Philippine Journal of Allied Health Sciences Vol 4 Iss 2

Volume 4 Issue 2 • February 2021 Editorial Publishing Research Protocols Ivan Neil Gomez, PJAHS Editor-in-Chief Letter to the Editor On why universal design must be considered the minimum in the field of the built environment Louie T. Navarro Original Articles Clinical Audit on Examination Tools Used by Physical Therapists in Metro Manila in Examining Conditions with Neck Pain Arlene Chiong Maya, Christopher Cruz, Hymn Nuntasomsaran, Pauline Alyssa Vega, John Ed Kevin Tan, Jerome Rivera Jr., Vanessa Regina Guevarra The Relevant Anatomy of the Biceps Tendon When Performing Tenodesis in Filipino Cadaveric Specimens Martin Louie Bangcoy , Charles Abraham Villamin, Chino Ervin Tayag, Patrick Henry Lorenzo Short Reports Impact of COVID-19 Pandemic in Filipino Occupational Therapy Practice Across Regions Rod Charlie Delos Reyes, Karla Czarina Tolentino, Wendy Sy A Literature Review on the Facilitators and Barriers to the Uptake of Interprofessional Collaboration in the Field of Assistive Technology within Rehabilitation Medicine Daryl Patrick Yao, Kenneth Matthew Beltran, Treisha Naedine Santos, Kaoru Inoue A Rapid Literature Review on the Strategies for Collaboration Between Occupational therapists and Speech-Language Therapists in the Field of Augmentative and Alternative Communication Daryl Patrick Yao, Kaoru Inoue, Ghislynne Dei-Anne



PJAHS • Volume 4 Issue 2 2021 Table of Contents Editorial Board Preface Ivan Neil Gomez 2 Preface to PJAHS Volume 4 Issue 2 Editor-in-Chief Editorial Catherine Joy Escuadra 3 Publishing Research Protocols Kim Gerald Medallon Ivan Neil Gomez, PJAHS Editor-in-Chief Managing Editors Letter to the Editor Donald Lipardo Donald Manlapaz 3 On why universal design must be considered the minimum in the field of the built environment Associate Editors Louie Navarro Valentin Dones III, Reil Vinard Espino, Paulin Grace Morato- Original Articles Espino, Karen Leslie Pineda Clinical Audit on Examination Tools Used by Physical Therapists in PJAHS Review Board 7 Metro Manila in Examining Conditions with Neck Pain Consuelo Suarez Arlene Chiong Maya, Christopher Cruz, Hymn Nuntasomsaran, Pauline Alyssa Anne Marie Aseron Vega, John Ed Kevin Tan, Jerome Rivera Jr., Vanessa Regina Guevarra Editorial Advisory Board The Relevant Anatomy of the Biceps Tendon When Performing 13 Tenodesis in Filipino Cadaveric Specimens Anna Lea Enriquez Martin Louie Bangcoy , Charles Abraham Villamin, Chino Ervin Tayag, Patrick Ethics Consultant Henry Lorenzo Archelle Callejo, Zyra Villamor, Short Reports Lyle Patrick Tancuangco, Jazzmine Gale Flores 22 Impact of COVID-19 Pandemic in Filipino Occupational Therapy Practice Across Regions Editorial Staff Rod Charlie Delos Reyes, Karla Czarina Tolentino, Wendy Sy Genejane Adarlo, Tsuyoshi Asai, Alvin Atlas, Katerina Los Baños- A Literature Review on the Facilitators and Barriers to the Uptake of Atlas, Stephanie Balid-Attwell, Interprofessional Collaboration in the Field of Assistive Technology 29 within Rehabilitation Medicine Rumpa Boonsinsukh, Umar Mohammad Bello, Mary Monica Daryl Patrick Yao, Kenneth Matthew Beltran, Treisha Naedine Santos, Kaoru Inoue Bueno, Ke-Vin Chang, Supat Chupradit, Jesus Alfonso Datu, A Rapid Literature Review on the Strategies for Collaboration Janine Margarita Dizon, Marian Grace Gabor, Karen Grimmer, 35 Between Occupational therapists and Speech-Language Therapists in Joel Guerrero, Usa Karukunchit, the Field of Augmentative and Alternative Communication Masayoshi Kubo, Cynthia Lai, Daryl Patrick Yao, Kaoru Inoue, Ghislynne Dei-Anne Ritzmond Loa, Steve Milanese, Davynn Tan, Jou Yin Teoh, Ruth 42 Announcements Segal, Sean Sullivan, Gian Carlo Torres, Atsuhiro Tsubaki, Jeric PJAHS Call for Papers Uy, Jana Patricia Valdez, Les 44 Regular Issue Paul Valdez, Candace Vickers, 45 Special Section Alexander Miles Yiu International Academic Editors The Philippine Journal of Allied health Sciences [ISSN: 1908-5044] is an Open Access, peer reviewed journal published by the University of Santo Tomas-College of Rehabilitation Sciences, Manila, Philippines. 1

PJAHS • Volume 4 Issue 2 2021 • Preface to PJAHS Volume 4 Issue 2 Copyright © 2021 PJAHS. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. To say that the past year has been challenging professionals. Three short reports are reported for the everyone is an understatement. in this issue. The first short report looks at the Disruptions in in academia, and in the scientific impact of the COVID-19 pandemic to Filipino community in general, has been tough. occupational therapists across regions. The next Nevertheless, here in PJAHS, we are grateful that two short reports are literature reviews. The we still continue to receive article submissions. first literature review discusses experiences in interprofessional collaboration in rehabilitation In this issue’s editorial, PJAHS introduces a new using assistive technology. The second literature model of article type that will accepted from review explores collaborative practices among hereon. Study protocols represents an innovative speech language pathologists and occupational research article typology that has gained therapists in the field of augmentative and attention in the past decade among scientific alternative communication. journals. It serves several important functions in improving scientific rigour and enhancing This issue of PJAHS presents an interesting mix scientific publishing. Thus, the decision in of articles from different allied health accepting study protocols will be enacted, with a professions, as well as types of articles. It is our complete guide presented at the end of this issue, hope that the expansion of the types of articles in the announcements section. discussed in the announcement section of this issue opens new opportunities for authors to We are happy to present to you six research submit their work to us. It is with an optimistic articles in the Volume 4 Issue 2 of the Philippine mind that we look forward your future Journal of Allied Health Sciences. Our letter to submissions. the editor explores the concept of universal design on how we conceptualize the built We thank the editorial board and pool of environments for people with disabilities. There international academic editors of PJAHS for their are two original research articles included in this valuable contribution to making this issue of issue. The first article audits the use of evidence- PJAHS possible and a reality. based practice tools used by physical therapists. This article challenges Filipino physical therapists in reflecting how they use these evidence-based outcome measures in their own practice. The second article is a first for the journal, which reports on a cadaveric study and provides practice implications as to how we can learn from their findings as allied health 2

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.001) Editorial Publishing Research Protocols Ivan Neil Gomez, Editor-in-Chief Article Received: December 31, 2020 Article Published: February 14, 2021 (online) Copyright © 2021 Gomez. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Over the years, scientific journals have evolved some point in the future, this definition may in their role from publishing research into a change in order to adapt to the constantly more proactive role of improving the state of evolving state of the knowledge base. research through supporting transparency and rigour.1 The scientific community has recognized The publication of research protocols has been that an important step towards transparency adopted by various local and international and rigour of the research process is the scientific journals. This is an important reporting of research protocols.2 Various innovation in the state of scientific publication as databases have been established offering it assists in addressing publication bias and information on on-going research projects to increases the internal validity of researches. inform patients and their family members, Among other things, it has also been suggested researchers, practitioners, grant funders, and the that the publication of research reports is community in general (i.e., ClinicalTrials.gov, essential in: peer review of the protocol prior to PROSPERO, Philippine Health Research implementation, highlighting quality research Registry(PHHR)). So much so, registry of studies in their early stages, reduces negative or research protocols in these databases is slowly inconvenient findings, recruitment of possible becoming standard in some countries. participants, aids in funding, prevention of “data fishing” through a priori data analysis plans, A research protocol is an empirical description of opens avenues for collaboration among a study proposal. While various authors and researchers, reduces unnecessary duplication of institutions may provide different definitions, research, facilitates subsequent publication of the Philippine Journal of Allied Health Sciences the completed research project, and grounding of (PJAHS) operationally define research protocols priority research areas among others.1,3,4 be a research article reporting the background, study objectives, methods, and expected results It is for these reasons that PJAHS is excited to of a proposed or ongoing research.2 This is a announce that starting with Volume 5, we are general definition that encompasses various now opening our submission system to Research research paradigms, approaches, and study Protocols. PJAHS will consider publishing study designs aimed towards answering relevant allied protocols (i.e., primary studies, systematic health clinical and research problems. As the reviews with or without meta-analysis) that have state of healthcare research continuously been approved by a funding agency and/or an evolves, PJAHS believes that such a definition ethics approval body. Whenever appropriate, enables a classical description that can stand the study protocols should be registered in test of time. Nevertheless, we recognize that at appropriate databases (i.e., ClinicalTrials.gov, 3

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.001) PROSPERO, PHRR, etc.). Study protocols are References: strongly recommended to follow relevant reporting guidelines (i.e., SPIRIT, SPIROS, 1. Eysenbach G. Peer review and publication of PRSIMA-P, or consult the list by the EQUATOR research protocols and proposals: a role for open Network). Study protocols without current ethics Access Journals. Journal of Medical Internet approval will not be considered. A more detailed Research. 2004;6(3):e37. DOI: description of the submission guidelines can be 10.2196/jmir.6.3.e37. seen in our website, https://pjahs.ust.edu.ph/submission/.2 2. Philippine Journal of Allied Health Sciences. Guidelines for Submission (PJAHS). Submission We recognize that this model of publishing is an Guideline. PJAHS; 2021. Available from: experiment. There will be a need for PJAHS to https://pjahs.ust.edu.ph/submission/. learn from our own experiences, as well as from other journals in order to fine-tune a framework, 3. Li T, Boutron I, Salman RA, Cobo E, Flemyng E, editorial and peer-review process, and even a Grimshaw JM, Altman DG. Review and publication format that can best respond to the specific of protocol submissions to trials–what have we needs of allied health research.5-7 Nonetheless, learned in 10 years? Trials. 2017;18(1):34. DOI: we believe that this is an important step towards 10.1186/s13063-016-1743-0. improving not only the state of our journal but of scientific research in the field of allied health. 4. Uppstad PH, McTigue E. A rationale for publishing Hence, from hereon, PJAHS joins the scientific peer-reviewed study protocols in the Nordic community in supporting the principle of Journal of Literacy Research in order to increase publishing peer-reviewed research protocols. scientific rigour. Nordic Journal of Literacy Research. 2020;6(1). DOI: 10.23865/njlr.v6.2010. 5. Gomez INB. The state of the journal. Philippine Journal of Allied Health Sciences. 2020;3(1). DOI: 0.36413/pjahs.0301.002. 6. Gomez INB. Critical Reflection in Responding to Reviewers’ Comments. Philippine Journal of Allied Health Sciences. 2020;3(1). DOI: 36413/pjahs.0302.001. 7. Gomez INB. In peer review we trust. Philippine Journal of Allied Health Sciences. 2020;4(1). DOI: 10.36413/pjahs.0401.001. 4

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.002) Letter to the Editor On why universal design must be considered the minimum in the field of the built environment Louie T. Navarro1,2,3 1louta et al., Manila, Philippines; 2louta et al., Tokyo, Japan (www.loutaetal.com); 3Interior Design Department, College of Fine Arts and Design, University of Santo Tomas, Manila, Philippines Correspondence should be addressed to: Louie T. Navarro1; [email protected] Article Received: November 5, 2020 Article Accepted: December 30, 2020 Article Published: February 14, 2021 (online) Copyright © 2021 Navarro et al. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The notion of universal design had its roots in but forget that for everyone story of success, our the early US disability rights movement of the humanity grounded in empathy is sidelined—as 1960s.1 Its widely credited ‘father,’ Ron Mace, if only through the trauma of experience can we defined universal design as “the concept of be human. designing all products and the built environment Not to be dismissive, the knowledge base to be aesthetic and usable to the greatest extent available to us now has been founded in such possible by everyone, regardless of their age, documentations of human experiences such as ability, or status in life.”2 Mace’s, and indeed, there have been great design Wheelchair-bound himself because of Polio innovations precisely because of this. One good acquired during childhood, Mace’s own example of this is the now common access ramps experiences—hindrances to social participation, that allow access for all—exemplifying the specifically physical (spatial) barriers that put fundamental notion of accessibility: that what him at a disadvantage3—led to the establishment many consider but another flight of steps is, in in 1989 of the Center for Accessible Housing, at fact, an insurmountable Everest to some. North Carolina State University in Raleigh, US.2,3 Currently known as The Center for Universal Flowing from this ‘reactionary’ narrative, the Design, this change in focus of the institute from shift from accessible design to universal design accessibility to universal design is representative was not as direct as one might think—incidental of a narrative arc that informs much of what is more fitting. As Steinfeld and Maisel1 would spatial designers use today in designing inclusive emphasize, designs that were intended to be for spaces. the exclusive use of the disabled population is slowly being revealed to be useful to all in fact: Albeit simplistic—as they say, there are more to “The result of the effort to eliminate it than meets the eye—I’d like to simply narrow discrimination, to make the world accessible and in on the attitude that underpins this arc, usable for all, is that unintended consequences beginning with the challenges faced by early are becoming evident.” The authors’ example of proponents of accessible design. this is how elevators in subway stations primarily meant to give access to the disabled As but just one of the many narratives of are now used by all ranging from travelers with humanity rising above adversity, we are almost luggage and those who are simply too tired from always inclined to highlighting such a triumph a day’s work.1 5

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.002) Crucially, the learnings derived from these past serve as a reminder to all that design is not challenges are essential to educational exclusive—with hopes of cultivating a mindset institutions that in turn play a vital role in paving by way of empathy by design. the way for a generation of ‘woke’ practitioners of the built environment.4 From here, we will see that we have come full circle in this brief history of universal design and Specific to the practice of interior design in the arrive at the core of what it really means to live country, the current curriculum has a provision in an inclusive world: social justice.1,4 As under the course Professional Practice and succinctly stated by Steinfeld and Maisel: Ethics that covers the study of B.P. 344 or The “Equality of access to the environment has Law to Enhance Mobility of Disabled Persons. always been an issue in civil rights.”1 Beyond education, this is further reinforced in the subject’s inclusion in the Board of Interior This is far from a polemic and is, in fact, but a Design examination administered by the letter that parallels the trajectory of the history Philippine Regulatory Commission. In the of universal design beginning with a personal professional practice, R.A. 10350 or the account of my own: after all, I have a niece Philippine Interior Design Act of 2012 and its diagnosed with Pervasive Developmental emphasis on the Continuing Professional Disorder-Not Otherwise Specified (PDD-NOS). It Development (CPD) programs offered by the can even be argued that this is but a reaction Philippine Institute of Interior Designers (PIID), based on the worry for this family member come ensures that designers are up to date with the the time that she will have to be on her own— advancements in universal design. only conveniently intersecting with my Although much has been gained in this professional practice. evolutionary process, it is now imperative that we continue moving forward in a direction that Given this frame and still consistent with the is defined by empathy. Beyond these ideas of narratives that continue to drive the ‘reactionary’ and the ‘incidental,’ we must improvements to universal design, this piece can continue to act and push for a truly inclusive be taken as such: a letter imploring future design language informed by empathy first and generations of practitioners in the built foremost. environment to be more mindful of the impact of our choices—and yes, critically, to be better than Foregrounding the Principles of Universal I was. Design5, designers must deepen their ties with various professionals from other fields—with References: Occupational and Physical Therapy at the forefront—for us to create spaces that are for 1. Steinfeld E, Maisel J. Universal design: designing inclusive use by all that accommodate the most vulnerable environments. New Jersey: John Wiley & Sons; 2012. members of society as a minimum. 2. The Center for Universal Design. About the center: Ronald Universal design must be considered the L. Mace. Raleigh: NC State University; c2008. Available baseline in the field of the built environment from: because we are but at the cusp of its fulfillment, https://projects.ncsu.edu/ncsu/design/cud/about_us/usr and there is a lot to be done still. onmace.htm Locally, we need to acknowledge that existing 3. Bringolf J. Who was Ron Mace. Centre for Universal Design frameworks and systems are long overdue for a Australia; c2017. Available from: revisiting—only after then can we even begin to http://universaldesignaustralia.net.au/who-was-ron- tackle the bigger problem of raising awareness. mace/ As designers of the built environment were once 4. Sirel A, Sirel O. “Universal Design” Approach for the accountable for discriminatory spatial practices Participation of the Disabled in Urban Life. Journal of Civil (i.e., physical barriers),1 we must now ensure Engineering and Architecture. 2018; 12: 11-21. Available that our designs moving forward also speaks of from: doi:10.17265/1934-7359/2018.01.002 inclusivity. That the everyday spaces we live in 5. Centre for Excellence in Universal Design. The 7 Principles. Dublin: National Disability Authority; c2020. Available from: http://universaldesign.ie/What-is Universal-Design/The-7-Principles/ 6

