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Background The importance of motor learning knowledge for physical therapist practice is well known; however, its application is lacking. Conceptual frameworks that place motor learning knowledge within a clinical context are a potential mediator to overcome this gap. Purpose This study aimed to conduct a scoping review of the literature to identify and describe the content of such conceptual frameworks in physical therapy/rehabilitation, including the approaches taken in their development and the "elements" or building blocks of motor learning–based interventions within each conceptual framework. Data Sources The data sources used were PubMed, CINAHL, and PsychInfo databases. Study Selection Articles that were selected had a primary focus on motor learning and its application in physical therapy/rehabilitation and were published between 2000 and 2017. Data Extraction Twelve of 62 relevant articles met the inclusion criteria. Data Synthesis Papers attempted to translate theoretical knowledge into a coherent, clinically accessible conceptual framework via 3 main approaches: synthesizing selected motor learning elements into original new conceptual frameworks, mapping motor learning elements in current clinical practices, and assembling selected motor learning elements. The elements of motor learning that were common across papers included theoretical concepts (such as "meaningful goal setting" and "active involvement"); practice variables (including the type, frequency, and timing of feedback; the focus of instructions; task breakdown; and the amount, variability, and order of practice); and intervention strategies (task specific and mental practice). Psychological aspects related to self-efficacy and motivation were also considered integral. Limitations Papers published before the year 2000 were excluded. Conclusion The scoping review revealed that the presentation of motor learning elements in a coherent framework encompassed very diverse approaches and used different categorization systems. In addition, to fully grasp the complexity of clinical practice, motor learning should be coupled with other fields of knowledge. [ABSTRACT FROM AUTHOR]

Background Many practitioners experience complex, uncertain, and unique clinical practice situations that can be navigated with reflection. Little is known about the theoretical and pragmatic perspectives of reflection in physical therapy. Purpose The purpose of this paper was to examine the literature on reflection in physical therapy and identify gaps in the literature. Data Source The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, EMBASE, Scopus, and PsycINFO were used to identify articles. Study Selection Studies were selected to describe: (1) theoretical concepts related to reflection, (2) examples of reflection, and (3) the use of reflection in clinical or educational contexts. Data Extraction Authors, year of publication, country of origin, publication type or source, methodology, conceptual approach (including terminology used, definition of terminology used), and practical approach (including theoretical underpinning, context of reflection/reflective practice, and target group) guided the data extraction. Data Synthesis A total of 46 articles were reviewed spanning from 1992 to 2017, which included research studies, field articles, editorials, and a review article. Theoretical underpinnings of reflection were based on the thoughts of Donald Schön. Written approaches to reflection were most common, and reflection was used to inform education, clinical practice, and professional growth. Limitations As with any review paper, there is a certain level of interpretation required when collating and interpreting data. Conclusions Reflection in physical therapy could be advanced by a thorough conceptualization of reflective practice, a broader and deeper pool of research to inform optimal implementation of reflection across the career span from learners to experts, and a clear definition and linkage of reflection to epistemologies of physical therapy practice. [ABSTRACT FROM AUTHOR]

Shared decision making (SDM) is a collaborative approach between clinicians and patients, where the best available evidence is integrated with patients' values and preferences for managing their health problems. Shared decision making may enhance patient-centered care and increase patients' satisfaction, engagement, adherence, and ability to self-manage their conditions. Despite its potential benefits, SDM is underutilized by physical therapists, and frequent mismatches between patients' and therapists' rehabilitation goals have been reported. Physical therapists can use evidence-based strategies, tools, and techniques to address these problems. This paper presents a model for SDM and explains its association with improved patient outcomes and relevance to situations commonly encountered in physical therapy. It describes freely available resources, including health literacy universal precautions, teach-back, motivational interviewing, decision aids, and patient-reported outcome measures that can help physical therapists integrate SDM into their clinical practices. This paper also explains SDM facilitators and barriers, suggests a theoretical framework to address them, and highlights the need for SDM promotion within physical therapy practice, education, administration, and research. [ABSTRACT FROM AUTHOR]

