Factors influencing interprofessional practices of physiotherapists working in private settings with people with low back pain: a qualitative study

Purpose: Collaboration and interprofessional practices are highly valued in health systems everywhere, partly based on the rationale that they improve outcomes of care for people with complex health problems, such as low back pain. Research in the area of low back pain also supports the involvement of different health professionals in the interventions for people who present this condition. The aim of this studywas to identify factors influencing the interprofessional practices of physiotherapists working in private settings with people with low back pain. Relevance: Physiotherapists, like other health professionals, are encouraged to engage in interprofessional practices in their dailywork. However, to date, very little is known of their interprofessional practices, especially in private settings. Understanding physiotherapists' interprofessional practices and their influencing factors will notably advance knowledge relating to the organisation of physiotherapy services for people with low back pain. Participants: Participants in this study were 13 physiotherapists including 10 women and 3 men, having between 3 and 22 years of professional experience, and working in one of 10 regions of the Province of Quebec (Canada). In order to obtain maximal variation in the perspectives, participants were selected using a recruitment matrix including three criteria: duration of professional experience, work location, and physical proximity with other professionals. Methods: Thiswas a descriptive qualitative study using faceto- face semi-structured interviews as the main method of data collection. An interview guide was developed based on an evidence-derived frame of reference. Each interview lasted between 55 and 95 minutes and was transcribed verbatim. Analysis: Qualitative analyses took the form of content analysis, encompassing data coding and general thematic regrouping. NVivo version 8 was used to assist data organisation and analysis. Results: Multiple factors influencing the interprofessional practices of physiotherapists were identified. The main factors include the consulting person's health condition, the extent of knowledge on health professionals' roles and fields of practice, the proximity and availability of professional resources, as well as daily work schedules. Conclusions: Our findings highlight the influence of multiple factors on physiotherapists' interprofessional practices, including professional practice and organisational issues. However, further research on the interprofessional practices of physiotherapists is still required. Research priorities targeting the views of other health professionals, as well as those of services users, would enhance our comprehension of interprofessional practices of physiotherapists. Implications: This study provides new insights that improve our understanding of the interprofessional practices of physiotherapists working in private settings with people with low back pain, more specifically on the factors influencing these practices. Based on our findings, implementing changes such as improving current and future health professionals' knowledge of the fields and roles of other health professionals through training may contribute to positively influencing interprofessional practices. Keywords: Interprofessional practices; Private practice; Low back pain Funding acknowledgements: This research was supported in part by a B.E. Schnurr Memorial Fund Research Grant administered by the Physiotherapy Foundation of Canada, as well as from a clinical research partnership in physiotherapy between the Quebec Rehabilitation Research Network (REPAR) and the Ordre professionnel de la physiothérapie du Québec (OPPQ). KP received doctoral-level scholarships from the Canadian Institutes of Health Research (CIHR) and the Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST). CE Dionne is a FRSQ senior Research Scholar. Ethics approval: This project was approved by the ethics research committee of the Institut de réadaptation en déficience physique de Québec.

Cholinergic regulation of bone.

Bone remodeling is regulated by the two branches of the autonomic nervous system: the adrenergic and the cholinergic branches. Adrenergic activity favors bone loss, whereas cholinergic activity has been recently shown to favor bone mass accrual. In vitro studies have reported that cholinergic activity induces proliferation and differentiation of bone cells. In vivo studies have shown that the inhibition of cholinergic activity favors bone loss, whereas its stimulation favors bone mass accrual. Clinical studies have shown that bone density is associated with the function of many cholinergic-regulated tissues such as the hypothalamus, salivary glands, lacrimal glands and langerhans cells, suggesting a common mechanism of control. Altogether, these observations and linked findings are of great significance since they improve our understanding of bone physiology. These discoveries have been successfully used recently to investigate new promising therapies for bone diseases based on cholinergic stimulation. Here, we review the current understanding of the cholinergic activity and its association with bone health.

Évangile de saint Jean.

Acquis le 2 avril 1743 de madame du Faÿ parmi 11 mss. pour le prix global de 1200 livres; cf. B.n.F., département des Manuscrits, Archives Ancien Régime 65, registre des acquisitions du département des Manuscrits 1667-1758, f. 291 "n° 87. Codex evangelii secundum Joannem, litteris auro depictis"; mention de la main de l'abbé Sallier "De madame du Fay. 12" (contreplat sup.); — note du XVe s. "Iste liber emptus fuit de precio scutorum LXV (...) M° CCCC° LXV°" (contreplat sup.); — anciennes cotes "87", "17" (Cv)

Décrets de Burchard.