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.003) Original Article Clinical Audit on Examination Tools Used by Physical Therapists in Metro Manila in Examining Conditions with Neck Pain Arlene Chiong Maya1, Christopher Cruz1, Hymn Nuntasomsaran1, Pauline Alyssa Vega1, John Ed Kevin Tan1, Jerome Rivera Jr.1, Vanessa Regina Guevarra1 1Department of Physical Therapy, College of Rehabilitation Sciences, University of Santo Tomas Correspondence should be addressed to: Arlene Chiong Maya1; [email protected] Article Received: September 7, 2020 Article Accepted: November 27,2020 Article Published: February 14, 2021 (online) Copyright © 2021 Chiong Maya et al. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Neck pain is considered the fourth leading cause of disability, with an annual prevalence rate of 15 to 30%. Using evidence-based practice in neck pain examination is a vital part of the rehabilitation process as it serves as a basis for determining the best treatment. The objective of the study is to determine the usage of recommended examination tool for neck pain among the physical therapists in selected hospitals and clinics in Metro Manila. Methods: The study has three distinct phases wherein phase 1 was the development and validation of a data extraction sheet, phase 2 was the assessment of interrater reliability among the investigators who will perform the chart review, and phase 3 was the chart review process. Descriptive statistics were used for data analysis. Results: In phase 1, the contents of the data extraction sheet were found to be valid. In phase 2, the inter-rater reliability was 96.7% percent. In phase 3, the visual analogue scale was the most commonly used examination tool, yielding a 54% usage. This was followed by cervical range of motion & cervical manual muscle testing (22%), palpation (15%), sensory testing (7%), postural assessment (6%), special test (4%), ocular inspection (2%), functional assessment (1%), Functional Index Measure (1%) and functional muscle testing (1%). Neck Disability Index, which was one of the literature-recommended examination tools, was not used. Conclusion: Visual analogue scale was the most commonly used examination tool in conditions with neck pain in selected hospitals and clinics in Metro Manila. Further investigation can be done in order to know the reasons for the use or nonuse of examination tools. Keywords: Clinical Audit, Neck Pain, Evidence-based Physical Therapy INTRODUCTION the management and prescription of interventions or medications for the patient.4 According to the Global Burden of Disease 2010 Study, neck pain is the fourth leading cause of EBP is the conscientious, explicit, and judicious disability, with an annual prevalence rate use of current best evidence in making decisions ranging from 15 to 30%.1 Proper examination of about the care of the individual patient. It entails neck pain should be done to have a clinical and integrating individual clinical expertise with the theoretical basis to determine the most suitable best available external clinical evidence from treatment. The examination of conditions with systematic research.5,6 Use of recommended neck pain includes, but is not limited to, proper examination tools from research is a form of history taking, measuring the range of motion, application of one of the aspects of EBP. muscle strength, functional analysis, and the use of outcome measure tools and self-administered The actual utilization of the recommended questionnaires.2 The use of these standardized examination tools is translated into tools will provide objective data of the patient’s documentation of the results in a patient’s chart. health status.3 Incorporating evidence-based To check for the documentation of the usage of practice (EBP) in the examination will also aid in recommended examination tools, a clinical audit 7

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.003) is recommended.3 Clinical audit is the process of Phase II: Interrater Reliability. Inter-rater systematically reviewing, evaluating, and reliability was done before the actual chart assessing current practice methods against review process to remove potential information research-based standards to improve clinical bias and maintain uniformity. Using the validated care for service users.3 It aims to recommend or data extraction sheet, the first ten physical support examination and treatment processes therapy charts were reviewed by all of the being carried out in practice. researchers for interrater reliability. Using interclass correlation, the results were analyzed, The objective of the study is to determine the and the kappa score should not be lower than 0.8 usage of recommended examination tools for to show a strong agreement among the neck pain among physical therapists of selected assessors.8 hospitals and clinics in Metro Manila. Phase III: Chart Review Process. All physical METHODS therapy charts of patients with neck pain in the selected hospitals and centers of Metro Manila Ethical Consideration. The study was reviewed who agreed to be part of the study were and approved by the Ethics Research Committee reviewed. Neck pain was defined as any to be a of the University of Santo Tomas- College of disorder that is reported above the shoulder Rehabilitation Sciences. The study was in blades.9 Charts that contained a diagnosis of agreement with ethical principles set by the headaches, temporomandibular joint disorder, Declaration of Helsinki. Number codes were sprain/strain, tumors, fractures, various assigned to the reviewed physical therapy chart infectious diseases, inflammatory arthropathies, to maintain anonymity of the patient, the and fibromyalgia.10 physical therapist, the doctor and the institution. The inclusion criteria for the clinical audit were Study Design. The design of the study was the charts that contained the following descriptive and observational. The study is information: (1) all physical therapy charts from composed of three phases. June 1, 2015 to June 30, 2016, (2) physical therapy charts of patients who had complaints of Phase I: Development and Validation of a any kind of neck pain; and (3) all physical Data Extraction Sheet for Chart Review. A therapy charts of patients with neck pain who literature search in five databases, Science were referred by the physician for examination Direct, PubMed, Medline, CINAHL, and Google or who were admitted in the hospital. Charts Scholar, was done in May 2016 to develop the without documentation of complaints of neck data extraction sheet. The search formula pain were excluded. Charts with incomplete data “examination tools AND neck pain AND physical in the documentation were also excluded. therapy” was used. Published articles between the years 2006 and 2016 were included in the The charts were then labeled with number codes study. to ensure confidentiality. The validated data extraction sheet was used to determine the A panel of experts composed of three physical examination tools used. therapists with at least five years of experience in handling patients with neck pain7 was invited Statistical Methods. All data were entered in to validate the developed data extraction sheet. Microsoft Excel. Descriptive statistics, using They were asked to rate the items in the frequency tables, was used to analyze the data in formulated data extraction sheet using a Microsoft Excel. validation form that contains a 4-point rating scale: 1=not relevant, 2=somewhat relevant, RESULTS 3=quite relevant, and 4=highly relevant. An open-ended question of “what other examination Phase I: Development and Validation of a tools should be in the data extraction sheet” was Data Extraction Tool for Chart Review. Out of also asked from the experts. An item in the data the total of 82,304 hits in databases searched, extraction sheet must be unanimously rated as 4 only 100 articles were found to be relevant. Out in order for it to be included in the final draft. of the 100 articles, title and abstract filter were 8

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.003) done. The articles included were those that were Table 1. Demographics n*(total:706) % categorized Level I (Systematic Review) or II (Randomized Control Trial) in the National Gender 262 37% Health and Medical Research Council (NHMRC) Male 444 63% Evidence Hierarchy.8 After the title and abstract Female filter, only 16 articles were found to be relevant 115 16% in the study. (Supplement A). Age 136 19% 20-30 159 23% The panel of experts reviewed the first draft of 31-40 184 26% the data extraction sheet, and only the items 41-50 72 10% visual analogue scale (VAS), cervical range of 51-60 40 6% motion (CROM), and neck disability index (NDI) 61-70 were unanimously graded as 4. The panel >70 recommended the addition of the items cervical manual muscle testing (CMMT) and special tests. Note: n is Number The final draft (Supplement B) included the recommendations, and all the items were then Table 2. Results Using the Data Extraction Sheet given a grade of 4 by the experts. n (total: % Phase II: Interrater Reliability. The first ten 706) charts were collected to check for interrater reliability. The interrater reliability result was VAS Yes 382 54% 96.7% percent or a kappa score of 0.97, showing No 324 46% strong agreement among the six assessors.25 CROM Yes 154 22% Phase III: Chart Review Process. Out of the 26 No 552 78% selected hospitals and centers, eight agreed to be part of the study. A total of 20,249 charts was CMMT Yes 152 22% gathered, and out of this number, 706 charts met the inclusion criteria. Table 1 contained the No 554 78% demographics of patients from the charts Special Test Yes 27 4% collected. The diagnoses of the charts included the following: cervical strain (10%), cervical No 679 96% impingement (3%), cervical radiculopathy (8%), NDI Yes 0 0% cervical spondylosis (29%), cervical stenosis (1%), muscle strain (23%), cervical herniated No 706 100% nucleus pulposus (3%), torticollis (2%) and myofascial pain syndrome (27%). Others PA 83 6% Table 2 and Figure 1 showed that majority of the charts in the selected hospitals and centers Palpation 131 15% utilized VAS the most, followed by CROM, CMMT, and special tests. NDI was not used in all of the FMT 2 1% charts reviewed. There are a few charts that FA 5 1% showed the use of other examination tools such as postural assessment, palpation, functional OI 6 2% muscle test, functional assessment, Functional Sensory Testing 51 7% Index Measure, ocular inspection, and sensory testing. FIM 4 1% Movement analysis 1 0% Note. n is Number; VAS is Visual Analogue Scale; CROM is Cervical Range of Motion; CMMT is Cervical Manual Muscle Testing; NDI is Neck Disability Index; PA is Postural Analysis; FMT is Functional Muscle Testing; FA is Functional Analysis; OI is Ocular Inspection; FIM is Functional Index Measure DISCUSSION The study findings showed that VAS was the most commonly used neck pain examination tool. Many health care professionals utilize the examination of pain as a basis for their evaluation and treatment approach.26 According to Petala et al., VAS has good reliability and validity, suited to parametric analysis, and is easy to use.27 The use of VAS can be further improved by taking into 9

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.003) Figure 1. Presence of Examination Tools in the Charts Reviewed (Note: Figure 1 depicts that the Visual Analogue Scale (VAS) was utilized the most in the examination of neck pain followed by Cervical Range of Motion (ROM), Cervical Manual Muscle Test (MMT), and Palpation. Other examination tools used but with lesser frequency were Postural Analysis (PA), Sensory Testing, Special test, Ocular Inspection (OI), Functional Index Measure (FIM), Functional Muscle Testing (FMT), and Movement Analysis. Neck Disability Index (NDI) was not used during neck examination in the audit period.) context the patient’s experience of pain, attitude Jette et al., and Biering-Sørensen et al., wherein towards pain, experience of psychologic distress, they found out that only a limited number of exhibited illness behaviors, and social measurement instruments is being used by environment.2 Other measures of pain, such as physical therapists.28, 29,30 The studies questionnaires including the psychological and investigated on the barriers for the limited use, social aspects, can be recommended to make the and these were the lack of knowledge, examination of a patient more holistic.2 insufficient integration in practice, and lack of time, and no instruments available in practice. 28 Misailidou et al. recommended the use of CROM, To improve and promote the use of examination CMMT, and palpation because patients with neck tools, a training program can be designed. A pain present with a decrease in range of motion study by Dizon et al. showed that the use of a and strength compared to those with individuals contextually designed EBP training program for without neck pain. Patients with neck pain were Filipino physical therapists showed significant found to present with trigger points; this gains in knowledge and skills.31 necessitates the inclusion of palpation in the examination.2 Our study showed that there was Newton-Brown et al. stated that implementation only less than 30% utilization of these literature- of clinical audit could contribute to the recommended examination tools. The reason improvement in the process of patient behind the gap can be further investigated in examination. The study showed that there was future researches. One of the factors contributing departmental change in the process of patient to non-usage could be the absence of a clinical examination after an audit. This process practice guideline in neck pain in the Philippines. produced new medical and nursing Our results were consistent with the findings documentation in the patients’ charts.32 The from separate studies done by Swinkels et al., conduct of this clinical audit should hopefully 10

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.003) improve the examination process of neck pain in Conflicts of interest the selected hospitals and centers in Metro The authors of this paper declare no conflicting Manila. interest. Limitations and Recommendations. To avoid Supplementary Materials confirmation bias, the authors would like to Supplementary Material A. Results of the emphasize that the method of the study was Literature Search purely observational. It did not investigate the Supplementary Material B. Data Extraction Sheet possible reason for the usage or non-usage of certain neck examination tools. It did consider the current knowledge, skills, and attitudes of the physical therapists towards EBP. For future studies, it is recommended to identify References the reasons of the physical therapists as to how and why they choose to use a certain 1. Cohen SP. Epidemiology, diagnosis, and treatment of examination tool, the barriers from using these neck pain. Mayo Clinic Proceedings. 2015;90(2):284- tools, and if they are encouraged or given 299. training in using outcome-measure tools. Training of physical therapists and an audit 2. Misailidou V, Malliou P, Beneka A, Karagiannidis A, is also recommended to check if training can Godolias G. Assessment of patients with neck pain: a change physical therapists' behavior towards review of definitions, selection criteria, and EBP. measurement tools. Journal of Chiropractic Medicine. Since our study only included non-specific neck 2010;9(2):49-59. pain conditions, it is also recommended to determine the recommended examination tools 3. Capelli O, Riccomi S, Scarpa M et al. Clinical audit in for specific conditions or diagnosis of neck pain. primary care: from evidence to practice. Primary Care at a Glance - Hot Topics and New Insights. 2012. CONCLUSION Available at: http://cdn.intechopen.com/pdfs- VAS was the most commonly used literature- wm/35858.pdf. Accessed May 12, 2016. recommended examination tool in the examination of neck pain in selected hospitals 4. Slaven E, Mathers J. Differential diagnosis of shoulder and clinics in Metro Manila. There was only less and cervical pain: a case report. Journal of Manual & than 30% utilization of the recommended Manipulative Therapy. 2010;18(4):191-196.. examination tools in neck pain. 5. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Individual Author’s Contributions Richardson WS. Evidence based medicine: what it is Ms. Arlene C. Chiong Maya and Mr. Christopher and what it isn't. BMJ. 1996 Jan 13;312(7023):71-2. G. Cruz conceptualized the study design. All authors performed data collection, analyzed 6. Schreiber J, Stern P. A review of the literature on the data, drafted and revised the manuscript, evidence-based practice in physical therapy. The gave final approval of the version to be Internet Journal of Allied Health Sciences and Practice. submitted for publication and agreed to be 2005 Oct 1;3(4). accountable in all aspects of the manuscript. 7. Dizon JMR, Grimmer-Somers K, Kumar S. The physical Disclosure Statement therapy profile questionnaire (PTPQ): development, The authors have nothing to disclose. validation and pilot testing. BMC Research Notes. 2011;4(1). 8. NHMRC additional levels of evidence and grades for ... [Internet]. [cited 2020 Nov 26]. Available from: https://www.mja.com.au/sites/default/files/NHMRC. levels.of.evidence.2008-09.pdf 9. Sutbeyaz S, Sezer N, Koseoglu B. The effect of pulsed electromagnetic fields in the treatment of cervical osteoarthritis: a randomized, double-blind, sham- controlled trial. Rheumatology International. 2005;26(4):320-4. 10. Dundar U, Evcik D, Samli F, Pusak H, Kavuncu V. The effect of gallium arsenide aluminum laser therapy in the management of cervical myofascial pain syndrome: a double blind, placebo-controlled study. Clinical Rheumatology. 2006;26(6):930-934. 11

