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Objective: The purpose of this review was to identify quality indicators described in the literature that may be used as quality measures in hospital physical therapy units., Methods: The following sources were searched for quality indicators or articles: Web of Science, MEDLINE, IBECS, Latin American and Caribbean Health Sciences Literature, Cumulative Index of Nursing and Allied Health, Academic Search Complete, SportDiscus, SciELO, PsychINFO, Consejo Superior de Investigaciones Cientificas, and Scopus databases; the Agency for Healthcare Research and Quality, National Health System Indicator Portal, Joint Commission on Accreditation of Healthcare Organizations, and Organisation for Economic Co-operation and Development websites; and the National Quality Forum's measures inventory tool. Search terms included "quality indicator," "quality measure," "physiotherapy," and "physical therapy." Inclusion criteria were articles written in English, Spanish, French, or Portuguese aimed at measuring the quality of care in hospital physical therapy units. Evidence-based indicators with an explicit formula were extracted by 2 independent reviewers and then classified using the structure-process-outcome model, quality domain, and categories defined by a consensus method., Results: Of the 176 articles identified, only 19 met the criteria. From these articles and from the indicator repository searches, 178 clinical care indicators were included in the qualitative synthesis and presented in this paper. Process and outcome measures were prevalent, and 5 out of the 6 quality domains were represented. No efficiency measures were identified. Moreover, structure indicators, equity and accessibility indicators, and indicators in the cardiovascular and circulatory, mental health, pediatrics, and intensive care categories were underrepresented., Conclusions: A broad selection of quality indicators was identified from international resources, which can be used to measure the quality of physical therapy care in hospital units., Impact: This review identified 178 quality of care indicators that can be used in clinical practice monitoring and quality improvement of hospital physical therapy units. The results highlight a lack of accessibility, equity, and efficiency measures for physical therapy units., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Physical Therapy Association.)

Epigenetic processes enable environmental inputs such as diet, exercise, and health behaviors to reversibly tag DNA with chemical "marks" that increase or decrease the expression of an individual's genetic template. Over time, epigenetic adaptations enable the effects of healthy or unhealthy stresses to become stably expressed in the tissue of an organism, with important consequences for health and disease. New research indicates that seemingly non-biological factors such as social stress, poverty, and childhood hardship initiate epigenetic adaptations in gene pathways that govern inflammation and immunity, two of the greatest contributors to chronic diseases such as diabetes and obesity. Epigenetic processes therefore provide a biological bridge between the genome-an individual's genetic inheritance-and the Social Determinants of Health-the conditions in which they are born, grow, live, work, and age. This Perspective paper argues that physical therapy clinicians, researchers, and educators can use the theoretical framework provided by the International Classification of Functioning, Disability, and Health (ICF model) to harmonize new discoveries from both public health research and medically focused genomic research. The ICF model likewise captures the essential role played by physical activity and exercise, which initiate powerful and widespread epigenetic adaptations that promote health and functioning. In this proposed framework, epigenetic processes transduce the effects of the social determinants of health and behaviors such as exercise into stable biological adaptations that affect an individual's daily activities and their participation in social roles. By harmonizing "nature" and "nurture," physical therapists can approach patient care with a more integrated perspective, capitalizing on novel discoveries in precision medicine, rehabilitation science, and in population-level research. As the experts in physical activity and exercise, physical therapists are ideally positioned to drive progress in the new era of patient-centered population health care., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Amongst adults with chronic pain, overweight and obesity are highly prevalent. The association between chronic pain and overweight is driven by several explanations, including increased biomechanical load, changes in the gut microbiome, and low-grade (neuro)inflammation. Moreover, the link between overweight, obesity and chronic pain can best be considered from a lifestyle perspective. Since conservative treatment for chronic pain is often limited to short-term and small effects, addressing important comorbidities within a lifestyle approach could be the next step towards precision medicine for these patients. Indeed, evidence shows that combining weight reduction with conservative pain management is more effective to reduce pain and disability, compared to either intervention alone. This perspective article aims to update the reader with the current understanding of the possible explanatory mechanisms behind the interaction between overweight/obesity and chronic pain in an adult population. Second, this paper applies this knowledge to clinical practice, including assessment and conservative treatment of overweight/obesity in adults with chronic pain. Henceforth, clinical recommendations and guidelines are provided based on available scientific evidence and the authors' clinical expertise., Impact: This paper will guide clinicians in the implementation of weight reduction programs within pain management., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