Background. Adjuvant endocrine therapy in breast cancer has increased survival rates; however, it is not without musculoskeletal side effects. Purpose. The purpose of this review was to systematically and critically appraise the available scientific evidence concerning the effect of adjuvant endocrine treatment on grip strength in women being treated for breast cancer. Data sources and study selection. The National Library of Medicine (MEDLINE-PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Excerpta Medical Database by Elsevier (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Physiotherapy Evidence Database (PEDro) were searched from inception to February 2017 for appropriate papers that could answer the focused question. The searches were independently screened by 2 reviewers. The data from 7 papers that met the eligibility criteria were processed for further analysis. Data extraction and synthesis. The collective data and the statistical analysis of all included studies were summarized and presented in a descriptive manner. If not provided, based on data from the individual included studies, a mean percent change in grip strength was calculated. The included studies evaluating aromatase inhibitors had inconclusive outcomes, and studies with a follow-up of 6 or 12 months showed a percent reduction in grip strength varying from 0.1% to 9.7%. None of the included studies showed a significant decrease in grip strength in tamoxifen users, with a percent reduction in grip strength varying from 1.4% to 2.2%. Limitations. The 7 studies included cohort studies lacking a control group. Conclusions. There is inconclusive evidence for a small decrease in grip strength in women treated for breast cancer who are also receiving aromatase inhibitors. In those that use tamoxifen, grip strength did not change significantly. [ABSTRACT FROM AUTHOR]

Background. Mobility limitations are common following stroke and frequently lead to poor participation in physical activity (PA). Purpose. The purpose of this study was to describe PA across the various stages following stroke (acute, subacute, and chronic). Data Sources. Searches were conducted in 5 databases. Study Selection. Eligible studies included participants with stroke whose PA was quantitatively measured for at least 4 hours in a single session. Two reviewers independently reviewed titles and abstracts. Data Extraction. One reviewer extracted data and assessed quality using the Downs and Black checklist. Weighted means were calculated for PA outcomes. Data Synthesis. Searches yielded 103 eligible papers including 5306 participants aged 21 to 96 years. Devices (eg, activity monitors) were used in 73 papers, and behavioral mapping (observational monitoring) in 30. Devices show that people with stroke took on average 5535 steps per day (n = 406, 10 studies) in the subacute phase and 4078 steps (n = 1280, 32 studies) in the chronic phase. Average daily walking duration (% measured time) was higher in the chronic phase (9.0%, n = 100) than subacute (1.8%, n = 172), and sedentary time was >78% regardless of time post stroke. Acute data were lacking for these variables. Matched healthy individuals took an average of 8338 steps per day (n = 129). Behavioral mapping showed time in bed was higher in the acute than subacute phase (mean 45.1% versus 23.8%), with similar time spent sitting (mean 37.6% versus 32.6%). Limitations. Limitations of this review include not pooling data reported as medians. Conclusions. Physical activity levels do not meet guidelines following stroke. Time spent inactive and sedentary is high at all times. Increasing PA and developing standardized activity targets may be important across all stages of stroke recovery. [ABSTRACT FROM AUTHOR]

