see which positionwould be most effective at facilitating the internal obliqueand transverse abdominus muscles while carrying out theabdominal drawing-in manoeuvre.

Method The study employed an experimental, samesubject design using a convenience sample of 12 asympt-omatic subjects. Ethical approval was gained from theUniversity Ethics Committee. Using surface electromyo-graphy over the internal oblique and transverse abdominusmuscles, the mean output of electrical activity from themuscles over a ten-second period was calculated. Measure-

ments were taken in each of the two positions of four-pointkneeling and crook lying during the abdominal drawing-inmanoeuvre. The order of the two interventions was variedto avoid order effects and a pilot study was carried outbefore the investigation to ensure feasibility and reliability.

Results The data were analysed descriptively andinferentially using SPSS for Windows version 10.0.Descriptive analysis highlighted the mean value for four-point kneeling (15.4 mV) was greater compared with crooklying (8.7 mV). A Wilcoxon signed rank test revealedsignificantly greater electrical activity in four-point kneeling(p = 0.028) compared with crook lying.

Conclusion The findings of this study suggest that four-point kneeling may be preferable over crook lying as amethod of teaching the abdominal drawing-in manoeuvre.This has possible implications for clinical practice in termsof patients with stabilising muscle dysfunction. Thispreliminary study therefore highlights an area worthy offurther research.

Discussion/conclusion The study has highlighted manyemergent issues that are relevant when looking at pro-fessional groupings and practice. It does seem, however,that each profession’s pre-registration training appears toset up the professional boundaries in the first place.

References

Allen, I (2000). ‘Challenges to the health services: The professions’, British Medical Journal, 320, 1533-35.

Department of Health (2000). The NHS Plan: A plan forinvestment, A plan for reform, Cmnd 4818-1, HMSO.