While the American Physical Therapy Association has upheld a code of ethics since 1935, the philosophical underpinnings of physical therapist practice have yet to be robustly explicated. Theoretical work in the field of philosophy of medicine can be engaged to study physical therapist practice. Modifying the phenomenological and teleological framework of Edmund Pellegrino, a physician and prominent bioethicist, the purpose of this theoretical paper is to particularize Pellegrino's philosophy of medicine to construct an internal morality of physical therapy. Acknowledging that the internal morality of health care professions is founded in the relationship between a patient and a health care professional, this paper analyzes the nature and telos, or end, of physical therapy through 3 phenomena of physical therapy-the fact of disability, the act of profession, and the act of physical therapy. This paper claims that, rather than medicine's clinical truth of a good treatment decision, physical therapy's clinical truth is a good process that capacitates patients. This relational approach to an internal morality robustly underpins a philosophy and ethics of physical therapy., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The American Physical Therapy Association has supported the development of clinical practice guidelines to promote and support evidence-based practice and reduce unwarranted practice variation. Essential to the success of this effort is the generation of knowledge translation, a concept that emphasizes the translation of global knowledge to an application that can be effectively integrated into clinical practice. The Physical Therapy Clinical Practice Guideline for the Management of Individuals with Heart Failure published in the Physical Therapy Journal in January 2020 provides a broad base of knowledge related to evidence-based treatment interventions for patients with heart failure. However, the application and integration of this knowledge in clinical practice need further elucidation. Therefore, this perspective paper aims to serve as a complementary knowledge translation resource to the recently published practice guideline to maximize the utilization of contemporary evidence in clinical practice. This resource provides the physical therapist with practical guidance in the management of patients with heart failure by placing research findings in the context of other knowledge and practice norms that can be applied at the point of care and across the continuum of care. We propose a novel ABCDE (assessment, behavior modification, cardiorespiratory fitness, dosage, and education) practical framework. This clinical paradigm is grounded in ongoing physical therapist assessment throughout the episode of care, along with behavior modification, assessment of cardiorespiratory fitness, appropriate selection and dosing of interventions, and patient education. Examples highlighting the use of this model in patients with heart failure across the continuum of care are provided for application in clinical care., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

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., (© 2020 American Physical Therapy Association.)

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., (© 2019 American Physical Therapy Association.)

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.

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., (© 2017 American Physical Therapy Association.)

Background: To date, there has been no attempt to describe or compare physical therapy as practiced globally, nor any evidence that an international data set exists to support this effort. It is known that research evidence can be used in strategic and tactical ways, especially within the highly politicized context of the policy arena. The International Private Practitioners Association recognized the potential value a global evidence base could have in influencing policy and supporting professional development in a number of countries, yet it lacked a mechanism to achieve these aims., Objectives: The purposes of this study were: (1) to identify and test an international data set, definitions, and means of data collection and (2) to establish views in relation to the value of international collaborations., Design: A mixed, prospective design was used in the study., Method: Phase 1 (2006-2007) involved the development of a data set, definitions, and Web-based and paper-based data collection options involving 98 physical therapists from 68 physical therapy practices in 7 countries. Phase 2 (2008-2009) involved testing of the data set in 34 practices involving 3,195 patient episodes and included physical therapist feedback of experience, local relevance of the data set, and value of international collaborations., Results: Testing confirmed the relevance and reliability of the data set and definitions and a preference for Web-based data collection (74.0%). Physical therapist feedback supported these findings. Most respondents (60.0%-100.0%) reported the value of further international collaborations for their profession nationally or internationally., Limitations: Although a true international collaboration, the limited sample size should be recognized., Conclusions: It is possible to develop an agreed-upon international data set and means of data collection. Testing appears to support its acceptability and relevance for use in practice. Participants highly valued the opportunity to undertake international collaborations that may benefit their profession nationally and internationally. Further testing and use of the data set are advocated before final validation is sought.