Background. Exercise is recommended for people with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), yet there is little information to guide safe and effective mobilization and exercise for these patients. Objectives. The purpose of this study was to develop a clinical decision-making tool to guide health care professionals in the assessment, prescription, monitoring, and progression of mobilization and therapeutic exercise for patients with AECOPD. Design and Methods. A 3-round interdisciplinary Delphi panel identified and selected items based on a preselected consensus of 80%. These items were summarized in a paper-based tool titled Mobilization in Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD-Mob). Focus groups and questionnaires were subsequently used to conduct a sensibility evaluation of the tool. Results. Nine researchers, 13 clinicians, and 7 individuals with COPD identified and approved 110 parameters for safe and effective exercise in AECOPD. These parameters were grouped into 5 categories: (1) "What to Assess Prior to Mobilization," (2) "When to Consider Not Mobilizing or to Discontinue Mobilization," (3) "What to Monitor During Mobilization for Patient Safety," (4) "How to Progress Mobilization to Enhance Effectiveness," and (5) "What to Confirm Prior to Discharge." The tool was evaluated in 4 focus groups of 18 health care professionals, 90% of whom reported the tool was easy to use, was concise, and would guide a health care professional who is new to the acute care setting and working with patients with AECOPD. Limitations. The tool was developed based on published evidence and expert opinion, so the applicability of the items to patients in all settings cannot be guaranteed. The Delphi panel consisted of health care professionals from Canada, so items may not be generalizable to other jurisdictions. Conclusions. The AECOPD-Mob provides practical and concise information on safe and effective exercise for the AECOPD population for use by the new graduate or novice acute care practitioner. [ABSTRACT FROM AUTHOR]

Participation in adequate physical activity improves the health status of cancer survivors, enhances their survival, and reduces their risk of cancer recurrence. However, cancer survivors engage in low levels of physical activity and have limited access to rehabilitation services that could increase their participation. No optimal framework has been developed that supports physical activity participation among cancer survivors. Given the growth in numbers of cancer survivors, development of a framework may provide a pathway to facilitate timely and appropriate care. This perspective paper describes the development of the Cancer Rehabilitation to Recreation (CaReR) Framework and its practical implications. The CaReR Framework uses a tailored, stepped approach to guide health services and clinicians on the design and implementation of interventions to promote physical activity among cancer survivors. Implementation of the CaReR Framework will improve continuity and quality of care for cancer survivors and promote physical activity with the ultimate aim of improving health outcomes. [ABSTRACT FROM AUTHOR]

Background. Play is vital for development. Infants and children learn through play. Traditional standardized developmental tests measure whether a child performs individual skills within controlled environments. Play-based assessments can measure skill performance during natural, child-driven play. Purpose. The purpose of this study was to systematically review reliability, validity, and responsiveness of all play-based assessments that quantify motor and cognitive skills in children from birth to 36 months of age. Data Sources. Studies were identified from a literature search using PubMed, ERIC, CINAHL, and PsycINFO databases and the reference lists of included papers. Study Selection. Included studies investigated reliability, validity, or responsiveness of play-based assessments that measured motor and cognitive skills for children to 36 months of age. Data Extraction. Two reviewers independently screened 40 studies for eligibility and inclusion. The reviewers independently extracted reliability, validity, and responsiveness data. They examined measurement properties and methodological quality of the included studies. Data Synthesis. Four current play-based assessment tools were identified in 8 included studies. Each play-based assessment tool measured motor and cognitive skills in a different way during play. Interrater reliability correlations ranged from .86 to .98 for motor development and from .23 to .90 for cognitive development. Test-retest reliability correlations ranged from .88 to .95 for motor development and from .45 to .91 for cognitive development. Structural validity correlations ranged from .62 to .90 for motor development and from .42 to .93 for cognitive development. One study assessed responsiveness to change in motor development. Limitations. Most studies had small and poorly described samples. Lack of transparency in data management and statistical analysis was common. Conclusions. Play-based assessments have potential to be reliable and valid tools to assess cognitive and motor skills, but higher-quality research is needed. Psychometric properties should be considered for each play-based assessment before it is used in clinical and research practice. [ABSTRACT FROM AUTHOR]