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.003) 11. Gur A, Sarac A, Cevik R, Altindag O, Sarac S. Efficacy of 22. Macdermid JC, Walton DM, Avery S, Blanchard A, 904 nm gallium arsenide low level laser therapy in the Etruw E, Mcalpine C, et al. Measurement Properties of management of chronic myofascial pain in the neck: A the Neck Disability Index: A Systematic Review. double-blind and randomized-controlled trial. Lasers Journal of Orthopaedic & Sports Physical Therapy. in Surgery and Medicine. 2004;35(3):229-235. 2009;39(5):400-C12. 12. Chow R, Heller G, Barnsley L. The effect of 300 mW, 23. Young B, Walker M, Strunce J, Boyles R, Whitman J, 830 nm laser on chronic neck pain: A double-blind, Childs J. Responsiveness of the Neck Disability Index randomized, placebo-controlled study. Pain. in patients with mechanical neck disorders. The Spine 2006;124(1):201-210. Journal. 2009;9(10):802-808. 13. Dunning JR, Butts R, Mourad F, Young I, Fernandez- 24. Brosseau L, Wells GA, Tugwell P & et al.. Ottawa Panel de-Las Peñas C, Hagins M, Stanislawski T, Donley J, evidence-based clinical practice guidelines on Buck D, Hooks TR, Cleland JA. Upper cervical and therapeutic massage for neck pain. Journal of Body upper thoracic manipulation versus mobilization and and Movement Therapy. 2012 Jul;16(3):300-325. exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC 25. McHugh ML. Interrater reliability: the kappa statistic. Musculoskeletal Disorders. 2016 Feb 6;17:64. Biochemia Medica. 2012;22(3):276-82. 14. Marchand GH, Myhre K, Leivseth G, Sandvik L, Lau B, 26. Bliss SJ, Flanders SA, Saint S. A Pain in the Neck. New Bautz-Holter E, et al. Change in pain, disability and England Journal of Medicine. 2004;350(10):1037- influence of fear-avoidance in a work-focused 1042. intervention on neck and back pain: a randomized controlled trial. BMC Musculoskeletal Disorders. 27. Petala E, Kapoukranidou D, Christos K. Assessment of 2015;16(1). Patients with Neck Pain: The Most Valid Measurement Tools. Research and Reviews Journal of Medical and 15. Dunleavy K, Kava K, Goldberg A, Malek M, Talley S, Health Sciences. 2015;4. Tutag-Lehr V, et al. Comparative effectiveness of Pilates and yoga group exercise interventions for 28. Swinkels RA, Peppen RPV, Wittink H, Custers JW, chronic mechanical neck pain: quasi-randomised Beurskens AJ. Current use and barriers and parallel controlled study. Physiotherapy. facilitators for implementation of standardised 2016;102(3):236–42. measures in physical therapy in the Netherlands. BMC Musculoskeletal Disorders. 2011;12(1). 16. Langevin P, Roy J-S, Desmeules F, Lamothe M, Robitaille S. Cervical radiculopathy: a randomized 29. Jette DU, Halbert J, Iverson C, Miceli E, Shah P. Use of clinical trial evaluating the short-term effect of two Standardized Outcome Measures in Physical manual therapy and exercise protocols. Therapist Practice: Perceptions and Applications. Physiotherapy. 2015;101. Physical Therapy. 2009;89(2):125-135. 17. Campa-Moran I, Rey-Gudin E, Fernández-Carnero J, 30. Biering-Sørensen F, Haigh R, Holgersson MH, Paris-Alemany A, Gil-Martinez A, Lara SL, et al. Ravnborg MH. Brugen af effektmål i Comparison of Dry Needling versus Orthopedic fysiurgisk/reumatologisk rehabilitering. Resultat af en Manual Therapy in Patients with Myofascial Chronic spørgeskemaundersøgelse [Use of outcome measures Neck Pain: A Single-Blind, Randomized Pilot Study. in physical medicine/rheumatological rehabilitation. Pain Research and Treatment. 2015;2015:1–15. Results of a questionnaire study]. Ugeskr Laeger. 2001 Jan 29;163(5):612-6. Danish. 18. Bokarius AV, Bokarius V. Evidence-based review of manual therapy efficacy in treatment of chronic 31. Dizon JMR, Grimmer-Somers K, Kumar S. musculoskeletal pain. Pain Practice. 2010;10(5):451- Effectiveness Of The Tailored Evidence Based Practice 458. Training Program For Filipino Physical Therapists: A Randomized Controlled Trial. BMC Medical Education. 19. Meseguer A, Fernández-de-las-Peñas C, Navarro-Poza 2014;14(1):147. J, Rodríguez-Blanco C, Gandia J. Immediate effects of the strain/counterstrain technique in local pain 32. Newton-Brown E, Fitzgerald L, Mitra B. Audit evoked by tender points in the upper trapezius improves emergency department triage, assessment, muscle. Clinical Chiropractic. 2006;9(3):112-118. multi-modal analgesia and nerve block use in the management of pain in older people with neck of 20. Alreni A, Harrop D, Gumber A, McLean S. Measures of femur fracture. Australasian Emergency Nursing upper limb function for people with neck pain: a Journal. 2014 Nov;17(4):176-83. systematic review of measurement and practical properties (protocol). Systematic Reviews. 2015;4(1). 21. Gay R, Madson T, Cieslak K. Comparison of the Neck Disability Index and the Neck Bournemouth Questionnaire in a sample of patients with chronic uncomplicated neck pain. Journal of Manipulative and Physiological Therapeutics. 2007;30(4):259-262. 12

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.004) Original Article The Relevant Anatomy of the Biceps Tendon When Performing Tenodesis in Filipino Cadaveric Specimens Martin Louie Bangcoy1, Charles Abraham Villamin1, Chino Ervin Tayag1, Patrick Henry Lorenzo1 1Department of Orthopedics, University of Santo Tomas Hospital, Manila, Philippines Correspondence should be addressed to: Martin Louie Bangcoy1; [email protected] Article Received: October 1, 2020 Article Accepted: December 2, 2020 Article Published: February 14, 2021 (online) Copyright © 2021 Bangcoy et al. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Biceps tenodesis is a technique frequently performed in shoulder surgeries. Various techniques have been described, but there is no consensus on which technique restores the length-tension relationship. Restoration of the physiologic length-tension relationship has been correlated to better functional outcomes, such as decreased incidence of residual pain or weakness of the biceps. The objective of this study was to measure the anatomic relationship of the origin of the biceps tendon with its zones in the upper extremity. This would provide an anatomic guide or an acceptable placement of the tenodesis to reestablish good biceps tension during surgery. Methods: The study used nine adult cadavers (five males, four females) from the [withheld for blinded review]. Nine shoulder specimens were dissected and markers were placed at five points along each biceps tendon: (1) Labral origin (LO) (2) Superior bicipital groove (SBG) (3) Superior border of the pectoralis tendon (SBPMT) (4) Musculotendinous junction (MTJ) and (5) Inferior border of the pectoralis tendon (IBPMT). Using the origin of the tendon as the initial point of reference, measurements were made to the four subsequent sites. The humeral length was recorded by measuring the distance between the greater tuberosity and the lateral epicondyle as well as the tendon diameter at the articular surface. Results: The intraclass correlation coefficient was excellent across all measures. A total of nine cadavers were included. Mean age of patients was 66.33 years old, ranging from 52-82 years old. These were composed of five male and four female cadavers. The mean tendon length was 24.83mm ± 4.32 from the origin to the superior border of the bicipital groove, 73.50mm ± 6.96 to the Superior Border Pectoralis Major Tendon, 100.89mm ± 6.88 to the Musculotendinous Junction, and 111.11mm ± 7.45 to the Inferior Border Pectoralis Major Tendon. The mean tendon diameter at the articular origin was 6.44mm ± 1.76. Conclusion: This study provided measurement guidelines that could restore the natural length-tension relationship during biceps tenodesis using the interference screw technique in Filipinos. A simple method of restoring a normal length-tension relationship is by doing tenodesis close to the articular origin and creating a bone socket of approximately 25mm in depth, using the superior border of the bicipital groove as a landmark. Keywords: long head of the biceps tendon, biceps tenotomy, biceps tenodesis INTRODUCTION subscapularis tendon repair, pain associated with massive rotator cuff tears, and some Lesions of the long head of the biceps tendon Superior Labrum Anterior and Posterior (SLAP) (LHBT) are common shoulder pathologies that lesions.2, 3 Treatment can be tenotomy or can result to persistent pain and functional tenodesis. Tenotomy is simpler but has been impairment. LHBT lesions can be isolated but are associated with deformity due to distal frequently associated with complex shoulder migration, fatigue with resisted elbow flexion, conditions, such as shoulder instability or rotator and supination strength loss.4 Tenodesis, on the cuff tears. The decision of whether to do other hand, is associated with improved conservative or surgical management of LHBT lesions might depend on the associated shoulder cosmesis, lower rates of deformity, weakness pathology and the chronicity of symptoms.1 with supination, and continued spasm requiring reoperation.2 Surgery is indicated for isolated biceps tendinitis, subluxation or tears, concomitant 13

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.004) Tenodesis of the biceps tendon is a common Dissection started with the excision of skin and procedure performed for shoulder pathology. subcutaneous tissue from the anterior half of the Multiple surgical tenodesis techniques have been shoulder, distally to the elbow. A standard described. However, little consensus exists about deltopectoral approach was used. The insertion which technique best reproduces the physiologic of the pectoralis major tendon was left intact and length-tension relationship found in the native uninjured. The humeral insertion of the shoulder. There are few papers that studied the pectoralis tendon was used as a landmark. anatomy of the biceps tendon and the optimal Removing the anterior half of the deltoid tenodesis position to restore length-tension exposed the rotator cuff. The cuff was ensured relationship. intact and free of any pathology (e.g., rotator cuff tears, evidence of prior arthroscopic surgery). In one study, they recommended that for Next, the biceps tendon was identified and used arthroscopic suprapectoral tenodesis using as a reference point to develop the rotator interference screws, the superior border of the interval. Some parts of the supraspinatus and bicipital groove is an effective landmark for subscapularis tendon were released at their tenodesis. They have recommendations insertions to permit enhanced visualization of regarding the amount of tendon that can be the biceps tendon and its course from the labral resected and the ideal location for tenodesis origin to the intertubercular groove. (both arthroscopic and subpectoral) to restore the normal length-tension relationship.7 The measurement technique was adapted from the study of Kovack, Idoine and Jacob.7 Figure 1a However, no study has been done on showed the specific locations along the biceps Asian/Filipino cadavers. Therefore, the tendon where tagging sutures and pins were recommended measurement guidelines cannot placed to enable anatomic length measurements. be applied in our setting. With this in mind, this (1) Labral origin (LO) (2) Superior bicipital anatomic study specifically investigated the groove (SBG) (3) Superior border of the length and possibly, the optimal location for pectoralis tendon (SBPMT) (4) biceps tenodesis in Filipinos. The resting tension Musculotendinous junction (MTJ) and (5) produced by the tenodesis may lead to Inferior border of the pectoralis tendon (IBPMT). unfavorable clinical outcomes that depend on this said location. We hypothesized that the All measurements were done twice by two length and diameter of the biceps tendon would examiners to determine similarity in differ between male and female specimens. measurements. Measurements were taken based on the corresponding landmarks as seen on METHODOLOGY Figure 1a. Upon approval from The University of Santo The total biceps tendon length (TTL) was Tomas – College of Rehabilitation Sciences Ethics measured from the labral origin to the Review Committee, nine embalmed cadavers musculotendinous junction (LO-MTJ). Next, the were dissected for analysis. There were five male distance from the labral origin to the superior and four female cadavers used in this study. biceps groove (LO-SBG) was measured. This There were nine right-sided and nine left-sided measurement was taken laterally to the articular shoulders included. margin of the humeral head at the superior aspect of the bicipital groove, just before it All dissections were performed by one of two transitioned inferior and distal. Next, the examiners: a fellowship-trained shoulder superior and inferior borders of the pectoralis specialist or a fellowship-trained joint/tumor major tendon were identified. Measurements specialist and a senior orthopedic resident. from the labral origin (LO to the musculotendinous junction (LO-MTJ), superior Each specimen was composed of the shoulder border of the pectoralis major tendon (LO- girdle, clavicle, scapula, and all accompanying SBPMT), and inferior border of the pectoralis soft tissue structures, from the arm down to the major tendon (LO-IBPMT) were obtained. These hand. values were then gathered from the biceps MTJ 14

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.004) Figure 1a. Location landmarks in relation to the long Figure 1b. Cadaveric set up during dissection showing head of the biceps tendon (LHBT). (A) Labral Origin (LO); the location landmarks in relation to the long head of the (B) Super Bicipital Groove (SBG); (C) Superior Border of biceps tendon as pinned. (Green) Labral Origin (LO); the Pectoralis Tendon (SBPMT); (D) Musculotendinous (White) Super Bicipital Groove (SBG); (Red) Superior Junction (MTJ); (E) Inferior border of the pectoralis Border of the Pectoralis Tendon (SBPMT); (Blue) tendon (IBPMT). Musculotendinous Junction (MTJ); (Yellow) Inferior border of the pectoralis tendon (IBPMT). Figure 1. Location landmarks in relation to the long head of the biceps tendon. to the inferior (MTJ-I) and superior (MTJ-S) outcome assessors was used for the analysis. borders of the pectoralis tendon by subtracting Continuous variables were presented as mean/ the measurements gathered from above (MTJ – standard deviation (SD) while categorical SBPMT) (IBPMT – MTJ). The diameter of the long variables were presented as head biceps tendon was also determined from its median/interquartile range (IQR) depending on articular origin accordingly. Lastly, the distance data distribution. An Independent t-test was between the greater tuberosity and the lateral used to compare the continuous variables by sex. epicondyle measured the humeral length. All Paired t-test was used to compare the measurements were tabulated as seen on Table 2 continuous variables by laterality (left/ right). (Length of Biceps Tendon from Origin to Correlation between humeral length and each Anatomic Landmark and Tendon diameter at tendon length was determined using Pearson’s labral origin). correlation coefficient (r). Correlation coefficient was interpreted as follows: 0.90-1.00: very high, Statistical Analysis. Data were encoded in MS 0.70-0.90: high; 0.50-0.70: moderate; 0.30-0.50: Excel 2016 by the researcher. Stata MP version low; 0-0.30: negligible. values ≤0.05 were 14 software was used for data processing and considered statistically significant.6 analysis. The Intraclass correlation coefficient (ICC) for absolute agreement was utilized to RESULTS assess the reliability between the two outcome assessors. Depending on the ICC value, the agreement was rated as excellent (>0.75), good (0.60-0.74), moderate (0.40-0.59), or poor (<0.40).5 The average measure of the two 15