Background and Purpose: Excessive sweating, known as hyperhidrosis, involves the eccrine sweat glands of the axillae, soles, palms, and/or forehead. The use of iontophoresis to reduce or eliminate excessive sweating has been described since 1952. The purpose of this case report is to describe the use of tap water galvanism (TWG) using direct current (DC) with a patient who had postsurgical hyperhidrosis., Case Description: The patient was a 36-year-old male electrician with traumatic phalangeal amputation and postsurgical development of hyperhidrosis. Tap water galvanism was administered using a DC generator, 2 to 3 times per week for 10 treatments. The patient's hands were individually submerged in 2 containers of tap water with the electrodes immersed directly into the containers. Each hand was treated with 30 minutes of TWG at 12 mA. Hyperhidrosis was measured by a 5-second imprint and subsequent tracing of the left hand placed on dry paper toweling., Outcomes: The patient's hyperhidrosis decreased from the full left palmar pad, with a surface area of 10.3x12.0 cm, to a reduced area of wetness that covered a 2.2-x2.7-cm area. The patient returned to work as an electrician without needing absorbent gloves, which had prevented him from performing electrical work., Discussion: Following use of TWG, the patient's palmar hyperhidrosis returned to normhidrosis.

Background and Purpose: The purpose of this study was to identify the current ethical issues facing physical therapists and (2) ethical issues that may be faced in the future by physical therapists., Subjects and Methods: The Delphi technique was used as the research design for this study. The panel of experts for the study were selected from Papers submitted by past and present members of the Judicial Committee of the American Physical Therapy Association. A series of three questionnaires were sent to the members of the panel. Following the Delphi technique, the first questionnaire contained broad questions designed to elicit a wide range of responses. The second and third questionnaires were then developed from the information received in the preceding questionnaire., Results: The results of the first question of the study identified 10 current ethical issues as consensus choices by the panel and 3 issues as near-consensus. The panel responses to the second question identified 4 future ethical issues. A combined list of current and future contained 16 issues in physical therapy., Conclusion and Discussion: The 16 issues addressed ethical considerations in different areas of physical therapy practice: 6 issues involving patient rights and welfare, 5 professional issues, and 5 issues relating to business and economic factors. Thirteen of these issues have not been discussed in previous physical therapy literature and would be suggested topics for future study.

The purpose of this study was to establish intratester and intertester reliability of four methods of measuring wound surface area from transparency film tracings. Wound area measurements were obtained in 31 subjects with venous stasis ulcers. After tracing each wound on transparency film, wound area was calculated by (1) multiplying length and width measurements with a ruler, (2) placing the transparency film over graph paper and counting the squares, (3) using a planimeter, and (4) using a digitizer. Intraclass correlation coefficients (ICCs) for intratester measurements were .99 for each method. The ICC values for intertester measurements ranged from .97 to .99. The results of this study indicate that intratester and intertester wound measurements can be taken reliably with the graph paper, planimeter, and digitizer methods. The graph paper technique may be preferable in most clinical settings, because it is low in cost and easy to use.

The purpose of this study was to examine the interrater reliability of grades obtained by physical therapy and occupational therapy tutors in rating their students' term papers. This study was carried out in two phases. In phase 1, four student essay papers (two physical therapy students' papers and two occupational therapy students' papers) with grades that had been assigned from the previous year's course were randomly selected from a bank of papers. These papers were independently rated by three course planners (who were responsible for planning, coordinating, and tutoring in the course), and agreement as to the assignment of grades for each paper was established. In phase 2, the same students' essays were rated independently by eight course tutors. To test for differences among students' written essay papers and for differences among the raters in the subcategories of discipline (physical therapy versus occupational therapy) and level of expertise (novice versus experienced) in grading essays, a three-way analysis of variance was performed. An intraclass correlation coefficient (ICC) was calculated for interrater reliability. Although there were no statistically significant differences among the tutors with regard to their discipline and expertise, the reliability analysis produced an ICC of .79. Strategies to enhance the reliability of grading essays are discussed.

