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The article looks at several enhancements undertaken by the magazine "Physical Therapy" as of May 2019, including its transition from a paper-based to a digital-only journal, the addition of features to improve the digital reading experience, and the launch of mobile apps for its readers.

The author discusses some highlights of the activities and achievements of the American Physical Therapy Association (APTA) in 2004. He notes the increase in the number of APTA members, surpassing the pre-Balanced Budget Act levels of the 1990s. APTA collaborated with the Veterans Health Administration and the Association of Rehabilitation Nurses to develop a white paper on improving patient handing and movement tasks.

The author provides a framework for the importance of the area of regenerative rehabilitation to physical therapist practice and highlights the articles that inaugurate the special series. He refers to the regenerative rehabilitation as the integration of principles and approaches from the fields of rehabilitation science and regenerative medicine. He cites the focus of regenerative medicine on the enhancement of endogenous stem cell function to repair tissue function lost due to injury.

The article offers updates from the Foundation for Physical Therapy as of July 2014. Topics include the foundation's alumni publications such as the online publication in the "American Journal of Physical Medicine & Rehabilitation" of the paper "Predicting Functional Performance and Range of Motion Outcomes After Total Knee Arthroplasty" by M. J. Bade et al, funding opportunities for 2014 such as the Kendall Scholarship and Research Grant programs, and an update on foundation alumni.

A letter to the editor is presented in response to the paper "Physical Therapist-Established Intensive Care Unit Early Mobilization Program: Quality Improvement Project for Critical Care at the University of California San Francisco Medical Center" published in "Physical Therapy" journal.

Background. Lymphedema is a common complication of cancer treatment, resulting in swelling and subjective symptoms. Reliable and valid measurement of this side effect of medical treatment is important. Purpose. The purpose of this study was to provide best evidence regarding which measurement instruments are most appropriate in measuring lymphedema in its different stages. Data Sources. The PubMed and Web of Science databases were used, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Study Selection. Clinical studies on measurement instruments assessing lymphedema were reviewed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) scoring instrument for quality assessment. Data Extraction. Data on reliability', concurrent validity, convergent validity, sensitivity, specificity, applicability', and costs were extracted. Data Synthesis. Pooled data showed good intrarater intraclass correlation coefficients (ICCs) (.89) for bioimpedance spectroscopy (BIS) in the lower extremities and high intrarater and interrater ICCs for water volumetry, tape measurement, and perometry (.98-.99) in the upper extremities. In the upper extremities, the standard error of measurement was 3.6% (a=0.7%) for water volumetry, 5.6% (cr=2.1%) for perometry', and 6.6% (cr=2.6%) for tape measurement. Sensitivity of tape measurement in the upper extremities, using different cutoff points, varied from 0.73 to 0.90, and specificity values varied from 0.72 to 0.78. Limitations. No uniform definition of lymphedema was available, and a gold standard as a reference test was lacking. Items concerning risk of bias were study design, patient selection, description of lymphedema, blinding of test outcomes, and number of included participants. Conclusions. Measurement instruments with evidence for good reliability and validity were BIS, water volumetry, tape measurement, and perometry, where BIS can detect alterations in extracellular fluid in stage 1 lymphedema and the other measurement instruments can detect alterations in volume starting from stage 2. In research, water volumetry is indicated as a reference test for measuring lymphedema in the upper extremities. [ABSTRACT FROM AUTHOR]

Education research has been labeled the 'hardest science" of all, given the challenges of teaching and learning in an environment encompassing a mixture of social interactions, events, and problems coupled with a persistent belief that education depends more on common sense than on disciplined knowledge and skill. The American Educational Research Association specifies that education research--as a scientific field of study--examines teaching and learning processes that shape educational outcomes across settings and that a learning process takes place throughout a person's life. The complexity of learning and learning environments requires not only a diverse array of research methods but also a community of education researchers committed to exploring critical questions in the education of physical therapists. Although basic science research and clinical research in physical therapy have continued to expand through growth in the numbers of funded physical therapist researchers, the profession still lacks a robust and vibrant community of education researchers. In this perspective article, the American Council of Academic Physical Therapy Task Force on Education Research proposes a compelling rationale for building a much-needed foundation for education research in physical therapy, including a set of recommendations for immediate action. [ABSTRACT FROM AUTHOR]

Background. A positive attitude toward evidence-based practice (EBP) has been identified as an important factor in the effectiveness of the dissemination and implementation of EBP in real-world settings. Objective. The objectives of this study were: (1) to describe dimensions of Icelandic physical therapists' attitudes toward the adoption of new knowledge and EBP and (2) to explore the association between attitudes and selected personal and environmental factors. Design. This study was a cross-sectional, Web-based survey of the total population of full members of the Icelandic Physiotherapy Association. Methods. The Evidence-Based Practice Attitude Scale (EBPAS) was used to survey attitudes toward EBP; the total EBPAS and its 4 subscales (requirements, appeal, openness, and divergence) were included. Linear regression was used to explore the association between the EBPAS and selected background variables. Results. The response rate was 39.5% (N=211). The total EBPAS and all of its subscales reflected physical therapists' positive attitudes toward the adoption of new knowledge and EBP. Multivariable analysis revealed that being a woman was associated with more positive attitudes, as measured by the total EBPAS and the requirements, openness, and divergence subscales. Physical therapists with postprofessional education were more positive, as measured by the EBPAS openness subscale, and those working with at least 10 other physical therapists demonstrated more positive attitudes on the total EBPAS and the openness subscale. Limitations. Because this was a cross-sectional survey, no causal inferences can be made, and there may have been unmeasured confounding factors. Potential nonresponse bias limits generalizability. Conclusions. The results expand understanding of the phenomenon of attitudes toward EBP. They reveal potentially modifiable dimensions of attitudes and the associated characteristics of physical therapists and their work environments. The findings encourage investigation of the effectiveness of strategies aimed at influencing various dimensions of attitudes toward EBP. [ABSTRACT FROM AUTHOR]

The article talks about the cost of higher education in the U.S., rising debts due to student loans, and its impact on the physical therapist profession. Topics include factors affecting costs from increased federal regulation to rising costs of employee health insurance, the consequences of high student loan debt from delays in starting families, buying homes, and saving for retirement, and how changes in higher education affordability has affected physical therapist students.