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.004) The intraclass correlation coefficients were 111.11mm ± 7.45 to the Inferior Border excellent across all measures (Table 1). Pectoralis Major Tendon. The mean tendon diameter at the labral origin was 6.44mm ± 1.76 A total of nine cadavers were included. The mean and did not show a difference between male and age of patients was 66.33 years old, ranging from female specimens. Moreover, measures across 52-82 years old. It composed of five male and all borders showed no statistically significant four female cadavers. The overall length of the difference by sex and laterality as seen in Table 3 biceps tendon from the origin to every anatomic (comparison of measures by sex) and Table 4 landmark was illustrated in Table 2. (comparison of measures by laterality). The mean tendon length was 24.83mm ± 4.32 Furthermore, the total length of the biceps from the origin to the superior border of the tendon had a high negative correlation to tendon bicipital groove, 73.50mm ± 6.96 to the Superior diameter as demonstrated on the scatterplot Border Pectoralis Major Tendon, 100.89mm ± matrix (Figure 4). 6.88 to the Musculo-tendinous Junction, and Table 1. Intraclass correlation coefficient between two outcome assessors. ICC (95% CI) VARIABLES 0.80 (0.25 – 0.95) 0.79 (0.36 – 0.95) Superior Border Bicipital Groove- Right 0.81 (0.03 – 0.96) Superior Border Bicipital Groove- Left 0.91 (0.66 – 0.98) Superior Border Pectoralis Major Tendon- Right 0.82 (0.27 – 0.96) Superior Border Pectoralis Major Tendon- Left 0.76 (0.21 – 0.94) Musculo-tendinous Junction- Right 0.79 (0.36 – 0.95) Musculo-tendinous Junction- Left 0.76 (0.22 – 0.94) Inferior Border Pectoralis Major Tendon- Right 1.00 (0.97 – 1.00) Inferior Border Pectoralis Major Tendon- Left 0.99 (0.72 – 1.00) Humeral Length- Right 0.96 (0.85 – 0.99) Humeral Length- Left 0.96 (0.85 – 0.99) Tendon Diameter at Articular surface- Right Tendon Diameter at Articular surface- Left Table 2. Length of Biceps Tendon from Origin to Anatomic Landmark and Tendon diameter at labral origin VARIABLES (n=9) Range Mean ± SD Superior Border Bicipital Groove 24.83 ± 4.32 24 – 30 Superior Border Pectoralis Major Tendon 73.50 ± 6.96 61.50 – 82.50 Musculo-tendinous Junction 100.89 ± 6.88 90 – 105.2 Inferior Border Pectoralis Major Tendon 111.11 ± 7.45 101.50 – 122.50 Tendon Diameter at Articular surface 6.44 ± 1.76 5 – 11 Humeral Length 267.22 ± 42.36 162.50 – 300 16

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.004) Table 3. Comparison of measures by sex (n=9) MALE FEMALE P VALUEa (n=5) (n=4) VARIABLES Mean ± SD 0.8150 24.50 ± 2.74 Mean ± SD 0.7138 Superior Border Bicipital Groove- Right 24.20 ± 3.88 22.25 ± 6.28 0.1944 Superior Border Bicipital Groove- Left 73.30 ± 5.73 22.25 ± 4.37 0.1492 Superior Border Pectoralis Major Tendon- Right 73.80 ± 7.55 0.7610 Superior Border Pectoralis Major Tendon- Left 100.20 ± 72 ± 7.49 Musculo-tendinous Junction- Right 8.19 72.50 ± 6.42 0.6009 100.60 ± 98.75 ± 5.92 Musculo-tendinous Junction- Left 4.87 0.9712 111.20 ± 99.75 ± 5.25 Inferior Border Pectoralis Major Tendon- Right 7.97 0.8144 107 ± 5.39 111 ± 7.95 Inferior Border Pectoralis Major Tendon- Left 0.5474 6.10 ± 0.22 108.38 ± 0.6346 Tendon Diameter at Articular surface- Right 6.40 ± 0.42 11.24 0.0906 Tendon Diameter at Articular surface- Left 288.50 ± Humeral Length- Right 6.88 ± 2.78 0.1240 12.20 7.00 ± 2.71 Humeral Length- Left 282.50 ± 240.63 ± aIndependent t-test was used 8.10 53.75 240.63 ± 53.75 Tendon Diameter (l1e0ft) 12 Tendon Diameter (right)10 12 68 68 4 4 150 200 250 300 150 200 250 300 Humeral length (left) Humeral length (right) Figure 4a. Humeral length is significantly correlated with Figure 4b. Humeral length is significantly correlated with tendon diameter in the left side (r = -0.8417; p value = tendon diameter in the right side (r = -0.8584; p value = 0.0044). A high negative correlation was observed between 0.0031). A high negative correlation was observed between the two measures. the two measures. Figure 4. Scatterplot matrix of Humeral length and Tendon Diameter (a) Left; (b) Right DISCUSSION However, restoring the length-tension relationship can be challenging when using this The purpose of this study was to postulate technique. The information gathered in this anatomically based values of the normal length study could help restore the length-tension of the biceps tendon and possibly, provide relationship during biceps tenodesis using the surgical recommendations for LHBT tenodesis interference screw technique. based on the findings. Biceps tenodesis using an interference screw has been reported to be strongest biomechanically.7,8 17

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.004) In performing biceps tenodesis using an Based on the mean tendon length at this area, no interference screw, a bone tunnel or socket was tendon resection was needed because the created to contain the length of the screw. The tendon's length remaining after tenotomy at this tip of the tendon was contained at the bottom of level matched the length of the interference the bone tunnel, adjacent to the interference screw. Hence, doing tenodesis at the articular screw. Hence, to be able to restore the length- margin was the preferred choice by most tension relationship of the biceps tendon, the surgeons. length of the tendon and length of the screw was considered. Tendon length was attributed to its However, restoring the length-tension anatomic location and the length of tendon relationship was more complex with a distal resected. Screw length was flexible and tenodesis because both tendon length and screw established the depth of the bone tunnel, as well length changed. In performing subpectoral as the depth of tendon insertion. In this paper, tenodesis, the goal was to position the the length of the biceps tendon from the articular musculotendinous junction of the biceps at the origin of the proximal humerus to the bicipital lower border of the pectoralis major. In an groove was at 24.83mm ± 4.32. Therefore, if anatomic study by Jarrett, McClelland and biceps tenotomy will be done at the level of the Xerogeanes,11 it was established that the glenoid margin for tenodesis, creating a 25mm musculotendinous junction of the biceps was at bone tunnel at the superior border of the approximately 22mm distal to the upper border bicipital groove would restore the length-tension of the pectoralis major tendon and 31mm relationship. With this in mind, a 23mm proximal to the lower border of the pectoralis interference screw was suitable to allow for major tendon. Moreover, in a paper by Denard et 2mm of the tendon at the tip of the screw within al.,10 the musculotendinous junction was the bone tunnel. (Figure 2 Biceps tenodesis determined 25mm distal to the superior border above the bicipital groove, adjacent to the of the pectoralis major tendon and articular margin of the humeral head). approximately 20mm proximal to the lower border of the pectoralis major tendon. This is in line with a study by Denard et al.,10, which used the superior border of the bicipital In this study, the musculotendinous junction was groove as an effective landmark in performing approximately 27mm distal to the upper border tenodesis. In reference to this paper, the mean of the pectoralis major tendon and 12mm length of the biceps tendon from the labral origin proximal to the lower border of the pectoralis was at 25mm. Therefore, doing a tenotomy at the major tendon. The measurements obtained were level of the glenoid for tenodesis, which created a different from the abovementioned studies since 25mm bone socket, restored length-tension the specimens used were amputated above the relationship. As a result, a 23mm interference elbow that could have affected the values. For screw was used to allow for 2mm of the tendon this study, the cadaveric specimens included the to remain at the tip of the screw. The authors entire arm from the scapula to the hand. This further stressed the advantage of doing possibly helped us obtain more accurate tenodesis at this location. Based on the mean measurements. It showed that to restore the tendon length at this area, no tendon resection normal biceps length-tension relation, a was needed because the tendon's length from the subpectoral tenodesis should be performed labral origin was at 25mm. Therefore, doing a above the lower border of the pectoralis major tenotomy at the level of the glenoid for tendon, approximately 12mm proximal to the tenodesis, which created a 25mm bone socket, lower border of the pectoralis major tendon. For restored length-tension relationship. As a result, example, if a 10-15mm interference screw will a 23mm interference screw was used to allow for be utilized, 10 to 15mm of biceps tendon should 2mm of the tendon to remain at the tip of the be removed, and the tendon should be 12mm screw. The authors further stressed the proximal to the lower border of the pectoralis advantage of doing tenodesis at this location. major tendon (Figure 3). 18

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.004) Figure 2. Biceps tenodesis above the bicipital groove, adjacent to the articular margin of the humeral head. (A) The normal biceps tendon averages 25mm in length from its origin to the humeral head. (B) The tenotomy site (arrow) at the level of the glenoid. (C) a bone socket is created adjacent to the articular margin of humeral head, and the tendon is secured in this socket with a interference screw. As shown in the inset, allowing for 2mm of tendon to be at the tip of the screw, a 23 mm long interference screw at this location will maintain the length-tension relation of the biceps because the native tendon is 25mm long from its origin to this location of tenodesis. (PMT pectoralis major tendon). Figure 3. The proper location for a subpectoral tenodesis. (A) the musculotendinous junction (MTJ) of the long head of the biceps tendon is located beneath the pectoralis major tendon (PMT). The MTJ is approximately 27mm below the upper border of the PMT and 12mm above the lower border of the PMT. (B) The tenotomy site (arrow) at the level of the glenoid, and a proximal portion of the tendon is resected until there is only 15mm of tendon remaining above the MTJ. (C) A bone socket is created 12mm above the lower border of the PMT, and the tenodesis is performed at this location to maintain the normal position of the biceps tendon. As shown in the inset, a 12mm long interference screw at this location will allow for a small amount of tendon at the base of the screw and maintain the length-tension relation of the biceps This study also provided anatomic diameters of to 7mm diameter interference screw would be the biceps tendon at the labral origin measured appropriate at this level. at 6.44mm ± 1.76 with no difference seen by sex and laterality. Biomechanically, the smallest This study also demonstrated that there were no diameter screw was recommended.11 Taking into differences in tendon length and diameter at the mind the suture preparation of the biceps tendon labral origin across gender and laterality. This (whipstitch placement) slightly increased its was consistent in a study by Hussain et al.15 and diameter. In most cases, a 7 to 8mm diameter Denard et al.10 that showed no difference in interference screw was suitable when doing mean length of the long head of the biceps tenodesis at the proximal humerus. If no suture tendon between male and female specimens. preparation were done to the biceps tendon, a 6 Furthermore, this paper demonstrated a negative correlation between humeral length 19

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.004) and tendon diameter. A longer humeral length Disclosure Statement resulted in a decreased tendon diameter. The authors have no disclosures for this paper. The strength of this study was that it provided guidelines for surgeons regarding the amount of Conflicts of Interest tendon to be resected. It also demonstrated the ideal location for tenodesis, which would help in The authors of this paper declare no conflicting restoring the anatomic relationship of the biceps interest. tendon. This would be theoretically appealing since complications such as pain and fixation Acknowledgements failure were known complications after tenodesis. These can be ideally minimized if the This paper was supported by the University of length-tension relationship was regained. In Santo Tomas Hospital Department of addition, using the specimens that included the Orthopedics. We are thankful to Dr. Jeremy entire arm and scapula improved the James C. Munji who provided his expertise that measurements obtained in this study. Since greatly contributed the research. We are also Filipino cadaveric specimens were utilized, these grateful to the University of Santo Tomas College results were deemed applicable in the local of Rehabilitation Sciences for giving is the setting. Furthermore, this study will provide an opportunity to use their cadaveric specimens for in-depth explanation of how to perform biceps this research. tenodesis. It can help further broaden the knowledge of allied health professionals to help References in their practice. 1. Galasso O, Gasparini G, De Benedetto M, Familiari F, This study presented several limitations. The Castricini R. Tenotomy versus tenodesis in the tendon measurements may not apply to all cases treatment of the long head of biceps brachii tendon since histopathology reports were lesions. BMC Musculoskeletal Disorders. 2012;13: 205. undetermined. Moreover, the study did not consider tendon measurements after tendon 2. Boileau P, Baqué F, Valerio L, Ahrens P, Chuinard C, preparation that may affect the tendon diameter. Trojani C. Isolated arthroscopic biceps tenotomy or The small sample size is also a limitation. More tenodesis improves symptoms in pateints with massive cadaveric specimens must be included if another irreperable rotator cuff tears. The Journal of Bone & similar study will be conducted in the future. Joint Surgery. 2007; 89:747-757. CONCLUSION 3. Boileau P, Parratte S, Chuinard C, Roussanne Y, Shia D, Bicknell R. Arthroscopic treatment of isolated type II This study provided measurement guidelines SLAP lesions: Biceps tenodesis as an alternative to that could restore the natural length-tension reinsertion. The American Journal of Sports Medicine. relationship during biceps tenodesis in Filipinos. 2009; 37:929-936. A simple method to restore the normal length- tension relationship is to do tenodesis close to 4. Kelly AM, Drakos MC, Fealy S. Taylor SA, O’Brien SJ. the articular origin and by creating a bone socket Arthroscopic release of the long head of the biceps 25mm in depth. However, tenodesis at a more tendon: Functional outcome and clinical results. The distal location varies depending on the tendon American Journal of Sports Medicine. 2005; 33:208- length and depth of the bone tunnel. 213. Individual Author’s Contribution 5. Fleiss JL, Levin B, Paik MC. Statistical methods for rates and proportions. 3rd ed.New Jersey: John Wiley & C.V., C.T., P.L.; conceptualized the study, helped in Sons, Hoboken. 2013. drafting and revising study content, substantially contributed to design of work and acquisition of 6. Mukaka MM. A guide to appropriate use of correlation data, and helped in revision of content coefficient in medical research. Malawi Medical Journal: The Journal of Medical Association of Malawi. 2012; 24(3): 69-71. 7. Kovack T J, Idoine JD, Jacob PB. Proximal biceps tenodesis: An anatomic study and comparison of the accuracy of arthroscopic and open techniques using interference screws. Orthopaedic Journal of Sports Medicine. 2014; 2(2): 2325967114522198. 20

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.004) 8. Ozalay M, Akpinar S, Karaeminogullari O, et al. Mechanical strength of four different biceps tenodesis techniques. Arthroscopy. 2005; 21:861-866. 9. Richards DP, Burkhart SS. A biomechanical analysis of two biceps tenodesis fixation techniques. Arthroscopy. 2005; 21:861-866. 10. Denard, PJ, Dai X, Hanypsiak B T, Burkhart SS. Anatomy of the biceps tendon: implications for restoring physiological length-tension relation during biceps tenodesis with interference screw fixation. Arthroscopy. 2012; 28(10), 1352-1358. 11. Jarrett CD, McClelland WB Jr, Xerogeanes JW. Minimally invasive proximal biceps tenodesis: An anatomical study for optimal placement and safe surgical technique. Journal of Shoulder and Elbow Surgery. 2011; 20:477-480. 12. Slabaugh MA, Frank RM, Van Thiel GS, et al. Biceps tenodesis with interference screw fixation: A biomechanical comparison of screw length and diameter. Arthroscopy. 2011; 27:161-166. 13. Brasseur JL. The biceps tendons: From the top and from the bottom. Journal of Ultrasound. 2012; 15(1), 29-38. 14. Elser F, Braun S, Dewing CB, Giphart JE, Millet OJ. Anatomy, function injuries and treatment of the long head of the biceps brachii tendon. Arthroscopy. 2011; 27(4), 581592. 15. Hussain WM, Reddy D, Atanda A, Jones M, Schickendantz M, Terry MA. The longitudinal anatomy of the long head of the biceps tendon and implications on tenodesis. Knee Surgery Sports Traumatology Arthroscopy. 2015; 23(5),1518-1523. 16. Lafrance R, Madsen W, Yaseen Z, Giordano B, Maloney M, Voloshin, I. Relevant anatomic landmarks and measurements for biceps tenodesis. The American Journal of Sports Medicine. 2013; 41(6), 1395-1399. 21

