Objectives: Pain assessment is enigmatic. Although clinicians and researchers must rely upon observations to evaluate pain, the personal experience of pain is fundamentally unobservable. This raises the question of how the inherent subjectivity of pain can and should be integrated within assessment. Current models fail to tackle key facets of this problem, such as what essential aspects of pain are overlooked when we only rely on numeric forms of assessment, and what types of assessment need to be prioritized to ensure alignment with our conceptualization of pain as a subjective experience. We present the multimodal assessment model of pain (MAP) as offering practical frameworks for navigating these challenges. Methods: This is a narrative review. Results: MAP delineates qualitative (words, behaviors) and quantitative (self-reported measures, non–self-reported measures) assessment and regards the qualitative pain narrative as the best available root proxy for inferring pain in others. MAP offers frameworks to better address pain subjectivity by: (1) delineating separate criteria for identifying versus assessing pain. Pain is identified through narrative reports, while comprehensive assessment is used to infer why pain is reported; (2) integrating compassion-based and mechanism-based management by both validating pain reports and assessing underlying processes; (3) conceptualizing comprehensive pain assessment as both multidimensional and multimodal (listening/observing and measuring); and (4) describing how qualitative data help validate and contextualize quantitative pain measures. Discussion: MAP is expected to help clinicians validate pain reports as important and legitimate, regardless of other findings, and help our field develop more comprehensive, valid, and compassionate approaches to assessing pain.

Method:We reviewed the ethics content in the online curricula of 27 Canadian rehabilitation programs (OT & PT). Courses addressing ethical issues were identified through keyword searches, and were then subjected to both quantitative and textual descriptive analyses. Results:The mean proportion of credits allotted to courses that included ethics terminology was 5.9% (SD=1.4) for OT and 6.5% (SD=4.8) for PT (p=0.69). The most common terms in the course descriptions were 'ethics/ethical' followed by 'legal', 'professionalism', 'deontology' and 'regulatory'. Textual analysis revealed eight course topics, the most frequent being: standards of practice, ethical decision-making, clinical courses and mediation/communication. Conclusion:With the growing recognition and status of occupational therapy and physiotherapy in the healthcare system, and corresponding shifts in how professionals are being trained, it is crucial to assess and reflect upon the place accorded to and manner of teaching ethics.!

Purpose: Physiotherapy in private practice differs from physiotherapy practised in a public setting in several ways, the most evident of which is the for-profit nature of private physiotherapy clinics; these differences can generate distinct and challenging ethical issues. The objectives of this article are to identify ethical issues encountered by physiotherapists in private practice settings and to identify potential solutions and recommendations to address these issues. Method: After a literature search of eight databases, 39 studies addressing ethical issues in a private practice context were analyzed. Results: A total of 25 ethical issues emerging from the included studies were classified into three main categories: (1) business and economic issues (e.g., conflicts of interests, inequity in a managed care context, lack of time affecting quality of care); (2) professional issues (e.g., professional autonomy, clinical judgment, treatment effectiveness, professional conduct); and (3) patients' rights and welfare issues (e.g., confidentiality, power asymmetries, paternalism vs. patient autonomy, informed consent). Recommendations as to how physiotherapists could better manage these issues were then identified and categorized. Conclusions: The physiotherapy community should reflect on the challenges raised by private practice so that professionals can be supported-through education, research, and good governance-in providing the best possible care for their patients.Key Words: ethics, professional; private practice; private sector. RÉ SUMÉObjet : La pratique privé e de la physiothé rapie diffè re de la pratique de la physiothé rapie dans un é tablissement public pour plusieurs raisons, la plus é vidente é tant la nature lucrative des cliniques privé es. Ces diffé rences soulè vent des questions d'é thique uniques et é pineuses. Le pré sent article vise à cerner les enjeux é thiques qui se pré sentent aux physiothé rapeutes qui travaillent en pratique privé e et à identifier des solutions et des recommandations é ventuelles. Mé thode : À la suite d'une revue de la litté rature dans huit bases de donné es, trente-neuf é tudes portant sur les enjeux é thiques dans le contexte de la pratique privé e ont é té analysé es. Ré sultats : Au total, vingt-cinq enjeux é thiques dé coulant des é tudes retenues ont é té classé s en trois principales caté gories : (1) les enjeux commerciaux et é conomiques (p. ex., les conflits d'inté rê ts, l'iniquité dans le contexte de la gestion des soins, le manque de temps influant sur la qualité des soins); (2) les enjeux professionnels (p. ex., l'autonomie professionnelle, le jugement clinique, l'efficacité des traitements, la conduite professionnelle) et (3) les enjeux lié s aux droits et au bien-ê tre des patients (p. ex., la confidentialité , l'asymé trie du pouvoir, le consentement é clairé ainsi que le paternalisme contre l'autonomie des patients). Des recommandations sur la fac¸on dont les physiothé rapeutes pourraient mieux gé rer ces enjeux ont aussi é té identifié es e...