Objective Patients with neck pain commonly have altered activity of the neck muscles. The craniocervical flexion test (CCFT) is used to assess the function of the deep neck flexor muscles in patients with musculoskeletal neck disorders. Systematic reviews summarizing the measurement properties of the CCFT are outdated. The objective of this study was to systematically review the measurement properties of the CCFT for assessing the deep neck flexor muscles. Methods The data sources MEDLINE, EMBASE, Physiotherapy Evidence Database, Cochrane Central Register of Controlled Trials, Scopus, and Science Direct were searched in April 2019. Studies of any design that reported at least 1 measurement property of the CCFT for assessing the deep neck flexor muscles were selected. Two reviewers independently extracted data and rated the risk of bias of individual studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk-of-bias checklist. The overall rating for each measurement property was classified as "positive," "indeterminate," or "negative." The overall rating was accompanied with a level of evidence. Results Fourteen studies were included in the data synthesis. The ratings were positive, and the level of evidence was moderate for interrater and intrarater reliability and convergent validity. There was conflicting rating and level of evidence for discriminative validity. Measurement error was indeterminate, with an unknown level of evidence. Responsiveness was negative, with a limited level of evidence. A limitation of this study was that only papers published in English were included. Conclusions The CCFT is a valid and reliable test that can be used in clinical practice as an assessment test. Because of the conflicting and low-quality evidence, caution is advised when using the CCFT as a discriminative test and as an outcome measure. Future better-designed studies are warranted. [ABSTRACT FROM AUTHOR]

Over the last decade, there has been a marked increase in attention to, and interest in, femoroacetabular impingement syndrome (FAIS). Despite continued efforts by researchers and clinicians, the development, progression, and appropriate treatment of FAIS remains unclear. While research across various disciplines has provided informative work in various areas related to FAIS, the underlying pathomechanics, time history, and interaction between known risk factors and symptoms remain poorly understood. The purpose of this perspective is to propose a theoretical framework that describes a potential pathway for the development and progression of FAIS. This paper aims to integrate relevant knowledge and understanding from the growing literature related to FAIS to provide a perspective that can inform future research and intervention efforts. [ABSTRACT FROM AUTHOR]

A critical factor to move the field of physical therapy forward is the measurement of fidelity during comparisons of interventions. Fidelity translates as "faithfulness"; thus, fidelity of intervention means faithful and correct implementation of the key components of a defined intervention. Fidelity measurement guards against deviations from, or drift in, the delivery of a targeted intervention, a process necessary for evaluating the efficacy of rehabilitation approaches. Importantly, attention to fidelity measurement differentiates rehabilitation approaches from each other. However, earlier research comparing physical therapist interventions often reported findings without careful attention to fidelity measurement. The purpose of this paper is 2-fold: (1) to support the development of intervention-specific fidelity measures in physical therapy research as the gold standard for translating research findings to clinical practice, and (2) to describe the process of creating a multi-dimensional fidelity measurement instrument in rehabilitation intervention. Improved attention to fidelity measurement will allow the rehabilitation field to communicate interventions clearly with a direct link to outcomes and target the implementation of our improved intervention for the right patient problem with the right dose and the right ingredients at the right time. [ABSTRACT FROM AUTHOR]

Best practice recommendations in cancer care increasingly call for integrated rehabilitation services to address physical impairments and disability. These recommendations have languished primarily due to a lack of pragmatic, generalizable intervention models. This perspective paper proposes a clinically integrated physical therapist (CI-PT) model that enables flexible and scalable services for screening, triage, and intervention addressing functional mobility. The model is based on (1) a CI-PT embedded in cancer care provider clinics, and (2) rehabilitation across the care continuum determined by the patient's level of functional mobility. The CI-PT model includes regular screening of functional mobility in provider clinics via a patient-reported mobility measure—the Activity Measure for Post-Acute Care, a brief physical therapy evaluation tailored to the specific functional needs of the individual—and a tailored, skilled physical therapist intervention based on functional level. The CI-PT model provides a pragmatic, barrier-free, patient-centric, data-driven approach to integrating rehabilitation as part of standard care for survivors of cancer. The model standardizes CI-PT practice and may be sufficiently agile to provide targeted interventions in widely varying cancer settings and populations. Therefore, it may be ideal for wide implementation among outpatient oncological settings. Implementation of this model requires a shared approach to care that includes physical therapists, rehabilitation administrators, cancer care providers, and cancer center administrators. [ABSTRACT FROM AUTHOR]