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.005) Short Report Impact of COVID-19 Pandemic in Filipino Occupational Therapy Practice Across Regions Rod Charlie Delos Reyes1, Karla Czarina Tolentino1, Wendy Sy2 1Philippine Academy of Occupational Therapists, Inc., Philippines; 2University of Perpetual Help System JONELTA - Biñan, Philippines Correspondence should be addressed to: Rod Charlie Delos Reyes1; [email protected] Article Received: October 3, 2020 Article Accepted: November 30, 2020 Article Published: February 14, 2021 (online) Copyright © 2021 Delos Reyes et al. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract The Philippine Government has implemented community quarantine throughout the country to respond to the COVID-19 pandemic that has since profoundly affected the lives, health, and well-being of individuals, families, and communities. This has also created an impact on the practice of occupational therapy in the country as the pandemic presents occupational disruptions in the new normal. This paper summarizes the current conditions of the practice of occupational therapy in times of the unprecedented disaster highlighted by the COVID-19 crisis and the situation of practitioners and recipients of service across the regions of the country. Findings conclude that there are: (1) emerging delivery service patterns, (2) consequences of COVID-19 to therapists, and (3) insights moving forward. Keywords: COVID-19, occupational therapy, Philippines, chapters INTRODUCTION to occupy time and bring purpose and meaning to life.4 This is important because the core of In light of the worldwide spread of the occupational therapy practice is the task of coronavirus disease (COVID-19), the Philippine ensuring that everyone, from all walks of life government has aimed to mitigate its with different levels of ability and independence, socioeconomic and health impacts by declaring is able to perform and participate in meaningful different levels of community quarantine activities in the environment where they are in. throughout the country, all of which have significant consequences on the lives, health, and In the Philippines, the wide-scale impact of the well-being of Filipinos.1,2 The country’s pandemic becomes even more complex for community quarantine measures, which are persons with disabilities because of prevailing among the longest-lasting in the world,3 attitudinal, institutional, and environmental consisted of social distancing, cessation of the barriers. This prompted the Philippine Academy operations of non-essential institutions and of Occupational Therapists, Inc. (PAOT), as the entities, restrictions of any form of travel, among professional organization of occupational others. therapists in the country, to release in May 2020 the Board Resolution 2020-003 (or the Interim For occupational therapists in many parts of the Guidelines on the practice of Occupational world, this is an unprecedented time that Therapy amidst the Coronavirus Disease (COVID- evolves every day, and this may significantly 19) situation in the Philippines) to provide affect how people participate in their guidance and recommendations to its members occupations, or the activities that they do—as an individual, in families, and with communities— 22

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.005) and recipients of service to ensure the safety of anecdotes from some participants, and raw all while providing or receiving quality survey results. Because all findings are based occupational therapy services.5 In support of only on the submissions of each chapter, the data this, the chapters of the organization have been analyzed may not necessarily indicate the instrumental in disseminating information, prevailing situation across the entire nation and, upholding, enforcing, and monitoring practice as such, should be taken with caution. standards and ethics, as well as serving as linkages to regions outside Metro Manila, In this paper, a secondary analysis was utilized especially during these difficult times.6 to synthesize the overall impact of the COVID-19 pandemic with regards to the occupational This paper aims to synthesize all the therapy practice in the Philippines across information that has been gathered from the regions. To wit, secondary analysis is a cost- recognized and potential chapters across the effective and useful method when there is country in an effort to understand the overall already available data, such as summarized impact of the COVID-19 pandemic with regards reports.7 All these reports were compiled by the to the occupational therapy practice in the first author, and only the number of participants Philippines. was clarified with each chapter. The compilation was the sole set of data analyzed through PARTICIPANTS AND SETTING thematic analysis following the six-step process proposed by Caulfield: familiarization, coding, Currently, there are four recognized chapters generating themes, reviewing themes, defining and three potential chapters (organized groups and naming themes, and writing up.8 The first of occupational therapists in a region applying and last authors conducted independent coding for official recognition from PAOT). In this paper, and the generation of preliminary themes. All both recognized and potential chapters are participated in the finalization of the themes to considered as PAOT chapters. Information ensure rigor. gathering was done during July 2020, four months after the implementation of community Table 1. Participants of the Remote Surveys and Online quarantine in different areas of the country. Discussions More than a third of the participants are practicing in pediatrics based on the data Chapter Online Online analyzed. Survey Discussions Central Luzon 35 * APPROACH Central Visayas 3 * Mindanao 7 * Upon the approval of the PAOT Board of National Capital Region 18 19 Directors, the Committee on Chaptership tasked Southern Tagalog 17 15 each PAOT chapter to assess its members on the Western Visayas 3 8 impact of COVID19 through remote surveys and *No discussion was done online discussions. Questions such as, but not limited to, “What are the impact of COVID-19 on their lives and service recipients?”, “How was the experience of service delivery during the pandemic?” and “How do they see their future after the pandemic?” guided their surveys. It was ensured that all participants were asked for verbal or written consent before participating in each survey as it was assured that participation is voluntary and would not affect standing with PAOT. Each chapter was asked to submit reports with no strict format or template, which included summarized narratives of their surveys, 23

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.005) FINDINGS burdened with other responsibilities outside of direct patient care. Three themes emerged: (1) Emerging service delivery service patterns, (2) Consequences of Another major source of worry for many COVID-19, and (3) Moving forward (see Table 2). participants is the risks associated with in- person therapy services. Although rehabilitation Emerging Service Delivery Patterns professionals are considered as essential healthcare workers or front-liners,10 therapists Shift to Teletherapy. The ongoing worldwide who are working in private clinics are not crisis has made Filipino occupational therapists compensated with hazard pay. In addition, there abruptly shift to teletherapy, an action made by are still no definitive guidelines published by necessity and not by choice. Teletherapy is a PAOT or any government agency for a safe service model that has been utilized in other return to private therapy centers, which left countries since the late 1990s but was an many clinic owners and managers scrambling to unpopular mode of service delivery in the come up with their own protocols to support Philippines even before the pandemic. For many clinic-based practice. Adding to the confusion is Filipino occupational therapists, teletherapy has the unclear standards for therapy centers to re- its appeal (subtheme 1.1) and drawbacks open, as local government units have (subtheme 1.2) (see Table 3). implemented varying policies when it comes to health and safety protocols. This makes it New Normal in the Clinical Setting. For some difficult for clinic owners and managers to find participants who resumed face-to-face therapy and utilize a model to help comply with these sessions in clinics, hospitals, and other facilities, standards. they also had to make adjustments with their practice delivery. Health sectors and companies Threats to Practice. Before the pandemic, there had to look into the redesign and construction of were some individuals that can be identified as facilities to encourage air circulation, training of pseudo-professionals, who have represented healthcare workers on infection prevention and themselves as legitimate therapists without the control, sourcing of personal protective necessary educational background and clinical equipment (PPE), and the optimal settings for training required to practice occupational care delivery and how it is reimbursed (e.g. therapy. Unfortunately, there have been more online and mobile payments).9 But even with reports of pseudo-professionals surfacing in the these precautions, a majority of the participants provinces and rural areas during these times, expressed anxiety and uncertainty on the levels where the public may not have access to of safety at work, especially for those who have information that can protect them from children or elderly parents at home and are also Table 2. Impact of COVID19 in Philippine Occupational Therapy Practice Theme 1: Emerging Service Delivery Patterns 1.1 Shift to Teletherapy 1.2 New Normal in the Clinical 1.3 Threats to Practice Setting 1.1.1 Benefits 1.1.2 Obstacles Theme 2: Consequences of COVID-19 to Therapists 2.1 Decreased Financial 2.2 Rising Mental Health 2.3 Activity Engagement as a Coping Security Concerns Mechanism Theme 3: Moving Forward 3.1 Challenges and Opportunities 3.2 Professionals in the Future 24

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.005) Table 3. Benefits and Obstacles of Utilizing Teletherapy in the Philippines 1.2 Obstacles 1.1 Benefits • An ideal way to deliver care without • Described as hectic, draining, and a struggle endangering patients and their caregivers • The lack of available and skilled caregivers • Allows for treatment within a service at home recipient’s natural environment • Increased demand to plan and create or • Increases parental or caregiver satisfaction search for all activity materials needed for a session ahead of time • Increases family involvement • Preparations before sessions are • Effective therapy option for specific challenging and time-consuming populations • Concerns on of internet connection and availability of gadgets • Additional costs for some clients and their families fraudulent practices. They have become a more causing COVID-19 and how it affects the body, it common choice for service recipients because is common for everyone to experience increased they offer cheaper rates. However, they do not levels of distress and anxiety12,13 Occupational guarantee effective and evidence-based disruptions are inevitable, causing added intervention and only pose an alarm to the anxiety, stress, and strain physically as well as health and safety of the public that they attempt mentally.14 A number of participants have to serve. experienced, and are still experiencing, various degrees of emotional distress over the transition Consequences of COVID-19 to Therapists from in-person therapy to teletherapy. Aside from the exhaustion and screen fatigue, which is Decreased Financial Security. The majority, if very common for health practitioners offering not all, participants shared that they were online services,15,16 some have experienced eventually forced to downsize their lifestyles and difficulty in accepting or adjusting to the re-evaluate their financial priorities, or to go transition because they believed that the back to being dependent on their families community restrictions, and the pandemic itself, because of lack of work. Most of the participants were temporary. This, in itself, is also already a were consultants before the pandemic who were traumatizing event for service recipients as the paid per therapy session, and many of them do transition to the new normal was not anticipated not have the same financial benefits that at all.16 employees enjoy, such as health insurance and fixed monthly income. This meant additional There are also concerns about the inevitably financial burden when it comes to COVID-19 delayed career and life plans, which may cause testing and possible hospitalizations if they what is called a career shock or loss in direction contract the virus, special transportation when it comes to a career.14,18 Generally, expenses (because cheaper public transportation disruption to an early career path have is limited), and purchasing the needed PPE for significant career consequences for the next work.11 To augment their income, some several years.17,18 Nevertheless, the sudden participants have gone into other ventures, such change in employment (including as opening home-based and retail businesses, unemployment) coupled with the broader creating therapy and educational materials for societal and political changes that are currently sale, or even entering an unrelated industry happening in the country have made the altogether. participants re-examine either their career trajectories or life aspirations. Rising Mental Health Concerns. Because not much is known about the novel coronavirus 25

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.005) Finally, while some participants praise the other regions to provide a more enriching and Philippine government’s efforts to contain the contextualized experience. COVID-19 outbreak, a number of participants have grown dissatisfied with the heavy-handed Furthermore, the rising mental health issues of approach and contradicting statements from the practitioners should be addressed promptly country’s leaders. News reports of systemic since it can affect their service delivery and corruption in different government agencies,19 overall well-being. Creating a platform that can the apparent lack of transparency from the provide mental health response and support to health sector,20 and the lack of active response members, and a concrete plan to solve the other than to wait for a vaccine have culminated growing number of employment changes are two into a general sense of hopelessness for the windows of opportunities that the organization coming months. can look into to alleviate the burdens that therapists are currently facing. Activity Engagement as a Coping Mechanism. Without a doubt, the direct and indirect Finally, while one of PAOT’s mandates is to serve psychological and social effects of the COVID-19 its members and stakeholders, non-members pandemic are pervasive and could have lasting and newly licensed occupational therapists effects on a person’s mental health now and in should also be included in the discussions the future. For some participants, this is a time because the pandemic experience is universal for them to take a break and spend more time and social connections are all the more with their family due to the decreased workload important at this time. It has been suggested that and to explore new hobbies and interests. There PAOT revitalize its membership campaigns and are several participants who shared that they to make membership to the organization more have turned to their faith — by participating in approachable and inclusive. online religious services, among others — to cope with the trauma and distress brought about Professionals in the Future. As the Philippines by the pandemic, which research has shown to continues on its eight-month community be an important coping mechanism.21 As quarantine, Filipino occupational therapists face occupational therapists, they are aware that a daunting task to rise above obstacles and even when confined and isolated, people still explore unfamiliar and potential roles that do need to engage in a routine that includes being not only involve direct patient care. Because of physically active, having fun, staying in contact the physical restrictions, the COVID-19 pandemic with other people, and limiting media has opened up opportunities for practitioners to consumption in order to reduce stress and navigate the virtual environment, so some nourish emotional well-being.20,21 participants continue to view the situation as a challenge to learn something new, rediscover Moving Forward their strengths, and reflect on their passions. One participant shared that the true value of an Challenges and Opportunities. Being at the occupational therapist—rooted in creative forefront of the profession in the country, PAOT thinking and problem-solving—is being tested has been called to act on the current situation by during a prolonged crisis such as this ongoing strengthening its stand on teletherapy and pandemic, and they are hopeful that a new breed developing guidelines to enable standardization of occupational therapists will emerge. and assurance of safe and quality service delivery. Aside from this, participants have REFLECTIONS AND CONCLUSIONS appealed to PAOT to promote teletherapy more as a valid and effective mode of service delivery This paper explored the limited data from in order to address the demand for accessible Filipino occupational therapists who are therapy services. Many participants have also practicing in different regions of the country. expressed that continuing education Because of the pandemic, changes in care opportunities be given online. However, some delivery appear to have significant effects on have suggested that more comprehensive both the practitioners and the recipients of workshops be given, rather than lectures, to service—from its service delivery and the facilitate skill-building; and to get experts from 26

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.005) providers in varied aspects of their engagement and revising critically, approval of the version to in daily life to the future direction of the practice. be submitted for publication, and accountable for most aspects of the work; K.C.T.: acquisition, The first theme discusses teletherapy as the analysis, and interpretation of work, drafting the emerging mode of service delivery in lieu of work and revising critically, approval of the traditional face-to-face therapy. Despite the version to be submitted for publication, and guidelines released by PAOT, teletherapy has accountable for most aspects of the work; W.S.: been received with hesitation and uncertainty. analysis, and interpretation of work, drafting the This suggests that there is still room for further work and revising critically, approval of the development of this delivery model, through version to be submitted for publication, and research and contextual analysis, to better suit accountable for most aspects of the work. the context of Philippine healthcare. Likewise, with the transition to the new normal, Disclosure Statement traditional therapy practice must also undergo adjustments in order to better fit the new The first two authors are members of PAOT’s environment. This introduces a challenge to Committee on Chaptership, while the last author adjust and improve already established aspects is a regular member of PAOT. The views of the healthcare practice, such as the expressed in this paper do not reflect the general educational or training process, the licensure position or opinion of the organization. process, and the monitoring of care, just to name a few. The second theme discusses the consequences of Funding the pandemic on occupational therapy practice and its practitioners. While practitioners and the No funding agency supported the completion of general populace alike are both similarly this paper. affected by the pandemic, practitioners have the added obligations to provide frontline services at References the cost of their physical and mental health. Emphasis was placed by the participants on the 1. World Federation of Occupational Therapists. Public mental health strain they have experienced due Statement - Occupational Therapy Response to the to the stress of adaptation to the new COVID-19… | WFOT. 2020. Available from: environment, as well as of overall job security. https://wfot.link/covidpublic This prompts PAOT to create and prioritize plans that address these concerns to protect and care 2. World Health Organization. 100 days of COVID-19 in for its members and their recipients of care. the Philippines: How WHO supported the Philippine response. 2020. Available from: The third theme describes the windows of https://www.who.int/philippines/news /feature- opportunities from the perspective of the stories /detail/100-days-of-covid-19-in-the- participants that may guide the organization in philippines-how-who-supported-the-philippine- responding to the changes brought about by the response new normal. Occupational therapy is still a growing profession, and it continues to develop 3. The Economist. The Philippines’ fierce lockdown drags according to the needs of the populations that it on, despite uncertain benefits. 2020. Available from: serves while staying true to its foundation: to https://www.economist.com/asia/2020/07/11/the- promote health and well-being through philippines-fierce-lockdown-drags-on-despite- meaningful engagement for everyone from all uncertain-benefits walks of life. 4. American Occupational Therapy Association. The Role Individual Author’s Contributions of Occupational Therapy: Providing Care in a Pandemic. Aota.org. 2020. Available from: R.C.D.: conception of work, acquisition, analysis, https://www.aota.org/Advocacy-Policy/Federal-Reg- and interpretation of work, drafting the work Affairs /News/2020/OT-Pandemic.aspx 5. Carandang K, Medallon K, Mallari J, Tan-Ibanes V, Roderos K, Luib D et al. Interim Guidelines on the Practice of Occupational Therapy amidst the Coronavirus Disease (COVID-19) situation in the Philippines. Wfot.org. 2020. Available from: https://www.wfot.org/assets/resources/PAOT- Interim-Guidelines-on-the-Practice-of-OT-amidst-the- COVID-19-situation.pdf 27