A study of the scholarly activities of physical therapy faculty members in selected schools of allied health was conducted through a mailed questionnaire survey. The analysis of the data provided by the respondents (N = 127; 97.6%) revealed the following: 1) the respondents' primary scholarly activity was authorship of referred journal articles; 2) a majority of the respondents presented a paper at a professional meeting during the past three years; 3) only a small percentage of the respondents had directed extramurally funded projects; 4) the majority of the respondents indicated that their own academic preparation was the primary factor that encouraged their scholarly pursuits and that heavy teaching and administrative responsibilities were the primary discouraging factors; and 5) the respondents indicated that faculty scholarly activities are, and will continue to be, important considerations in academic promotion decisions. Comparison of the data provided by these respondents with data from the 1983 American Physical Therapy Association physical therapy faculty survey suggests modest gains in scholarly productivity. The implications of these findings are that faculty development programs are warranted and physical therapy administrators and faculty should join forces in finding more effective ways to involve faculty in research activities.

This paper describes physical therapy programs to assist physical therapists in the rehabilitation of patients with familial dysautonomia. There have been no reports in the literature about a physical therapy program for patients with this disease. A retrospective analysis of the clinical manifestations in 80 patients in a dysautonomia clinic was performed. Scoliosis and kyphosis were found in 92 percent of the patients, 93 percent had ataxia, 74 percent had feeding difficulties, 69 percent had frequent pneumonias, and 63 percent exhibited delayed developmental milestones. Cardiovascular, gastrointestinal, pulmonary, musculoskeletal, and neurological symptoms and treatments are discussed.

This paper presents legal and ethical considerations regarding informed consent for the evaluation and treatment of patients in physical therapy practice. Therapists traditionally think of informed consent in relation to clinical research, but as the trend toward independent practice and private practice increases in physical therapy, the physical therapist must understand the process of informed consent in relation to patient care. Legal concepts of battery, self-determination, and the fiduciary relationship create a legal foundation for informed consent. The patient's moral right to self-determination and the corresponding duty of health professionals to "do no harm" create a strong moral basis for gaining a patient's informed consent. Practical suggestions are offered to physical therapists to help them assess their need for obtaining informed consent.

This article examines the reliability and validity of the modified essay question. An 18-item modified essay question was developed and pretested on a group of clinical experts. After the pretest, the modified essay question was administered to a group of 25 physical therapy students immediately before their second level orthopedic placement. A reliability index of .39 (coefficient alpha) was calculated for the test. In addition, measures of validity were obtained by correlating the modified essay question scores with multiple-choice question scores and the students' in-clinic reasoning scores. The results suggest that the reliability coefficient found in this study is comparable to the medical literature. Also, the results showed that the modified essay question demonstrated a greater correlation with the in-clinic clinical reasoning score compared with the parallel content multiple-choice examination. Furthermore, preliminary evidence suggests that the modified essay question may be a useful paper and pencil tool in evaluating clinical reasoning. Finally, several shortcomings of this study are discussed in conjunction with a direction for further study.

This paper describes the application of external review to a physical therapy practice setting. The roots of the approach are examined in terms of consultation, accountability, and recognition of professionalization in physical therapy. The use of the structured interview as a data-gathering instrument is presented and the estimating of validity, reliability, and practicality is discussed. Implications for the use of external review as a tool in quality assurance are explored.

The purpose of this paper is to review the literature regarding research utilization by human service professionals, discuss factors that may contribute to utilization, describe recommendations that have been suggested to increase research utilization, and make suggestions for future investigations about research utilization by physical therapists. The literature suggests that research information is not used routinely by human service professionals. The nature of research communication, the training and personal characteristics of human service professionals, and the practice environments of human service professionals, such as physical therapists, probably influence the degree to which research is utilized. Specific interventions may be effective at increasing research utilization by physical therapists. A number of possible research methods are available for evaluating the present state of research utilization by physical therapists and the effects of interventions on this utilization.

Functional deficits in head-injured patients are a major concern to physical therapists involved in the rehabilitation process. Functional outcomes are affected by deficits in behavior, cognition, communication, and sensorimotor abilities. These deficits interact frequently and must be considered in planning and implementing treatment. The purpose of this paper is to describe the deficits affecting functional abilities, to discuss the rationale for functional assessment, and to provide treatment suggestions for functional retraining. The suggestions include retraining of protective and equilibrium responses and advanced locomotor skills and use of assistive devices or orthoses. Problems are identified in functional outcome reporting methods. Research endeavors are addressed for physical management during the recovery process and its relationship to functional outcomes.

