Yonder: Advanced practice physiotherapists, vaccination, dehydration, and school lunches

Ahmed Rashid

doi:10.3399/bjgp20X707909

Yonder: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature

Advanced Practice Physiotherapists

Rather than wait for long periods of time for appointments in orthopaedic or rheumatology clinics, patients with musculoskeletal conditions are now typically seen initially by advanced practice physiotherapists (APPs) who use their significant expertise and experience to triage patients, organise investigations, and complete initial treatments including injections. As the primary care workforce continues to diversify, there is also growing interest in developing such roles in the community. A research team from Ireland recently explored the experiences of patients attending such a service.¹ Participants were resoundingly positive about the APP service and benefits related to shorter wait times and seeing a specialist who listened and involved them in their management. Of note, some patients had already seen a physiotherapist and had preconceptions about what an APP could add. These concerns, however, were mitigated by the vast expertise that they found APPs to possess.

Vaccination

Vaccination hesitancy is a significant global healthcare challenge in the 21st century. The variability in quality of online information has been widely suggested to be relevant, both through websites and social media. In a recent study, public health researchers from France and Canada interrogated two official French-speaking websites that are used to inform the general public about recommended vaccines in France and Quebec.² Their analysis of 32 webpages, 14 videos, and two infographics showed, rather worryingly, that the approaches used to debunk misconceptions generally focused on the myth itself rather than the correct information. The authors conclude that given the availability of confusing and conflicting vaccine narratives, it is crucial that authoritative materials on vaccination are developed using best practices in risk communication.

Dehydration

Although largely preventable, dehydration continues to cause significant adverse outcomes in older people. It is also a very unfashionable, and therefore under researched, topic. It was pleasing to see, then, that a UK research team recently studied the views of community-dwelling older people and informal carers on hydration in later life and how older people can be supported to drink well.³ Four themes were generated: perceptions of healthy drinking, barriers to and facilitators of drinking in later life, and supporting older people to drink well. Concerns about urinary incontinence and knowledge gaps were significant barriers, whereas consideration of individual taste preference and functional capacity acted as facilitators. The authors recommend that advice on hydration should build on distinct habitual patterns (such as medication and mealtimes) incrementally, in manageable steps. As clinical pharmacists are increasingly completing medication reviews in primary care, they are identified as one potential group to deliver this important advice.

School lunches

As children spend most of their waking hours at school, the dietary choices made there have significant consequences for their childhood development and later life. Given that immigrants to the US are known to face challenges in their dietary habits on their arrival to the country, and the fact that these are linked to obesity and chronic disease, a research team in Indiana recently examined food choices among immigrant families with school-age children.⁴ The 52 parents who took part in the study had children in classes ranging from kindergarten to grade 12. They felt that schools were generally serving the needs of immigrant children by serving varieties of foods during lunchtime. A large majority of parents indicated that their children ate their home-country staple foods for dinner and on non-school days, and many felt that school lunches were a helpful way to introduce their children to ‘American food’. The authors do note, though, that many parents indicated that school lunch was not available in their home countries and it may therefore be the case that any lunch provided at school exceeded their expectations.

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