Acquis le 3 août 1824 de M. de Bure, libraire, suite à la vente Chardin, n° 462, pour un prix non précisé; cf. B.n.F., département des Manuscrits, Archives Modernes 492ter, registre des acquisitions du département des Manuscrits 1821-1830, f. 142-143 "Burcardi Wormaciensis episcopi decreta, in fol. ms. sur vélin", et barré "belle et riche reliure, v. b. 10e siècle"; — ex-libris "Liber Cornely Duyn Aëmstelredamensis" (1); — cathédrale de Fréjus, cf. ex-libris du XIVe s. "Est ecclesie Forojuliensis" (1 et 259v); Delisle, Cab. des mss., II, 367.

"Platonis de Republica libri decem".

Acquis en brumaire an VII (octobre-novembre 1798); cf. B.n.F., département des Manuscrits, Archives Modernes 492, registre des acquisitions du département des Manuscrits an II-an XIV (1793-1805), f. 40 "VI M DLXXXVIII A. Codex chartaceus, Parisiis emptus anno 7 seu 1798, quo continentur Platonis de Republica libri X, interprete Antonio Cassarino siculo, praemisso hujus prooemio. Is codex seculo (blanc) videtur exaratus"; — note ms. de la fin du XVIIIe s. ou du début du XIXe s. de la main de La Porte du Theil "L'exemplaire que l'on voit ici de la traduction latine des Livres de Platon De Republica a été proposé par le citoyen Du Vivier, graveur en médailles, et acquis pour la Bibliothèque, au moyen d'un échange de quelques livres de piété à prendre dans ce qu'on appeloit alors les Dépôts provisoires, authorisé par le Ministère; comme il appert par les Lettres et états conservés ans le secrétariat de la Bibliothèque" (contreplat sup.)

[Petri de Riga Aurora].

Acquis le 8-12 floréal an VIII (28 avril-2 mai 1804), envoyé de la ville de Sens et remis au département des Manuscrits par le conservateur Millin, et placé dans le grenier du Levant à la suite des mss. venus de Compiègne; cf. B.n.F., département des Manuscrits, Archives Modernes 492, registre des acquisitions du département des Manuscrits an II-an XIV (1793-1805), f. 107 "Biblia sacra metrica a Petro de Riga, cod. memb. s. XIV exaratus in fol."; Delisle, Cab. des mss., II, 15; — ne provient pas de l'abbaye d'Orval (dioc. de Trèves), contrairement à l'avis de Delisle qui a confondu ce ms. et le latin 9749, cf. Cab. des mss., II, 389; A.-C. Fraeijs de Veubeke, Scriptorium, 31, 1977, 348 et 27, 1973, 106 (catalogue des mss. subsistants d'Orval) mais de l'abbaye de Vaux-Luisant, cf. latin 9562

Le Secret des secrets, attribué à Aristote.

Acquis le 29 juin 1827 de M. Pontier, libraire d'Aix-en-Provence, pour le prix de 25 francs; cf. B.n.F., département des Manuscrits, Archives Modernes 492ter, registre des acquisitions du département des Manuscrits 1821-1830, f. 196 "Ms. in 4° sur velin, maroquin rouge, intitulé Secreta secretorum Aristotelis ad Alexandrum"; — note du XVIe s. "Hunc librum ex Avinione olim attulit nobilis et eruditus vir Guilelmus de Pleurre Priceii ad Albam dum in humanis ageret dominus, quem longo postea tempore possedit, et in pretio habuit ejus filius nobilis atque eruditus nec minus honestus ac praepotens vir Colinus de Pleurre qui anno Domini 1504 mensis martii die tertia medio sublatus, Ludovica Mole ejus conjux cordata atque honesta foemina hunc mihi Nicolao Prunel dono dedit, quam Deus longaevam faveat; Colino vero pro dicto locum pacis misericorditer tribuat. Nicolaus Prunel, abbas coenobii S. Lupi" (75)

"Francisci Barbari liber de re uxoria" (3), avec des lettres de Pogge (2, 47v).

Acquis parmi 44 mss. provenant du cabinet du pape Pie VI (Giovanni-Angelo Braschi) "peu après l'envoi principal des mss. du Vatican en 1797"; cf. B.n.F., département des Manuscrits, Archives Modernes 492, registre des acquisitions du département des Manuscrits an II-an XIV (1793-1805), f. 49, description éditée par M.-P. Laffitte, Bulletin du Bibliophile, 1989/2, 310.