The purpose of this paper is to discuss general treatment guidelines for treating patients with acute burns and to review pathophysiology of acute burn injuries. I will discuss skin composition briefly, give a review of acute burn pathophysiology and medical treatment, outline the psychological factors physical therapists should consider when working with these patients, and discuss physical therapy for the patient with acute burns. Physical therapy for patients with burns has become a specialty as knowledge of burn injuries increases. I have attempted to review physical therapy burn knowledge for inexperienced clinicians beginning to treat patients with acute burns.

Although single-subject research design has been discussed at some length in the recent physical therapy and occupational therapy literature, there has been little attempt to describe the procedures used for interpreting the experimental effects of such research. The purpose of this paper is to present the use of two strategies for determining whether changes have occurred as a result of experimental manipulation. The first strategy, visual analysis of graphed data, relies on visual interpretation of changes in data patterns both within and between experimental conditions. The second strategy is the use of statistical procedures such as trend estimation, the Rn statistic, and time series analysis. Finally, the issues of both clinical and statistical significance in interpreting the results of single-subject research are discussed.

This paper was presented as the keynote speech at the Seventh International Congress of the World Confederation for Physical Therapy. The question of what it will take to strengthen physical therapy as a world force for the health of mankind is examined. The past and present status of physical therapy and the Confederation are assessed as background for looking at ways to help the Confederation become truly a World Confederation for Physical Therapy.

Public school physical therapy is a new area for the physical therapy profession. Cooperation and communication with all professionals dealing with the disabled child are essential. This paper gives suggestions to help the physical therapist deal with other school personnel.

The purpose of this paper is to present a clinically feasible method to provide objective, quantitative information regarding the quality of a patient's gait. The technique used is simple and economical and requires minimal equipment. The four basic temporal and distance factors are 1) stride length, 2) step length, 3) cadence, and 4) velocity. The technique requires the following equipment: 1) grid pattern, 2) stop watch, 3) portable tape recorder, 4) tape measure, 5) marking pen, and 6) masking tape. Case examples are provided to demonstrate the use of the data obtained.

This paper will assist the physical therapist in selecting and applying proper treatment for the disorder commonly referred to as "tennis elbow." The information 1) offers guidelines for determining the cause of pain; 2) assists in choosing a differential treatment plan; 3) outlines a complete, effective, and detailed rehabilitation program; and 4) includes an informative preventive program for the therapist and for the patient. The purpose of this paper is to present the information that the physical therapist needs to know in order to help the patient with "tennis elbow" return to the level of fitness necessary for participating in the athletic activity of his choice.

The purpose of this paper is to identify competencies needed in the area of biomechanics for physical therapists. The discussion is divided into the following three areas: prevention of movement dysfunction, patient evaluation, and patient treatment. Clinical examples for each area are included. Physical therapists must understand normal biomechanical development, pathomechanical development, biomechanics of normal movement, and pathomechanics of the musculoskeletal system. In addition, physical therapists should be experts in biomechanics of exercise and be able to analyze biomechanically various types of activities.

Recent court decisions are currently generating the need for the development of a more humane, school-based system of educational options for severely and profoundly handicapped children. This natural commitment, which includes provisions for various ancillary services, has major implications for the profession of physical therapy. This paper includes the problems, issues, and trends related to the development of public school physical therapy programs and presents some guidelines and suggestions which might be helpful in the implementation of such programs.

The purpose of this paper is to describe how two teaching models, the Inquiry Training Model and the Simulation Model, have been adapted for use in the physical therapy classroom. To help students synthesize the various physical therapy skills they were learning, variations of the Inquiry Training Model and the Simulation Model were used in addition to standard lectures and laboratories to teach the Evaluation Unit to junior level physical therapy students. The feedback obtained at the end of each class from both students and faculty members indicated that the learning experiences were considered both helpful and fun. This article summarizes the important components of the Inquiry Training Model and the Simulation Model. I recommend learning experiences based on these models to augment lecture and laboratory classes.

This survey was an attempt to identify which ethical decisions are most frequently encountered and are most difficult to make for practicing physical therapists. A questionnaire that described 30 situations with an ethical dimension was sent to 450 American Physical Therapy Association members practicing in New England. A total of 187 (41.5%) usable questionnaires was returned. Issues raised by items were designated as primary, secondary, or nonpriority. Seven primary and 11 secondary ethical issues were identified. In brief, these issues involve the decision about which patients should be treated, what obligations are entailed by that decision, who should pay for treatment, and what duties derive from the physical therapist's relationship; with other health professionals, including physicians. Some of these decisions are more frequent in certain types of employment facilities than in others. Sources of ethical conflict and the role of the professional organization in defining moral values for the profession are discussed in this paper, and implications for education are presented.