In the past, several researchers in the field of physiotherapy have asserted that physiotherapy clinicians rarely use ethical knowledge to solve ethical issues raised by their practice. Does this assertion still hold true? Do the theoretical frameworks used by researchers and clinicians allow them to analyze thoroughly the ethical issues they encounter in their everyday practice? In our quest for answers, we conducted a literature review and analyzed the ethical theoretical frameworks used by physiotherapy researchers and clinicians to discuss the ethical issues raised by private physiotherapy practice. Our final analysis corpus consisted of thirty-nine texts. Our main finding is that researchers and clinicians in physiotherapy rarely use ethical knowledge to analyze the ethical issues raised in their practice and that gaps exist in the theoretical frameworks currently used to analyze these issues. Consequently, we developed, for ethical analysis, a four-part prism which we have called the Quadripartite Ethical Tool (QET). This tool can be incorporated into existing theoretical frameworks to enable professionals to integrate ethical knowledge into their ethical analyses. The innovative particularity of the QET is that it encompasses three ethical theories (utilitarism, deontologism, and virtue ethics) and axiological ontology (professional values) and also draws on both deductive and inductive approaches. It is our hope that this new tool will help researchers and clinicians integrate ethical knowledge into their analysis of ethical issues and contribute to fostering ethical analyses that are grounded in relevant philosophical and axiological foundations.

BackgroundExample-based learning using worked examples can foster clinical reasoning. Worked examples are instructional tools that learners can use to study the steps needed to solve a problem. Studying worked examples paired with completion examples promotes acquisition of problem-solving skills more than studying worked examples alone. Completion examples are worked examples in which some of the solution steps remain unsolved for learners to complete. Providing learners engaged in example-based learning with self-explanation prompts has been shown to foster increased meaningful learning compared to providing no self-explanation prompts. Concept mapping and concept map study are other instructional activities known to promote meaningful learning. This study compares the effects of self-explaining, completing a concept map and studying a concept map on conceptual knowledge and problem-solving skills among novice learners engaged in example-based learning.MethodsNinety-one physiotherapy students were randomized into three conditions. They performed a pre-test and a post-test to evaluate their gains in conceptual knowledge and problem-solving skills (transfer performance) in intervention selection. They studied three pairs of worked/completion examples in a digital learning environment. Worked examples consisted of a written reasoning process for selecting an optimal physiotherapy intervention for a patient. The completion examples were partially worked out, with the last few problem-solving steps left blank for students to complete. The students then had to engage in additional self-explanation, concept map completion or model concept map study in order to synthesize and deepen their knowledge of the key concepts and problem-solving steps.ResultsPre-test performance did not differ among conditions. Post-test conceptual knowledge was higher (P < .001) in the concept map study condition (68.8 ± 21.8%) compared to the concept map completion (52.8 ± 17.0%) and self-explanation (52.2 ± 21.7%) conditions. Post-test problem-solving performance was higher (P < .05) in the self-explanation (63.2 ± 16.0%) condition compared to the concept map study (53.3 ± 16.4%) and concept map completion (51.0 ± 13.6%) conditions. Students in the self-explanation condition also invested less mental effort in the post-test.ConclusionsStudying model concept maps led to greater conceptual knowledge, whereas self-explanation led to higher transfer performance. Self-explanation and concept map study can be combined with worked example and completion example strategies to foster intervention selection.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-015-0308-3) contains supplementary material, which is available to authorized users.