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.005) 6. Isaac C. Guidelines on the institution and governance of 19. Malindog-Uy A. Corruption Amid A Pandemic OTAP Chapters. PAOT; 2005. [Internet]. The ASEAN Post. 2020 [cited 18 September 2020]. Available from: 7. Cheng H, Phillips M. Secondary analysis of existing https://theaseanpost.com/article/corruption-amid- data: opportunities and implementation. pandemic 2014;26(6):371-375. 20. Bayod R. Ethics of care and Philippine politics during 8. Claulfield J. How to Do Thematic Analysis | A Step-by- the COVID-19 outbreak. Eubios Journal of Asian and Step Guide & Examples. Scribbr. 2020. Available from: International Bioethics. 2020;30:69-76. Available from: https://www.scribbr.com/methodology/thematic- https://www.eubios.info/EJAIB42020.pdf analysis/ 21. Goodman B. Faith in a time of crisis. 9. Baur A, Georgiev P, Munshi I. Preparing for the next https://www.apa.org. 2020. Available from: normal after COVID-19. McKinsey & Company. 2020. https://www.apa.org/topics/covid-19/faith-crisis Available from: https://www.mckinsey.com/industries/healthcare- systems-and-services/our-insights/healthcare- providers-preparing-for-the-next-normal-after-covid- 19# 10. Keiser University. COVID-19: The Forgotten Frontline Workers - Keiser University. Keiser University. 2020. Available from: https://www.keiseruniversity.edu/covid-19-the- forgotten-frontline-workers/ 11. American Hospital Association. Hospitals and Health Systems Face Unprecedented Financial Pressures Due to COVID-19. 2020. Available from: https://www.aha.org/system/files/media/file/2020/ 05/aha-covid19-financial-impact-0520-FINAL.pdf 12. Malindog-Uy A. COVID-19 Impact On Mental Health Of Filipinos. The ASEAN Post. 2020. Available from: https://theaseanpost.com/article/covid-19-impact- mental-health-filipinos 13. Hu Z, Lin X, Chiwanda Kaminga A, Xu H. Impact of the COVID-19 Epidemic on Lifestyle Behaviors and Their Association With Subjective Well-Being Among the General Population in Mainland China: Cross-Sectional Study. Journal of Medical Internet Research. 2020;22(8):e21176. Available from: https://www.jmir.org/2020/8/e21176/ 14. American Psychiatric Association Foundation. Working Remotely During COVID-19: Your Mental Health & Well-Being. Workplacementalhealth.org. 2020. Available from: http://www.workplacementalhealth.org/getmedia/fd 8a9b98-b491-4666-8f27-2bf59b00e475/Working- Remotely-During-COVID-19-CWMH-Guide 15. Wilser J. The New York Times. 2020. Available from: https://www.nytimes.com/2020/07/09/well/mind/t eletherapy-mental-health-coronavirus.html 16. Zeavin H. Therapists Are Doing Sessions in Locked Bathrooms While Patients Call in From Their Cars. Slate Magazine. 2020. Available from: https://slate.com/technology/2020/04/therapy- coronavirus-telemedicine.html 17. Akkermans J, Richardson J, Kraimer M. The Covid-19 crisis as a career shock: Implications for careers and vocational behavior. Journal of Vocational Behavior. 2020;119(103434). Available from: https://www.sciencedirect.com/science/article/pii/S0 001879120300592?via%3Dihub 18. Rudolph C, Zacher H. COVID-19 and careers: On the futility of generational explanations. Journal of Vocational Behavior. 2020;119(103433). Available from: https://www.sciencedirect.com/science/article/abs/p ii/S0001879120300580?via%3Dihub 28

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.006) Short Report A Literature Review on the Facilitators and Barriers to the Uptake of Interprofessional Collaboration in the Field of Assistive Technology within Rehabilitation Medicine Daryl Patrick G. Yao1, Kenneth Matthew B. Beltran2, Treisha Naedine H. Santos3, Dr. Kaoru Inoue1 1Department of Occupational Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan; 2Skill Builders Therapy Services Corp., Manila, Philippines; 3College of Allied Medical Professions, University of the Philippines - Manila, Manila, Philippines Correspondence should be addressed to: Daryl Patrick G. Yao1; [email protected] Article Received: October 20, 2020 Article Accepted: December 12, 2020 Article Published: February 14, 2021 (online) Copyright © 2021 Yao et al. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Assistive technology (AT) enables an optimized life for persons with disability through the scaffolding of functional capabilities. However, AT provision faces challenges such as long approval processes, funding inadequacies, and difficulties integrating evidence into practice. A means to address these issues is through interprofessional collaboration (IPC), the process by which health professionals efficiently coordinate and work with each other towards a common goal to maximize limited resources. To promote its effective implementation, there is a need to know the facilitators and barriers that affect its implementation. Thus, this paper aims to review the facilitators and barriers to the uptake of IPC in the field of AT within rehabilitation medicine identified by existing literature. This literature review followed the steps outlined by The Model Systems Knowledge Translation Center. Articles published between January 2000 until September 2019 were retrieved from four electronic databases (Cochrane Library, PubMed, Scopus, Science Direct). Three studies were included in the study. Facilitators identified were: (1) optimal work culture, (2) professional competence, and (3) associating with team members. Barriers to effective IPC in the field of AT were identified as: (1) presence of professional silos, (2) lack of unified language, and (3) gaps in bureaucratic support. The mechanisms and factors in implementing interprofessional collaboration identified by the World Health Organization are vital in the field of AT. However, the barriers identified above need to be addressed to promote the uptake of IPC within this specialized field. Keywords: Collaborative practice; clinical setting; assistive product, service delivery INTRODUCTION Additionally, there are instances where health professionals recommend numerous and Assistive technology (AT) is any product used to conflicting types of AT to end-users. This greatly prevent, replace, or improve the functional impacts AT users in developing countries, where capabilities of persons with disabilities (PWDs) AT acquisition is typically an out-of-pocket to enable participation in daily life.1 AT expense by the user and their family.6 facilitates one’s ability to achieve well-being and Stakeholders need to decide and prioritize what allows for an equitable life.2,3 The World Health they perceive to be the most necessary of AT, Organization has supported the positive impact often with conflicting priorities or without the of AT on the health and well-being of a person guidance of the health professionals, thereby and their family, as well as broader limiting ideal performance. socioeconomic benefits.4 Despite these positive outcomes, AT provision is hindered by numerous A means to address these issues is through the factors. In Germany, AT providers and PWDs practice of interprofessional collaboration (IPC). experienced difficulty due to bureaucratic IPC occurs when health professions from various burden and long AT approval processes.5 29

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.006) backgrounds and specializations, together with Science Direct). Search combinations were stakeholders, work together as a team to deliver connected by Boolean operators and were the highest level of quality care.7 A greater formulated by using alternative terms and understanding of IPC will contribute towards wildcards of the following key terms: Assistive developing “flexible health workforces that Technology, Collaboration, and Rehabilitation enable local health needs to be met while (see Table 1). maximizing limited resources”.7 Table 1. Alternate Terms AT selection should be done with a team of professionals and consultants trained to match Assistive Collaborat* Rehabili* an AT to specific needs.8 Moreover, IPC has been found to optimize the AT prescription process.9 Technolog* Thus, there is a need to know the facilitators and barriers that affect the implementation of IPC. Assistive Product Cooperat* Knowing these facilitators and barriers will guide clinicians and organizations towards the Assistive Device Partnership first step to effectively implement an IPC-ready program within an institution. This paper aims Alliance to review the facilitators and barriers to the uptake of IPC in the field of AT within Data Collection. The search yielded 270 articles rehabilitation medicine identified by existing for screening (see figure 1). When there were literature. concerns about whether an article met the inclusion criteria, the team convened for METHODOLOGY deliberation. Data extracted from the articles that met the inclusion criteria were the title, This literature review was conducted using the authors, year published, country, research design, process outlined by The Model Systems team members, facilitators, and barriers. Knowledge Translation Center.10 Steps include (a) selection criteria, (b) search strategy, (c) data collection, (d) displaying data, and (e) analysis and synthesis. Selection Criteria. Inclusion criteria are as Figure 1. Search Process follows: (1) IPC done by a health professional with health or non-health professional/s or organization to create, select, acquire, train, or maintain an AT device used by a client, (2) all types of studies that discuss the actual process done in collaboration with other professionals, (3) published studies with electronic copy accessible from the internet, (4) studies published between January 2000 to September 2019, and (5) are published in the English Language. Exclusion criteria are as follows: (1) the use of rehabilitative devices which are used only as part of clinical treatment, (2) collaboration done in the process of formal education on a hypothetical client, and (3) editorials and commentaries. Search Strategy. Articles were independently searched and retrieved from four electronic databases (Cochrane Library, PubMed, Scopus, 30

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.006) Displaying Data. Three studies, which engage in IPC. In a study by Malinowsky and documented both facilitators and barriers to colleagues, the collaboration between collaboration, were included in the study. Four occupational therapists and assistant nurses studies were excluded due to the inability to were influenced by their varying understanding obtain full-text articles. The data gathered are of PWDs, which cascaded to their respective summarized in Table 2. approach to supporting the use of ATs.11 Additionally, possessing preliminary Analysis and Synthesis. Identified facilitators comprehension of ATs also assisted and barriers along with the features documented professionals in clarifying the use of ATs to in Table 2 were clustered according to their PWDs and their significant others, as well as common features via a free spreadsheet justifying the practical usability and necessity of program. Themes were then formulated from the ATs to other professionals11. Awareness of one’s clustered codes. role and other professions’ role in assessing and addressing a patient’s healthcare needs is a core RESULTS competency for effective collaboration.13 Facilitators. Three clusters from six codes were The use of a model for knowledge translation identified as facilitators towards IPC in the field can help professionals share a common of AT within the rehabilitation medicine (see understanding and language, not just among Table 3 for an overview). Notably, all facilitators professionals but also with the end-users of AT identified were congruent to that of the devices11. Providing practitioners with “a way of mechanisms and competencies necessary in thinking” can help them deliberate about ways to IPC.7,13 Findings are expounded in the translate their knowledge into practical use in subsequent sections. terms of designing interventions that support the use of AT.11 Optimal Work Culture. Effective communication strategies and shared decision-making were Sense of Team Membership. An opportunity for identified as facilitators9, which are in line with health workers to interact with other the mechanisms identified by WHO to stimulate professions and capacitate each other in their IPC.7 As many professionals are involved, respective professions lays the foundation for conflicting goals and differing perspectives are IPC.7 IPC entails incorporating multiple often observed.14 To address this issue, there is a perspectives across different professions to yield need to optimize the work culture through novel and holistic solutions to address complex practicing effective, consistent, and clear healthcare needs.11-2 Thus, recognizing the communication strategies between knowledge and experience of another health professionals, to share each professional’s professional is beneficial in identifying and perspective on the necessary characteristics providing the ideal AT device and to the end- needed from the AT by the user as determined users.9,11 by their specific needs, and to conglomerate to decide on a singular goal in relation to AT Barriers. Three clusters from five codes were provision.9 identified as barriers towards IPC in the field of AT within rehabilitation medicine. The barriers Professional Competence. As AT is a specialized identified below possess a compounding effect field with constant development, high wherein issues affecting AT service delivery, and expectations are embedded among challenges on the application of IPC in general professionals, necessitating the advancement of may influence one another; leading to complex new knowledge geared towards both AT and IPC. problems.15-18 Findings are expounded in the This knowledge is vital if one is to share subsequent sections. information and collaborate with other professionals.9,11-12 An understanding of the Silo mentality. The study by Malinowsky and practical use and applicability of an AT, as well colleagues captured the compartmentalization as the role of other stakeholders involved, may and the lack of shared accountability among impact a health professional’s inclination to professionals, as exemplified by one participant pointing out that AT prescription and follow-up 31

PJAHS • Volume 4 Issue 2 2021 • Table 2. Summary of Included Studies Title Advantages and disadvantages of An approach to fa Authors interdisciplinary consultation in the professionals rea prescription of assistive technologies for technology use in mobility limitations9 persons with dem de Laat FA, van Heerebeek B, van Netten JJ. Malinowsky C, Ro Year 2018 2013 Published Netherlands Sweden Country Research Cross-sectional study Grounded Theory Design Comparative Ana Team composition Technician: Occupational The prosthetist, orthotist, pedorthist or Assistant Nurses Facilitators orthopedic (shoe) technician Nurse identified Prescriber: Assistant Officer Rehabilitation specialists, orthopedic Barriers surgeons, vascular surgeons, others. identified ⚫ Clear communication rules ⚫ Shared know ⚫ Obtaining ne ⚫ Shared decision-making ⚫ Different fun ⚫ Shared knowledge of diagnosis and PWDs, whic device support the ⚫ Recognizing the knowledge and experience of the AT prescriber and AT technician ⚫ Poor Chemistry among professionals ⚫ Problems in ⚫ Planning problem (time efficiency) other ⚫ Reimbursement issues ⚫ Different foc ⚫ Non-adequate location for try-outs among profe ⚫ Differing vie responsible problems 32

• (doi:10.36413/pjahs.0402.006) acilitate healthcare Interdisciplinary development of manual and adiness to support automated product usability assessments for n everyday life for older adults with dementia: lessons learned12 mentia11 Boger J, Taati B, Mihailidis A. osenberg L, Nygård L. 2015 Canada y with Constant Reflection alysis erapists ⚫ Engineers s ⚫ Computer Scientists, ⚫ Human Factors Expert ⚫ Rehabilitation Scientist ⚫ Statistician ⚫ Clinical Research Assistants wledge and information ⚫ Careful Planning ew knowledge and tools ⚫ Familiarity with team members nds of knowledge about ⚫ Development of a shared understanding ch together could ⚫ Appreciation of significant outcomes use of AT… from multiple perspectives n understanding each None mentioned cuses of technology essions ews about who is for solving the client’s 2

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.006) is not a part of their responsibilities11. The education will promote more effective and participant, however, claimed that although AT efficient collaborative relationships.16 Attitudinal prescription is not within their immediate and administrative changes through the pursuit responsibility, they still communicate problems of professional development in terms of AT and surrounding AT with the occupational therapist. IPE, as well as equipping future professionals This sense of unequal accountability on the with core competencies of IPC is recommended. stakeholder’s optimal health can negatively affect service delivery as it perceives the patient As a lack of unified language impedes IPC in AT according to the different problems rather than provision, the International Organization for holistically. Standardization (ISO) released a classification and terminology of AT and products. At present, Lack of a Unified Language. The lack of a the most updated version is ISO 2016:9999.1 standardized and shared language can greatly However, contrary to its intention to unify the affect collaboration between professionals.9 language, it is a paid document, thereby limiting Interpretation of professional language poses a its accessibility. To strengthen IPC in AT challenge to the other members of the team, provision, there is a need for professionals to affecting the efficiency and interaction among have opportunities to be educated on a shared professionals and collaboration on goal setting.14 language. It is recommended for organizations to Additionally, terminologies for AT are exert further initiative to implement this on an inconsistent, leading to further difficulties in institutional scale through primer courses. communication and translating evidence into practice.20 In relation to a unified language, there is also a need for an internationally recognized standard Gaps in Bureaucratic Support. There are in AT provision. de Witte and colleagues notable difficulties arising from IPC within AT recommended the establishment of such to provision, such as logistical, administrative, and promote high-quality, accessible, and affordable financial impairments, exemplified by the need AT.21 They propose that a standardized method for adequate reimbursement processes and provides data that can be used to assess policy redundancy, among others.9 De Laat and impact and assessment. With an internationally colleagues proposed performing shared recognized process, the AT provision process is evaluation procedures and improving record optimized, leading to the promotion of storage and retrieval system by using digital professional cooperation, client-centeredness, means to address the challenges they identified9. and the use of pre-intervention strategies, which However, reimbursement issues are harder to can potentially impact the AT service needed. address, as these involve policy changes. Additionally, it is recommended to enact DISCUSSION organizational changes by utilizing the virtual context in data management and communication The studies provided a glimpse of the facilitators and optimizing service by removing redundant and barriers that influence the uptake of IPC in procedures to maximize limited resources. the field of AT within rehabilitation medicine. These facilitators must be utilized, while barriers Recommendation for further research. must be minimized in order to pursue ideal AT Further research regarding IPC in the context of service provision. AT is recommended to explore the extent of influence of each factor. Subjective accounts on A means to achieve this is by establishing a the experiences of major stakeholders, especially mindset early on by integrating interprofessional from differing cultures without established education (IPE) into existing curricula. IPE medical and social insurance schemes, also prepares professionals to collaborate and necessitates exploration. interact with colleagues while maintaining their identity during service delivery. This is in line Limitations. As the alternative terms were with the recommendations of Frenk and unilaterally agreed upon by the authors, there colleagues, who suggest that a reformation of may have been some lapses in identifying key terms. Furthermore, critical appraisal of retrieved articles was not done as it is beyond 33