Cardiac surgery via median sternotomy is performed in over 1 million patients per year worldwide. Despite evidence, sternal precautions in the form of restricted arm and trunk activity are routinely prescribed to patients following surgery to prevent sternal complications. Sternal precautions may exacerbate loss of independence and prevent patients from returning home directly after hospital discharge. In addition, immobility and deconditioning associated with restricting physical activity potentially contribute to the negative sequelae of median sternotomy on patient symptoms, physical and psychosocial function, and quality of life. Interpreting the clinical impact of sternal precautions is challenging due to inconsistent definitions and applications globally. Following median sternotomy, typical guidelines involve limiting arm movement during loaded lifting, pushing, and pulling for 6 to 8 weeks. This perspective paper proposes that there is robust evidence to support early implementation of upper body activity and exercise in patients recovering from median sternotomy while minimizing risk of complications. A clinical paradigm shift is encouraged, one that encourages a greater amount of controlled upper body activity, albeit modified in some situations, and less restrictive sternal precautions. Early screening for sternal complication risk factors and instability followed by individualized progressive functional activity and upper body therapeutic exercise is likely to promote optimal and timely patient recovery. Substantial research documenting current clinical practice of sternal precautions, early physical therapy, and cardiac rehabilitation provides support and the context for understanding why a less restrictive and more active plan of care is warranted and recommended for patients following a median sternotomy. [ABSTRACT FROM AUTHOR]

Measures of clinical significance have been in use for several decades as a means of interpreting clinical findings and patient-reported outcomes. The most common of these measures is the minimal clinically important difference. With the rise in popularity of measurements of clinical significance, several common misconceptions have arisen that may impact their interpretation and application to clinical practice. The purpose of this article is to present a schema for understanding measurement of clinical significance and use this to highlight the reasons why misuse and misinterpretation have occurred. A new measure of clinical significance is then defined that is intended to be resistant to these issues. Clinical significance has long been a topic of importance to researchers looking to make their findings interpretable and has been quantified in diverse ways. 1 Recently, there has been rapidly increasing interest in and use of an assortment of minimal (clinically) important difference measures. The range of their use is illustrated by the publications of reviews and meta-analyses in pain relief, 2 cognitive interventions for dementia, 3 and CT densitometry for patients with chronic obstructive pulmonary disease. 4 Consensus has not been reached for how clinical significance should be defined. Despite this, current methods fall into 2 distinct approaches. The first estimates measurement error levels, and the other quantifies the ability of the instrument to predict clinical outcomes of interest. The conceptual differences between the 2 approaches have not been clearly delineated in the literature. Further, additional conceptual and practical issues exist for measures using the second approach because it has not previously been framed as a clinical prediction problem. It is the aim of this paper to develop a framework to guide researchers in the use of clinical importance measures and to introduce a new methodology for predicting clinically meaningful change. We first propose 2 types of clinical significance measures relating to what we call the Detection and Clinical Prediction Problems. Next, we discuss weaknesses of existing measures of clinical prediction within this unifying framework. Finally, we define a new measure of clinical significance using predictive values and demonstrate its use with simulated data. [ABSTRACT FROM AUTHOR]

Around 20% of patients undergoing surgery for lumbar radiculopathy develop chronic pain after surgery, leading to high socioeconomic burden. Current perioperative interventions, including education and rehabilitation, are not always effective in preventing prolonged or chronic postoperative pain and disability. Here, a shift in educational intervention from a biomedical towards a biopsychosocial approach for people scheduled for lumbar surgery is proposed. Pain neuroscience education (PNE) is a biopsychosocial approach that aims to decrease the threat value of pain by reconceptualizing pain and increasing the patient's knowledge about pain. This paper provides a clinical perspective for the provision of perioperative PNE, specifically developed for patients undergoing surgery for lumbar radiculopathy. Besides the general goals of PNE, perioperative PNE aims to prepare the patient for postsurgical pain and how to cope with it. [ABSTRACT FROM AUTHOR]

