Résumé
Situation initiale : La Pratique Avancée en Physiothérapie (PAP) se développe progressivement en Suisse pour répondre aux enjeux croissants du système de santé (augmentation des coûts, pénurie de professionnels et complexité des soins). Si un recensement a été réalisé en Suisse alémanique, peu d’informations sont disponibles pour la Suisse romande. Pourtant, plusieurs fonctions de pratique avancée ont déjà vu le jour, sous différentes formes, dans des hôpitaux, cliniques ou cabinets privés. Ce travail a pour objectif d’identifier les pratiques avancées existantes en Suisse romande dans divers milieux de soins, mais aussi de comprendre comment ces rôles ont été instaurés et quelles sont leurs fonctions et leurs exigences spécifiques. Il répondra aux questions suivantes : « Quelles sont les pratiques avancées en physiothérapie existantes dans les contextes hospitaliers, cliniques ou ambulatoires de Suisse romande ? Comment les rôles de pratique avancée se sont mis en place et quelles sont les fonctions et les exigences spécifiques associées ? » Méthodologie : Une étude mixte, en deux étapes, a été conduite. D’abord, une enquête quantitative par questionnaire a permis d’identifier les rôles de pratique avancée. Ensuite, des entretiens semi-dirigés ont approfondi la mise en place des rôles, leurs fonctions et les exigences associées. Les données ont été analysées de manière descriptive. Résultats : L’enquête a identifié 16 rôles de pratique avancée répartis dans cinq cantons, dont quatre en cours de développement. Parmi les cinq professionnels interrogés en entretien, quatre exercent comme « cliniciens spécialisés » et un occupe une fonction de « physiothérapeute praticien spécialisé ». Tous décrivent des rôles en constante évolution. Les conditions d’accès varient selon les institutions : master ou plusieurs CAS spécialisés, et deux à cinq années d’expérience. Les obstacles évoqués concernent notamment des facteurs humains, un manque de temps et de ressources. Les facilitateurs comprennent le soutien institutionnel et l’influence de la pratique infirmière avancée. Des compréhensions diverses de la PAP ont également émergé. Conclusion : Cette étude off re une vue d’ensemble des PAP en Suisse romande, clarifie leur implantation, leur fonctionnement et les compétences attendues. Elle souligne l’importance de les défi nir précisément pour favoriser une réglementation cohérente.
Background During hospitalisation, older adults are at risk of experiencing functional decline unrelated to their initial condition, known as hospital-associated disability (HAD). HAD affects 37 % of hospitalised older adults. The population of older adults is expected to grow in the coming years, likely leading to an increase in cases of HAD. Published systematic reviews have certain limitations, leaving several questions unanswered about the prevention of HAD. Randomised controlled studies (RCT) with multiple training components (such as different strengthening and balance or walking components) are difficult to compare against single-component programmes. The aim of the study was to systematically evaluate the effectiveness of (single or multi-component) physical exercise programmes on the prevention of HAD in people over 65 years of age hospitalised in an acute care setting measured at hospital discharge. Methods Living systematic review with network meta-analysis of RCTs. As this study represents a living systematic review, findings are continuously updated. Physical exercise programmes were analysed as multi-component interventions. Risk of bias was evaluated using the ROBUST-RCT tool. Results In total 5967 records were screened for eligibility; 546 full texts were assessed, and 75 studies were included in the evidence synthesis. We analysed 19 pair-wise comparisons at discharge. Inconsistency in the network-analysis was low with I 2 = 8.6 %. The most effective programme was strengthening compared against usual care (SMD: 0.65; 95 % CI: 0.06; 1.24). The exercise programme with the highest precision was balance + strengthening + walking (SMD: 0.50; 95 % CI: 0.33; 0.67). Training focused on a single-component of basic daily activities was not more eff ective than usual care (SMD: –0.13; 95 % CI –0.44; 0.18). Conclusion This work enhances the understanding of how to prevent HAD by providing detailed insights into specifi c components of physical exercise. Currently, the intervention with the highest precision suggests using a multicomponent approach involving balance, strengthening, and walking components to prevent HAD in an acute care setting. A major issue with traditional systematic reviews is the lengthy publication process, which often results in findings becoming outdated by the time they are published. This living systematic review enables clinicians to stay current by rapidly integrating new findings into the evidence synthesis of HAD prevention.
Background During hospitalisation, older adults are at risk of experiencing functional decline unrelated to their initial condition, known as hospital-associated disability (HAD). HAD affects 37 % of hospitalised older adults. The population of older adults is expected to grow in the coming years, likely leading to an increase in cases of HAD. Published systematic reviews have certain limitations, leaving several questions unanswered about the prevention of HAD. Randomised controlled studies (RCT) with multiple training components (such as different strengthening and balance or walking components) are difficult to compare against single-component programmes. The aim of the study was to systematically evaluate the effectiveness of (single or multi-component) physical exercise programmes on the prevention of HAD in people over 65 years of age hospitalised in an acute care setting measured at hospital discharge. Methods Living systematic review with network meta-analysis of RCTs. As this study represents a living systematic review, findings are continuously updated. Physical exercise programmes were analysed as multi-component interventions. Risk of bias was evaluated using the ROBUST-RCT tool. Results In total 5967 records were screened for eligibility; 546 full texts were assessed, and 75 studies were included in the evidence synthesis. We analysed 19 pair-wise comparisons at discharge. Inconsistency in the network-analysis was low with I 2 = 8.6 %. The most effective programme was strengthening compared against usual care (SMD: 0.65; 95 % CI: 0.06; 1.24). The exercise programme with the highest precision was balance + strengthening + walking (SMD: 0.50; 95 % CI: 0.33; 0.67). Training focused on a single-component of basic daily activities was not more eff ective than usual care (SMD: –0.13; 95 % CI –0.44; 0.18). Conclusion This work enhances the understanding of how to prevent HAD by providing detailed insights into specifi c components of physical exercise. Currently, the intervention with the highest precision suggests using a multicomponent approach involving balance, strengthening, and walking components to prevent HAD in an acute care setting. A major issue with traditional systematic reviews is the lengthy publication process, which often results in findings becoming outdated by the time they are published. This living systematic review enables clinicians to stay current by rapidly integrating new findings into the evidence synthesis of HAD prevention.