There is growing recognition of the importance of knowledge translation activities in physical therapy to ensure that research findings are integrated into clinical practice, and increasing numbers of knowledge translation interventions are being conducted. Although various frameworks have been developed to guide and facilitate the process of translating knowledge into practice, these tools have been infrequently used in physical therapy knowledge translation studies to date. Knowledge translation in physical therapy implicates multiple stakeholders and environments and involves numerous steps. In light of this complexity, the use of explicit conceptual frameworks by clinicians and researchers conducting knowledge translation interventions is associated with a range of potential benefits. This perspective article argues that such frameworks are important resources to promote the uptake of new evidence in physical therapist practice settings. Four key benefits associated with the use of conceptual frameworks in designing and implementing knowledge translation interventions are identified, and limits related to their use are considered. A sample of 5 conceptual frameworks is evaluated, and how they address common barriers to knowledge translation in physical therapy is assessed. The goal of this analysis is to provide guidance to physical therapists seeking to identify a framework to support the design and implementation of a knowledge translation intervention. Finally, the use of a conceptual framework is illustrated through a case example. Increased use of conceptual frameworks can have a positive impact on the field of knowledge translation in physical therapy and support the development and implementation of robust and effective knowledge translation interventions that help span the research-practice gap.

Significant cross-program variation in the number of hours dedicated to ethics and the diversity of pedagogical methods used suggests that there is little consensus about how best to teach ethics. Further research on ethics pedagogy in PT and OT programs (i.e. teaching and evaluation approaches and effectiveness of current ethics teaching) would support the implementation of more evidence-based ethics education. Implications for Rehabilitation Ethics educators in Canadian PT and OT programs are experimenting with diverse educational approaches to teach ethical reasoning and decision-making to students, including lectures, problem-based learning, directed readings, videos, conceptual maps and clinical elective debriefing, but no particular method has been shown to be more effective for developing ethical decision-making/reasoning. Thus, research on the effectiveness of current methods is needed to support ethics educators and programs to implement evidence-based ethics education training. In our survey, 65% of ethics educators did not have any specialized training in ethics. Ensuring that educators are well equipped to support the development of necessary theoretical and applied competencies can be promoted by initiatives including the creation of tailored ethics teaching and evaluation tools, and by establishing communities of practice among ethics educators. This survey identified heterogeneity in ethics teaching content, format and duration, and location within the curriculum. In order to be able to assess more precisely the place accorded to ethics teaching in PT and OT programs, careful mapping of ethics content inside and across rehabilitation programs is needed - both in Canada and internationally. These initiatives would help advance understanding of ethics teaching practices in rehabilitation.

10 SOMMAIRELe conseil d'administration de la Commission de la santé et de la sécurité du travail (CSST) a mandaté un groupe de travail ayant pour mandat de lui faire des recommandations sur les mécanismes de prévention prévus par la Loi sur la santé et la sécurité du travail (LSST) et tout autre volet du régime de santé et de sécurité du travail.Le Conseil du patronat du Québec (CPQ) conjointement avec la Fédération des chambres de commerce du Québec (FCCQ) a mis sur pied un comité consultatif chargé d'assurer la coordination des demandes patronales provenant de tous les secteurs d'activité économique afin de faire valoir les préoccupations des employeurs auprès du groupe de travail présidé par monsieur Viateur Camiré. Le comité patronal représente plus de 72 000 employeurs issus des domaines privé, public et péripublic avec une masse salariale de plus de 45 milliards. BILANDepuis les 30 dernières années, les milieux de travail ont évolué en matière de gestion de la santé et de la sécurité du travail. L'avènement d'une tarification plus réactive ainsi que l'arrivée des mutuelles de prévention ont contribué notamment à hausser de façon importante le niveau de la prise en charge de la santé et de la sécurité du travail par les milieux.De 1999 à 2008, on a assisté à une baisse constante de la fréquence des accidents et des décès par accident, mais, étonnamment, les coûts des indemnités de remplacement du revenu (IRR) ont connu une hausse importante pendant la même période. Ainsi, alors que la masse salariale a augmenté de 19 %, le nombre de cas indemnisés en IRR a baissé de 29 %. Quand on compare le nombre d'IRR par chaque million de salaire ajusté, la baisse est encore plus spectaculaire et se situe à 41 %. LA SURINDEMNISATIONLa Loi sur les accidents du travail et les maladies professionnelles (LATMP), qui est un régime d'assurance, contient certains aspects qui lui donnent un caractère social allant souvent au-delà des principes d'assurance. Elle ne devrait cependant pas viser à accorder aux bénéficiaires des revenus supérieurs à ceux qu'ils auraient gagnés s'ils étaient restés au travail.Plusieurs exemples de surindemnisation sont bien documentés tels que le calcul de la base salariale pour un employé à temps partiel ou saisonnier ou, encore, la personne qui reçoit une rente de retraite et qui bénéficie d'une IRR.Chaque province possède son régime propre d'indemnisation. Par contre, on retrouve des mesures visant à limiter de façon plus ou moins importante de tels cumuls et, par conséquent, exercer un certain contrôle sur les coûts du régime.