Clinical assessment of movement and posture guides the decision-making process in designing interventions for infants and children with movement disorders. Clinical reasoning is influenced by the therapist's understanding of developmental processes. The views of development grounded in perception-action, dynamic systems, and neuronal group selection theories are well recognized in current literature and supported by a large body of research. Based on the available evidence, intervention must be task-specific, repetitive, and highly salient to the child. Furthermore, it must honor spontaneous exploration and active problem-solving, enhance the child's ability to perceive environmental affordances, and target optimal variability and adaptability of movement and posture. However, a neuromaturational approach to developmental assessment and intervention that relies on "teaching" motor milestones and emphasizes the importance of correcting movement patterns in infants and children developing atypically is still prevalent in the clinic. This perspective paper will: (1) examine evidence in support of a paradigm shift from neuromaturational views toward bringing the concepts of grounded cognition, variability, complexity, and adaptability to the forefront of clinical reasoning; and (2) introduce the Perception-Action Approach as a method of assessment and intervention that may serve as an agent of such a shift by augmenting knowledge translation for the clinician. [ABSTRACT FROM AUTHOR]

An introduction is presented wherein the editor discusses reports within the issue on topics including the use of Medicare claims data to simulate alternative cap payment policies, the validity of CMS G-code severity modifiers to detect change in a validated measure of functional status and a study of hospital discharge data from two states.

The author reflects on her tenure as editor in chief of "Physical Therapy Journal" (PTJ) where the Editorial Board evolved from one consisting of U.S.-based physical therapists to a board made up of international leaders in physical therapy, medicine and biomechanics. She points out that PTJ's research reports, perspectives and other published papers suggest an exponential growth in evidence with collaborative teams conducting research to help define best practice.

Background In 2015, the American Council for Academic Physical Therapy (ACAPT) developed 3 strategic initiative panels to address integrated clinical education, student readiness, and common terminology for physical therapist clinical education. Objective The purpose of this paper is to describe the results of the work from the Common Terminology Panel. Design This was a descriptive, consensus-based study. Methods Using a consensus process and data that were collected from a review of literature, a document analysis of core and historical professional documents, focus group discussions, and an online open comment period, panel members developed a glossary for physical therapist clinical education. Results The final glossary included 34 terms in 4 categories. The categories included clinical education infrastructure, sites, stakeholders, and assessment. The ACAPT Board of Directors approved the glossary in June 2017, and the ACAPT membership approved the glossary in October 2017. Limitations The focus of the glossary was on physical therapist clinical education. A future, similar project should be undertaken for physical therapist assistant clinical education. Conclusion This process resulted in a comprehensive glossary for physical therapist clinical education; changes to several current terms, including “internship” and “full-time clinical education experience”; and the addition of new terms, including “preceptor” and “site coordinator for clinical education.” New terminology will provide standard language for consistent communication and a common framework for all stakeholders. [ABSTRACT FROM AUTHOR]

Sleep disturbances occur in one third of the US population, and the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control has deemed insufficient sleep to be a public health problem. Knowledge about sleep and skills to screen sleep disorders and to promote sleep health have been recommended for physical therapists. Furthermore, in survey studies, physical therapists overwhelmingly agree that sleep is important for health and poor sleep impairs function. Sleep is critical for the proper functioning of the body, including immune function, tissue healing, pain modulation, cardiovascular health, cognitive function, and learning and memory. Sleep disruptions occur across the life span and in individuals with various conditions that are typically treated by physical therapists. Therefore, the purpose of this perspective paper is to (1) discuss the relevance of sleep to physical therapist practice, (2) recommend tools to screen for the 3 most common sleep disorders, and (3) provide suggestions for how therapists can integrate sleep health in prevention, health promotion, and wellness interventions. [ABSTRACT FROM AUTHOR]