We have described three separate uses of the chi-square distribution: comparing observed and expected frequency distributions of a nominal variable, testing for the independence of two variables, and using the chi-square test in determining correlation coefficients. We hope this paper has helped you gain an understanding of the uses of the chi-square test and the steps required to calculate this statistic.

This paper surveys selected historical foundations of the present American Physical Therapy Association's CODE OF ETHICS, showing the extent to which the present code draws upon oaths, ideas in ethics textbooks, and other sources. The article presenta a basis for understanding the significance of these historical influences and provides one means by which physical therapists can more fully appreciate the relevance of the code today.

This paper discusses certain issues of theory, concept, definition, and method in measurement that are of concern to physical therapy. The topics discussed include the place of measurement in science, definitions of measurement, direct and indirect measurement, the logical requirements of measurement, scales of measurement, precision and accuracy, and reliability and validity. Comments pertinent to physical therapy are included in the discussion, and the issues are summarized by a look at the complex problems of using EMG for measurement of muscle activity.

Faced with the difficult task of coordinating statewide health education, the Kentucky Council on Higher Education is using several manpower projection statistics as one component of their decision-making process. These manpower data are essential when considering the establishment, expansion, continuation, or termination of health-related academic programs. Three models were used to project manpower requirements for licensed physical therapists in Kentucky. The models were 1) manpower:population ratio, 2) trend analysis based on time series, and 3) the American Physical Therapy Association's health-needs method. Four variants of the manpower:population ratio model are discussed and presented: population ratio based ona 1) national ratio, 2) Kentucky ratio, 3) weighted national ratio, and 4) weighted Kentucky radio. The trend analysis model is presented and discussed. The health-needs approach, based on expert opinion and health-related variables, identifies the quantity and quality of services required to provide the Kentucky population with the best possible care. The paper concludes with three brief scenarios describing the possible effects of the three models and physical therapy in Kentucky. The scenarios unfold from differing assumption about the effects of manpower production on health care. Scenario A is a "current arrangement" scenario. Scenario B considers the effects of predicting future manpower requirements and resources based on the past. Scenario C projects the effects of a comprehensive plan on the goal of producing the best possible care for all Kentuckians.

This paper presents a new clinical education experience initiated at the University of Wisconsin-La Crosse. A Mock Clinic was developed that simulates a real-life physical therapy department: students adopt roles of both physical therapist and patient. Each student is student-therapist and student-patient at least once each session. At the beginning of each session, the student-therapist selects a patient treatment card (containing instructions submitted by academic and clinical faculty members) and a faculty supervisor discusses the role of the patient with the student-patient to assist him in accurately displaying signs and symptoms. The student-therapist alos meets with the faculty supervisor to review the patient and the approach. The student-therapist then "evaluates" and "treats" the student-patient. A group discussion concludes each session. Mock Clinic is a role-playing experience that provides the opportunity for students to see themselves in clinical situations and enables them to learn without involving real clients. Strengths and weaknesses of Mock Clinic identified by all participants are discussed.

The purposes of this paper is to orient physical therapists to Public Law 94-142 and to reflect upon the implications of this law for therapists in clinical settings and preservice training. Key phrases relative to this law are "least restrictive environment" and "free and appropriate education." Both phrases have direct implications for physical therapists because local educational agencies must provide services and experiences that are deemed appropriate for a child's educational needs. Physical therapists may deal in direct services, consultant roles, or evaluative processes. Public Law 94-142 has created unique opportunities for physical therapists in the public school setting.

For the past five years, two required courses in research methodology have been presented to physical therapy students during their senior year. The overall objective was to prepare students to use the scientific method in their approach to physical therapy practice. The content of the first course included didactic instruction on the research process with emphasis on reading and interpreting the medical and scientific literature. In conjunction with this experience, students developed research proposals. During the second course, students gathered data, analyzed and synthesized results, and prepared a complete research paper. To date 67 projects have been completed. Reactions to this learning experience and samples of abstracts written by students are presented.