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.006) the established scope of the review. Articles that References: were irretrievable due to limited resources might have also provided more information. A 1. International Organization for Standardization. ISO list of such articles is provided in the Appendix. 2016:9999. Assistive products for persons with disability — Classification and terminology. Geneva: CONCLUSION ISO; 2016 AT is a major healthcare component hindered by multiple factors, remediable with the application 2. Cook AM, Miller-Polgar J. Assistive Technologies: of effective IPC. Optimal work culture, Principles and Practice. 4th ed. St. Louis: Mosby; 2015. professional competence, and a sense of 496 p. membership will facilitate and optimize the synergy of AT and IPC. Efforts should be made to 3. United Nations. Convention on the Rights of Persons limit the influence of barriers, such as the lack of with Disabilities. New York: United Nations; 2006. 31 unified language, a silo mentality, and the gaps in p. bureaucratic support. Nonetheless, the retrieved studies have shown that the influence of IPC in 4. World Health Organization. Assistive technology. the field of AT justifies the need for further Switzerland: World Health Organization; 2018. research to identify ideal systems for efficient AT Available from https://www.who.int/news-room/fact- service delivery. sheets/detail/assistive-technology Individual author’s contributions 5. Henschke C. Provision and financing of assistive DPGY searched, analyzed, and wrote the paper; technology devices in Germany: A bureaucratic KMBB searched, analyzed, and co-wrote the odyssey? The case of amyotrophic lateral sclerosis and paper; TNHS searched, analyzed, and co-wrote Duchenne muscular dystrophy. Health Policy. the paper; KI Supervised the research providing 2012;105:176-84. critical discourse and arguments during analysis process. 6. Tanudtanud-Xavier CA. Issues and challenges in the provision of mobility devices in the Philippines. In: Disclosure Statement Purves S, Shamay-Lahat O. Joining Hands: Sharing The authors have nothing to disclose. This work Good Practice in Rehab Between the Western Pacific was not funded by any agencies/ organizations WHO CCs. 2013 Jun;(4):1-15. Available from http://www.rehab.go.jp/english/whoclbc/doc/Joining Conflicts of interest Hands4.pdf All authors declare no conflict of interest. 7. World Health Organization. Framework for action on Acknowledgment interprofessional education and collaborative practice. We would like to acknowledge the 2nd Asia- Switzerland: World Health Organization; 2010. Pacific Interprofessional Education and Available from Collaboration Conference and its organizers for https://www.who.int/hrh/resources/framework_actio providing us the venue to share the results of n/en/ this endeavor. 8. Assistive Technology Industry Association. What is AT? Supplementary Material Chicago: Assistive Technology Industry Association. Supplementary Material A. Appendix 2019. Available from https://www.atia.org/at- resources/what-is-at/ 9. De Laat FA, van Heerebeek B, van Netten JJ. Advantages and disadvantages of interdisciplinary consultation in the prescription of assistive technologies for mobility limitations. Disability and Rehabilitation: Assistive Technology. 2018;14(4):386-90 10. Model Systems Knowledge Translation Center. A Guide for Developing a Protocol for Conducting Literature Reviews. Washington: Model Systems Knowledge Translation Center; nd. Available from https://msktc.org/lib/docs/KT_Toolkit/MSKTC-Tool- Dev-SR-Prot-508.pdf 11. Malinowsky C, Rosenberg L, Nygard L. An approach to facilitate healthcare professionals readiness to support technology use in everyday life for persons with dementia. Scadinavian Journal of Occupational Therapy. 2013;21(3):199-209 12. Boger J, Taati B, Mihailidis A. Interdisciplinary development of manual and automated product usability assessments for older adults with dementia: 34

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.006) lessons learned. Disability and Rehabilitation: Assistive Technology. 2015;11(7):581-7 13. Interprofessional Education Collaborative Expert Panel. Core competencies for interprofessional collaborative practice. Washington: Interprofessional Education Collaborative; 2011 14. Atwal A, Caldwell K. Do multidisciplinary integrated care pathways improve interprofessional collaboration? Scandinavian Journal of Caring Sciences. 2002;16:360-7 15. Hoogerwerf EJ. Report: Global challenges in assistive technology-2. Italy: Association for the Advancement of Assistive Technology in Europe; 2015 16. Frenk J, Chen L, Bhutta ZA, Cohen J. Crisp N, Evans T, et al. Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. Lancet. 2010;376(9756):1923-58 17. Paul S, Peterson CQ. Interprofessional collaboration: Issues for practice and research. Occupational Therapy in Health Care. 2002;15(3-4):1-12. 18. Supper I, Catala O, Lustman M, Chemla C, Bourgueil Y, Letrilliart L. Interprofessional collaboration in primary health care: A review of facilitators and barriers perceived by involved actors. Journal of Public Health (Oxford). 2015;37(4):716-27 19. Clark KM. Interprofessional education: Making our way out of silos. Respiratory Care. 2018;63(5):637-9. 20. Friesen EL, Theodoros D, Russell TG. Assistive technology devices for toileting and showering used in spinal cord injury rehabilitation – A comment on terminology. Disability and Rehabilitation: Assistive Technology. 2014;11(1):1-2 21. De Witte L, Steel E, Gupta S, Ramos VD, Roentgen U. Assistive technology provision: towards an international framework for assuring availability and accessibility of affordable high-quality assistive technology. Disability and Rehabilitation: Assistive Technology. 2018;13(5):467-472 35

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.007) Short Report A Rapid Literature Review on the Strategies for Collaboration Between Occupational therapists and Speech-Language Therapists in the Field of Augmentative and Alternative Communication Daryl Patrick Yao1, Ghislynne Dei-Anne Andaya2, Kaoru Inoue1 1Department of Occupational Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan; 2 Able Center, Inc., Makati, Philippines Correspondence should be addressed to: Daryl Patrick Yao1; [email protected] Article Received: December 4, 2020 Article Accepted: December 28, 2020 Article Published: February 14, 2021 (online) Copyright © 2021 Yao et al. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract An alternative and augmentative communication (AAC) device replaces or supplements a person’s natural speech. Speech-Language Pathologists (SLPs) collaborate with a team of healthcare professionals in the process of identification and use of the right AAC device for a person with complex communication needs (CCN). In the Philippines, occupational therapists (OTs) and SLPs are more likely to collaborate in the treatment of their clients due to their interprofessional education (IPE) experience. However, most Filipino SLPs do not engage in interprofessional collaboration (IPC) when rendering AAC services. Thus, there is a need to identify existing literature that tackles collaborative practices to raise the quality of service and care. Hence, this study aimed to identify and discuss existing literature that documented IPE and IPC strategies between OTs and SLPs in the field of AAC. The structure of this literature review was guided and adapted from the topics outlined in the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Literature archived in two databases (Pubmed and Scopus) were reviewed. Two articles out of five studies were included in this review. Strategies found were “case based learning approach” for post-graduate students and the “Beyond Access model” in supporting practitioners. In conclusion, there is a dearth of literature on IPC practices among OTs and SLPs in the field of AAC. There is a need to report IPE and IPC efforts in the Philippines to provide applicable strategies to the local healthcare landscape. Keywords: Interprofessional collaboration, interprofessional education, assistive technology, occupational therapy, speech-language pathology, Philippines INTRODUCTION An alternative and augmentative communication provide an appropriate AAC device, SLPs (AAC) device is a type of assistive product that collaborate with a team of healthcare professionals.2 aids an individual with complex communication needs (CCN) to converse and interact with Interprofessional collaboration (IPC) happens others through replacing or supplementing a when one works with a team of health person’s natural speech.1 The use of AAC devices professionals toward a common goal to improve are well-identified within the domain of practice learning, quality services, team support, and of the speech-language pathology (SLP) decision-making.3,4 One of the many health profession as speech-language pathologists professional SLPs can collaborate with are (SLPs) possess adequate knowledge in terms of occupational therapists (OTs). Occupational language development, communication patterns, therapy (OT) is a client-centered health bodily structures and functions necessary for profession concerned with promoting health and speech, and AAC devices.2 To identify and 35

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.007) wellbeing through meaningful everyday Eligibility Criteria. Included articles are those activities.5 It has been asserted that OTs possess that discuss strategies for collaboration in the the competence to adequately provide assistive field of AAC. The team should include at least an products by looking at the interplay among OT and an SLP practitioner. Only articles person-activity-environment.6 published from January 2000 to September 2019 written in the English language were gathered. In the Philippines, OTs and SLPs tend to have more opportunities to collaborate in rendering Search Strategy. An electronic search was done intervention primarily due to the mandatory in the final week of October 2019. Articles exposure of most OTs and SLPs to archived in PubMed and Scopus were reviewed. interprofessional education (IPE) over a longer The following keywords were used for the period.7 However, when it comes to assessing search: alternative or augmentative and providing AAC for individuals with CCN to communication, collaboration, occupational achieve communication-related goals, 80-90% of therapy, and speech or speech-language Filipino SLPs rarely or never collaborated with pathology. The use of wild cards to include other other health professionals due to difficulties in associated variants and alternative terms, which identifying the role of others in the assessment are connected via Boolean operations, was done. process.8,9 Study Selection. A total of five articles were SLPs specializing in AAC-related services obtained and screened. Of the five articles, only observe four communicative competencies two articles were included in this study (see namely: linguistic competence, operational Figure 1). The articles were excluded for the competence, strategic competence, and social following reasons: a book chapter tackling AAC competence.10 All these competencies entail in general (n=1) and articles focusing on AAC collaborative effort. For instance, operational without discussing strategies for IPC (n=2). competence requires the need for OTs in providing a professional appraisal of the AAC Data Collection and Synthesis. The following user’s performance skills. Additionally, SLPs and information was extracted and tabulated: title, OTs could collaboratively assess an individual’s author(s), year published, country, type of social interaction skills needed for developing research, IPC strategy used, and features of the strategic and social competence. strategy. The finding was then summarized and described in the next section. The finding was Concretizing the collaborative practice done then appraised using the Critical Appraisal of a between both professions is a viable first step Case Study checklist.12 Studies were summarized towards raising the quality of service and care. and synthesized through the critical analysis of At present, there is a need to identify literature the tabulated information. that examines the collaboration between the two professions on a global scale to jumpstart such RESULTS collaboration in the Philippines. Hence, this study aimed to identify and discuss existing In this review, we discussed the retrieved literature that documented IPE and IPC literature used to enable an interprofessional strategies between OTs and SLPs in the field of collaborative practice between OTs and SLPs in AAC. the field of AAC. A summary of the included articles can be found in Table 1. METHODOLOGY The structure of this rapid literature review was guided and adapted from the topics outlined in the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Several steps were omitted to access information promptly and without compromising clinical decision-making despite the limited resources.11 36

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.007) Figure 1. Search Process Case Based Learning (CBL) Approach. CBL is defined as a form of learning through solving authentic clinical scenarios geared towards attaining a stated set of learning objectives and outcomes.15 Not all information was initially provided to facilitate inquiry and discovery. The CBL approach was utilized by Wallace and Benson.13 The formulated case scenarios were discussed by post-graduate OT and SLP students as part of formal coursework between the OT and SLP departments. Participants were arranged to communicate through face-to-face team meetings and online interactions spanning 25 to 45 minutes. The strategy brought about an increase in one’s understanding of the role and importance of others. The approach identified the value of professional communication in successful collaboration. Professional communication facilitated mutual respect and increased cooperation and collaboration among team members. Table 1. Summary of included studies Title Bringing Interprofessional Case-Based A Case Study of Team Supports for a Learning into the Classroom for Student with Autism’s Communication and Occupational Therapy and Speech- Engagement within the General Education Language Pathology Students13 Curriculum: Preliminary Report of the Beyond Access Model14 Author(s) Wallace SE, Benson JD Sonnenmeier RM, McSheehan M, Jorgensen CM Year Published 2018 2005 Country Type of Research USA USA Critical Appraisal IPC Strategy used one group pretest posttest Case Study (observational) Features of the strategy 6/10 8/10 Case based Learning Approach Beyond Access Model two-part IPE activity with out-of-class Four-phase model provided a framework online meeting and a 2-hour class was to the team to enhance their capacity in done among graduate students of the OT planning, evaluating, and implementing and SLP departments. Worksheets and student and team support for an inclusive instructions were provided to structure classroom setting. the meetings. 37

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.007) Beyond Access (BA) Model. The BA model was limited literature exists to tackle strategies created as an attempt to include students with applicable to a clinician’s busy day. Regardless, disabilities in the general education system both analyzed studies can be adapted and through the provision of support like AAC. The applied to the Philippine setting to create a model was devised by Jorgensen and colleagues better model for AAC service delivery. Adapting to provide an intervention with an appropriate the models can provide a structure to promote and individualized set of goals that were competency, especially for practitioners new to designed collaboratively by the intervention the concept of collaboration. team.16 The case study was done within a general education classroom to meet the communication IPE as a Springboard to an AAC-Ready IPC. needs of a child with Autism.14 The team The general concept of having a collaboration comprised of the following: the student’s ready workforce is through starting in the parents, an SLP practitioner, an OT practitioner, classroom IPE.17 Engaging in IPE increases the an AAC consultant, a classroom teacher, an likelihood and advancement of IPC in the instructional assistant, and a special educator. Philippines.9,18 Discussing AAC-related cases in the classroom may address the lack of The BA model identified four phases. The first understanding and importance of the non-AAC phase is a “comprehensive assessment of the specialist’s role in the AAC service delivery student and team supports,” which includes process.9 Wallace and Benson explored the use determining the goal, the student’s strengths and of a CBL approach with OT and SLP students to weaknesses, and the team’s perspective on their establish a sense of collaboration in the field of overall functioning. The second phase explores AAC.13 This approach provided a clear and describes the student’s support needs for delineation of roles in AAC assessment and learning the general education content through a intervention as it required the SLP and OT trial-and-error-like approach. The third phase students to have a professional discourse, involves observing and documenting encouraging the students to know and define performance. The last phase entails reviewing their specific roles within the team. While both and reflecting on student and team performance professionals can address the social competency, data. The educational team established a 45- OTs have a clear role when relating to minute meeting on a weekly basis with a mentor, operational competency (access and positioning) skilled with the BA model, guiding the team and SLPs have a distinct role in relating to throughout the process.14 These phases linguistic competency. However, there is much to juxtapose the process done by health know as to whether the participants were able to professionals, which include: evaluation, translate this learning experience into AAC planning, intervention, and revaluation. practice as educational and practice demands differ when it comes to overall logistics. It would The intervention team deemed that the use of be interesting to see the application of CBL in the BA model was able to improve the student’s actual practice. Moreover, there is a need to participation through communication, as well as explore the transference of learning from the increase the quality of the team’s service classroom to the workplace in terms of IPC delivery. This model may be considered for within the AAC practice. This could bridge or evidence-based practice IPC on AAC provision identify the gaps in the disparity between pre- and intervention in the school setting. professional training and professional practice Furthermore, a model that considers both necessary to strengthen IPE programs within the student and team factors in intervention country. planning provides a wider view for appropriate goal setting on both parties.14 Regardless, the study of Sonnenmeier and associates suggest that establishing a clear DISCUSSION understanding of one’s professional role, as well as the others, paved the way for IPC within This rapid literature review sought strategies for clinical practice.14 In fact, they asserted that the incorporating IPC into AAC practice. However, BA model is an effective tool in IPC due to the 38