Background. Little is known about the attitudes of children living in Central America toward people with disabilities or the effectiveness of a disability awareness program in influencing their knowledge and attitudes. Objective. The study objectives were to evaluate the effectiveness of a disability awareness program in influencing Belizean children's knowledge of and attitudes toward people with disabilities in the immediate short term and to describe the development of a university-community partnership that resulted in the development of a culturally appropriate disability awareness program. Design. This was a single-group pretest-posttest quasi-experimental study with cluster sampling. Methods. Study participants included 247 children (11-14 years old) from 8 primary schools in Toledo District, Belize. A paper-based disability awareness survey measuring knowledge of and attitudes toward people with disabilities was administered before and after an intervention. The intervention was a 90-minute multimodal disability awareness program. Hierarchical linear modeling was used to model the influence of the intervention on knowledge of and attitudes toward people with disabilities. Results. Significant improvements in knowledge of and attitudes toward people with disabilities were evident immediately after the intervention. Limitations. Children were not randomized to a control group. Although this feature was a limitation in terms of study design, the researchers believed that respecting the wishes of the school principals by providing the disability awareness intervention to all students was important. Conclusions. This study provided an example of how a university-community partnership can positively influence community outcomes. Further research is needed to assess long-term changes in Belizean children's knowledge of, attitudes toward, and behaviors toward people with disabilities, as well as the social inclusion and participation of children with disabilities. [ABSTRACT FROM AUTHOR]

Although much research has been done on repetitive transcranial magnetic stimulation (rTMS) in chronic stroke, only sparse research has been done in acute stroke despite the particularly rich potential for neuroplasticity in this stage. We attempted a preliminary clinical trial in one active, high-quality inpatient rehabilitation facility (IRF) in the United States. But after enrolling only 4 patients in the grant period, the study was stopped because of low enrollment. The purpose of this paper is to offer a perspective describing the important physiologic rationale for including rTMS in the early phase of stroke, the reasons for our poor patient enrollment in our attempted study, and recommendations to help future studies succeed. We conclude that, if scientists and clinicians hope to enhance stroke outcomes, more attention must be directed to leveraging conventional rehabilitation with neuromodulation in the acute phase of stroke when the capacity for neuroplasticity is optimal. Difficulties with patient enrollment must be addressed by reassessing traditional inclusion and exclusion criteria. Factors that shorten patients' length of stay in the IRF must also be reassessed at all policy-making levels to make ethical decisions that promote higher functional outcomes while retaining cost consciousness. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about the appointment of physical therapists in the Italian academia.

The authors convey their thoughts on the potential value of qualitative research papers in physical therapy. Topics discussed include the transition to a societal focus for the physical therapy profession in the U.S., types of research and commentary that can directly contribute to achieving outward-reaching goals, and ways in which the scientific credibility of qualitative research can be judged.

We developed a reporting guideline to provide authors with guidance about what should be reported when writing a paper for publication in a scientific journal using a particular type of research design: the single-case experimental design. This report describes the methods used to develop the Single-Case Reporting guideline In BEhavioural interventions (SCRIBE) 2016. As a result of 2 online surveys and a 2-day meeting of experts, the SCRIBE 2016 checklist was developed, which is a set of 26 items that authors need to address when writing about single-case research. This article complements the more detailed SCRIBE 2016 Explanation and Elaboration article (Tate et al., 2016) that provides a rationale for each of the items and examples of adequate reporting from the literature. Both these resources will assist authors to prepare reports of single-case research with clarity, completeness, accuracy, and transparency. They will also provide journal reviewers and editors with a practical checklist against which such reports may be critically evaluated. We recommend that the SCRIBE 2016 is used by authors preparing manuscripts describing single-case research for publication, as well as journal reviewers and editors who are evaluating such manuscripts. [ABSTRACT FROM AUTHOR]