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.007) effective communication and understanding of reflected in the survey conducted by Sy wherein the professionals’ role within the intervention while OTs and SLPs agree to IPC fostering a team.14 The use of a BA model revealed better quality of service to clients, they are significant progress in the four AAC surprisingly neutral to the statements that competencies and participation in the general describe IPC as “time-consuming,” curriculum, suggesting an improved interaction “unnecessarily complicating things,” and “using with the AAC user’s environment. Hence, the BA time that is better spent for other case-related model allows for effective IPC that may impact matters.”18 Furthermore, difficulties in an AAC user’s participation in daily life. identifying the roles of the OTs in direct AAC service provision may discourage SLPs from Having said this, structuring the CBL approach having case discussions with OTs specific to AAC, through the BA model can be adapted by SLPs rationalizing why SLPs do not consult OTs and and OTs in the Philippine setting to discuss AAC- other professionals in AAC assessment.9 These related cases during educational activities to attitudes may be credited to a lack of a context- springboard a better quality of service and a based intervention-focused collaboration model more effective service delivery model to or framework in the Philippines. individuals with CCN. The CBL approach allows the OTs and SLPs to address typical concerns of The inclusion of approaches, models, and an AAC user to achieve specific AAC-related frameworks of AAC into the IPE curriculum can goals. It also paved the way for increased provide OTs and SLPs a guide on how to awareness of the OTs’ and SLPs’ roles in AAC collaborate in clinical practice. Effective IPC service provision and theoretical discussions comes from a strong IPE foundation, as OTs and during IPE. The BA model may be used for SLPs who have had mandatory and/or voluntary theoretical intervention planning and goal- IPE are more likely to collaborate.18 Students setting. Furthermore, as there are few apply what they learn in their educational opportunities for IPC during laboratory classes experience; hence, introducing collaborative and practical clinic exercises, including the BA practices specific to AAC may inspire them to model in clinical experience during IPE may be a adopt these practices in clinical cases. Adapting beneficial framework for effective collaboration the BA model to be more logistically feasible or for AAC-related cases.19 creating one inspired by it can guide the collaborative practice in AAC-related cases. This Barriers for AAC Collaborative Practice in the will be extremely beneficial for individuals with Philippines. In the application of the strategies CCN, as well as for the advancement of the OT- identified to prepare and exercise IPE and IPC, SLP collaborative practice in the Philippine logistics issues such as schedule and time setting. allotment proved to be a problem. The issue of logistics is a common challenge, especially in the Recommendation for Research. Due to the Philippines, wherein health professionals are scarcity of data, there is a need to report scarce.20 Less than 10% of the total registered practices and strategies employed in other SLPs in the Philippines are certified to provide a settings. As there are no studies in the comprehensive evaluation and in-depth Philippines that reports the benefits and intervention for individuals with CCN.21,22 This translation of IPE into IPC, there is a need to implies a shortage of manpower needed for the document and create evidence-based provision, assessment, and intervention for approaches and models in AAC collaboration. Filipinos with CCN. Hence, the adaptation of such Additionally, there is a need to create a context- strategies to the Philippine context may be a specific strategy/ protocol for promoting IPC in challenge as the integration of the identified IPC AAC practice. Lastly, conducting a review with a strategies into everyday practice may mean broadened search, such as the use of more allocating time for collaborative meetings. databases and including more health Precious time that can instead be used to work professionals, may yield more information and with other clients in need of professional models, which may be more adaptable and services.12 This perspective has been well 39

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.007) applicable to the Philippine healthcare providing us the venue to share the results of landscape. this endeavor. We would also like to thank Ms. Limitations. Due to temporal constraints and Hana Hanifah for providing an external review of limited manpower and resources, only two this manuscript. databases were searched. Broadening the search to more databases and broadening the search References: terms, as well as considering collaboration done with other health professionals, may yield more 1. American Speech-Language-Hearing Association. studies. Augmentative and alternative communication. USA: American Speech-Language-Hearing Association; nd. CONCLUSION Available from: Existing literature on the IPE and IPC between https://www.asha.org/public/speech/disorders/AAC/ OTs and SLPs in the field of AAC exists but #working remains scarce. Two specific strategies to facilitate collaboration namely: “case based 2. Frailey C. Augmentative and alternative learning approach” and “beyond access model” communication: The role of the AAC team. USA: Super were identified. There is a need to report IPE and Duper Publications; 2005. Available from: IPC efforts in the Philippines to provide https://www.superduperinc.com/handouts/pdf/89_A applicable strategies to the local healthcare ugmentativeComm.pdf landscape and to create a context-specific strategy/ protocol for promoting IPC in AAC 3. DePaepe PA, Wood LA. Collaborative practices related practice. to augmentative and alternative communication: Current personnel preparation programs. Individual author’s contributions Communication Disorders Quarterly. 2001;22(2):77- DPG Yao; conceptualized, searched, analyzed, 86. and wrote the paper. GD Andaya; conceptualized, searched, analyzed, 4. Batorowicz B, Shepherd TA. Teamwork in AAC: and co-wrote the paper. Examining clinical perceptions. Augmentative and K Inoue; Supervised the research by providing Alternative Communication. 2011;27(1):16-25. critical discourse and arguments during analysis process. 5. World Federation of Occupational Therapists. Statement on occupational therapy. UK: World Disclosure Statement Federation of Occupational Therapists; 2010. Available The authors have nothing to disclose. This work from: https://www.wfot.org/resources/statement-on- was not funded by any agencies/ organizations. occupational-therapy Conflicts of interest 6. American Occupational Therapy Association. Assistive All authors declare no conflict of interest. technology and occupational performance. American Journal of Occupational Therapy. 2016;70(suppl. 2):1- Acknowledgment 10. We would like to acknowledge the 2nd Asia- Pacific Interprofessional Education and 7. Sy MP, Martinez PGV. The status of interprofessional Collaboration Conference and its organizers for education and collaboration within occupational therapy, physical therapy, and speech therapy professions in the Philippines. 2017 Association of Medical Education in Europe Conference; 2017 Aug 26- 30; Helsinki, Finland 8. Paul S, Peterson CQ. Interprofessional collaboration: Issues for practice and research. Occupational Therapy in Health Care. 2002;15(3-4):1-12. 9. Chua ECK, Gorgon EJR. Augmentative and alternative communication in the Philippines: A survey of speech- language pathologist competence, training, and practice. Augmentative and Alternative Communication. 2019;35(2):156-66. 10. Light J, McNaughton D. Communicative competence for individuals who require augmentative and alternative communication: A new definition for a new era of communication. Augmentative and Alternative Communication. 2014;30(1):1-18. 40

PJAHS • Volume 4 Issue 2 2021 • (doi:10.36413/pjahs.0402.007) 11. Triccio AC, Antony J, Zarin W, Striffler L, Ghassemi M, Ivory J, et al. A scoping review of rapid review methods. BMC Medicine, 2015;13:224. 12. Center for Evidence-Based Management. Critical appraisal of a case study. Netherlands: Center for Evidence-Based Management; nd. Available from https://www.cebma.org/wp-content/uploads/Critical- Appraisal-Questions-for-a-Case-Study.pdf 13. Wallace SE, Benson JD. Bringing interprofessional case- based learning into the classroom for occupational therapy and speech-language pathology students. Occupational Therapy in Health Care. 2018;32(2):1-12. 14. Sonnenmeier RM, McSheehan M, Jorgensen CM. A case study of team supports for a student with autism’s communication and engagement within the general education curriculum: preliminary report of the beyond access model. Augmentative and Alternative Communication. 2005;21(2):101-15. 15. McLean SF. Case-based learning and its application in medical and health-care fields: A review of worldwide literature. Journal of Medical Education and Curricular Development. 2016;3:39-49. 16. Jorgensen CM, McSheehan M, Sonnenmeier R. The beyond access model: Promoting membership, participation, and learning for students with disabilities in the general education classroom. Maryland: Brookes Publishing; 2009. 17. World Health Organization. Framework for action on interprofessional education and collaborative practice [Internet]. Switzerland: World Health Organization; 2010 [cited 2019 Sep 25]. Available from https://www.who.int/hrh/resources/framework_actio n/en/ 18. Sy MP. Filipino therapists’ experiences and attitudes of interprofessional education and collaboration: A cross- sectional survey. Journal of Interprofessional Care. 2007;31(6):761-70. 19. Costigan FA, Light J. A review of preservice training in augmentative and alternative communication for speech-language pathologists, special education teachers, and occupational therapists. Assistive Technology. 2010;22(4):200-12. 20. Cheng MH. The Philippines’ health worker exodus. Lancet. 2009;373(9658):111-2. 21. Philippine Association of Speech Pathologists. Directory. Philippines: Philippine Association of Speech Pathologists; nd. Available from http://pasp.org.ph/SLPs-Directory 22. Tinig AAC. List of affiliates. Philippines: Tinig AAC Project; nd . Available from https://www.tinigaacproject.com/list-of-affiliate 41

Announcements In response to continuously changing landscape Short Reports of scientific publishing, the Philippine Journal of Allied Health Sciences announces the expansion Short reports are a collection of various scientific on the type of articles that we will be accepting articles which may include clinical studies, case from henceforth. As mentioned in this issue’s reports, review articles, commentaries, studies editorial, we will start to accept research study on the reliability and/or validity of clinical protocols. The specific guidelines are explained measurement procedures, and other novel types below. Likewise, we have expanded and of articles discussed herein. Short reports on provided specific guidelines to the short reports early or initial findings of a research project must that authors may wish to submit to us. follow similar guidelines with original research articles. Other types of short reports may follow Study Protocol an unstructured format. An informative unstructured abstract of not more than 250 A study protocol is a research article the words is required. Short reports are limited to a describes the background, study objectives, maximum of 2000 words, three tables/figures, methods, and expected results of a proposed or and 20 references. ongoing research. PJAHS will consider publishing study protocols (i.e., primary studies, systematic Clinical Case Studies. Case studies are reports reviews with or without meta-analysis) that have on the clinical practice of a profession. These been approved by a funding agency and/or an articles provide a record of clinicians interact ethics approval body (proof of relevant with their patients and their interactions using documentation should be provided as a specific evaluation and intervention techniques. supplementary file). Whenever appropriate, We will accept case studies reporting clinical study protocols should be registered in practice with individual or multiple patients. appropriate databases (i.e. ClinicalTrials.gov, Ethical clearance from a recognized ethical PROSPERO, PHRR, etc.). Study protocols are review board is necessary. Abstracts can follow strongly recommended to follow relevant an unstructured format. The structure of the reporting guidelines (i.e. SPIRIT, SPIROS, main text should have the following sections: PRSIMA-P, or you may consult the list by the Introduction, Case Presentation, Management EQUATOR Network). Study protocol without and Outcome, and Discussion. current ethics approval will not be considered. Abstract and the manuscript body must include Case Reports. Case reports are descriptive the following sections: Background, Objective, reports on clinical issues and innovations from Methods, and Expected Results. Abstracts should the perspective of the allied health practitioner. not be more than 250 words, manuscript text not These articles should focus on practice more than 2500 words, a maximum of two tables implications, rather on research methodology. and/or figures, and up to 25 references. These articles may provide a short discussion on current practice issues and patterns, innovative 42

evaluation, and intervention techniques. An Literature Reviews. These types of articles abstract which follows an unstructured format is critical reviews the literature on a topic related needed. The main text may follow a similar to allied health practice. The review should cover unstructured format, however, the suggested recent and relevant literature to a contemporary structure should include sections on the allied health research and practice issue. A following: Introduction (including a description discussion on how the literature review informs of the social, cultural, economic and professional allied health science is expected. They follow an contexts), Rationale (reasons for the new unstructured format for the abstract and main practice, roles, evaluation or intervention), Role texts. of the Allied Health Profession, Implications to Practice, Impact to Allied Health Profession, Commentaries. These types of articles that Conclusion (including implications to other provides a critical or alternative view or insight settings, contexts, professions, or countries). to a recent development in the field of allied health. Authors may provide commentaries to Clinical Measurements. These types of practice guidelines, books, reports, or as articles should discuss the reliability and/or preferred, a previously published recent article validity of clinical measurement procedures in this journal. An unstructured abstract will be independent or as part of a main research study. required. The main text shall comprise of a The structure of the abstract and the text follows background, main text, and concluding remarks. that of original research articles. A discussion on Commentaries do not contain and tables or the empirical implications of the clinical figures. Opinions in commentaries are welcome, measurement testing to research and practice provided they are constructive and is grounded should be included. Ethical clearance from a on sound evidence. recognized ethical review board is necessary. Novel Articles. These are types of Initial Findings. These types of articles report miscellaneous articles that the editorial board on initial findings or results of an ongoing finds to be useful in the field of allied health research study. They may also be brief reports of science. These may include conference pilot studies as precursor to a main or larger- announcements, committee reports, white scale research study. The structure of the papers, introduction to a professional abstract and the text follows that of original association, local or international historical research articles. However, the article should accounts of allied practice, practice guidelines, discuss on how the initial findings can inform position papers, etc. These articles will follow an further research on the same or similar topics. unstructured abstract and main texts. You may Ethical clearance from a recognized ethical email us in advance to clarify whether your review board is necessary. article falls under this category. 43

CALL FOR PAPERS (Regular Issue) The Philippine Journal of Allied Health Sciences (PJAHS), the official academic journal of the College of Rehabilitation Sciences- University of Santo Tomas is now accepting manuscripts to be reviewed for its upcoming Volume 5 Issue 1. PJAHS is an online Open Access peer-reviewed scholarly journal which encourages authors to publish original scholarly articles in the fields of physical therapy, occupational therapy, sports science, speech-language pathology, nursing, psychology, biomedical engineering, pharmacy, nutrition, education and other allied health sciences. PJAHS will consider submissions on the following topics: human biomechanics, exercise physiology, physical activity in pediatrics and geriatrics, ergonomics, physiologic profiling of athletes, sports injury monitoring and clinical practice patterns in the allied health sciences. PJAHS publishes original research, systematic reviews and meta-synthesis, short reports, and letters to the editor. Authors who wish to submit manuscripts for review can view the relevant information by visiting our journal website at https://pjahs.ust.edu.ph/. The deadline for submission for the upcoming regular issue is on April 30, 2021. Accepted manuscripts will be published by August 2021. For any inquiries, email us at [email protected]. 44

CALL FOR PAPERS (Special Section on “Health-Related Outcome Measures for the Filipino Population”) The Philippine Journal of Allied Health Sciences (PJAHS), the official academic journal of the College of Rehabilitation Sciences- University of Santo Tomas is now accepting manuscripts to be reviewed for the Special Section of its upcoming Volume 5 Issue 1. The Special Section shall be dedicated to “Health-Related Outcome Measures for the Filipino Population.” We will be accepting manuscripts with psychometric research study designs that reports on the development, reliability testing, validity testing and/or diagnostic testing of well-established health-related outcome measures (i.e. checklists, questionnaires, assessments, evaluation tools and methods, etc.) and its contextualization for the Filipino clientele. The author guidelines for submission shall be similar to that our regular issue. Authors who wish to submit manuscripts for review can view the relevant information by visiting our journal website at https://pjahs.ust.edu.ph/. The deadline for submission for the upcoming regular issue is on April 30, 2021. Accepted manuscripts will be published by August 2021. For any inquiries, email us at [email protected]. 45