This section offers news briefs concerning the Foundation for Physical Therapy as of October 2013. Several alumni of the foundation published papers on physical therapy. The foundation is accepting applications for the Promotion of Doctoral Studies (PODS) scholarships and the New Investigator Fellowship Training Initiative (NIFTI). Susanne Morton has been appointed to the faculty of the Physical Therapy Department at the University of Delaware.

The article offers brief profiles of the members of the journal's editorial board for 2010/2011. Rana Shane Hinman graduated with a doctor of philosophy (PhD) degree from the University of Melbourne in Australia, where she also completed her physical therapy training. Nick Stergiou works as the Isaacson Professor and Director of the Health, Physical Education, and Recreation Biomechanics Laboratory at the University of Nebraska in Omaha. Sarah Westcott McCoy's expertise is associated with examination and intervention for postural control dysfunction.

The article offers physical therapy news briefs. The Foundation of Physical Therapy has published several research papers including "Anxiety and Stress Can Predict Pain Perception Following Cognitive Stress," by M. H. Bement and colleagues. The 2010 Promotion of Doctoral Studies (PODS) I scholarships have been awarded to several physical therapy students. The Foundation of Physical Therapy is accepting applications for the Kendall Scholarship and Research Grant programs.

A letter to the editor is presented in response to the article "Multidisciplinary Approach to Sex Education of Spinal Cord-Injured Patients," by R. Evans, E. Halar, A. DeFreece, and GL Larsen previously published.

Background. The importance of health professionals discussing health behaviors with patients is emphasized in Healthy People 2020, the national health objectives established by the US Department of Health and Human Services. Many physical therapists do not routinely discuss health behaviors with their patients. One reason may be uncertainty about how these discussions might be perceived by patients. Objective. The primary purpose of this study was to determine patients' opinions regarding physical therapists discussing the topics of physical activity, smoking, fruit and vegetable consumption, and maintaining a healthy weight during clinical visits. A secondary purpose was to determine whether patients believe that physical therapists should be role models for these behaviors. Design. This was a descriptive cross-sectional survey. Methods. Patients were surveyed at 8 outpatient clinics in Michigan and Minnesota. A written questionnaire collected information about the participants' health behaviors, their opinions about physical therapists discussing their health behaviors during clinical visits, and their opinions about physical therapists role-modeling healthy behaviors. Results. The survey response rate was 45.6%. A total of 230 patients participated. Most participants agreed that physical therapists should speak to them about physical activity (91.3%), maintaining a healthy weight (73%), and abstaining from smoking (51.3%). Fewer participants agreed that physical therapists should advise them about fruit and vegetable consumption (32.1%). The majority of participants agreed that physical therapists should be role models for engaging in regular physical activity (83.4%), maintaining a healthy weight (71.7%), and abstaining from smoking (63.9%). Limitations. Limitations of this study include the potential for response bias and limited generalizability. Conclusions. Most participants believed it is appropriate for physical therapists to speak with them about and be role models for the behaviors of physical activity, maintaining a healthy weight, and abstaining from smoking. Physical therapists have the opportunity to support the goals of Healthy People 2020 by discussing health behaviors with their patients. [ABSTRACT FROM AUTHOR]

Background. In the McKenzie system of mechanical diagnosis and therapy (MDT), a reliable system for the management of spinal problems, classifications are used to guide management strategies. For the classification of extremity disorders, interexaminer agreement has not been investigated with patients. Objective. The study objective was to investigate interexaminer agreement for provisional MDT extremity classification with patients. Design. This was a reliability study with examiner masking. Methods. A therapist with an MDT credential observed the assessments made by 2 therapists with MDT diplomas, who successively performed MDT assessments for 33 patients with extremity pain on the same day. Immediately after each evaluation, all 3 therapists assigned the most appropriate MDT classification from 15 categories; they were unaware of each other's selection. The observed agreement and the Cohen kappa were calculated for the MDT classifications. Results. The observed agreement for the 15 MDT categories of classification between the therapist with an MDT credential and the first therapist with an MDT diploma was 78.8%. The Cohen kappa was .72 (95% confidence interval=.54, .89), indicating good agreement. However, the observed agreement between the 2 therapists with MDT diplomas when the patient was assessed separately was 42.4%. The Cohen kappa was .21 (95% confidence interval=.01, .41), indicating poor agreement. Limitations. Study limitations included convenience sampling of patients, the small number of examiners, and the limited extremity experience of the therapists with MDT diplomas. Conclusions. Interexaminer agreement for provisional MDT extremity classification was good when the examiners were seeing the same patient concurrently but poor when the patient was seen successively. Further studies are needed to establish which factors, including study method, are responsible for the divergent results of the MDT assessments of extremity disorders. [ABSTRACT FROM AUTHOR]

An interview with Dr. Carole B. Lewis, adjunct professor at the George Washington University Medical Center Department of Health Care Services, is presented. Topics discussed include her volunteer work with children as an unpaid assistant to a physical therapist at United Cerebral Palsy Center of Greater Cleveland, the percentage of new graduates' first job that is in geriatrics, and the percentage of physical therapy education programs with a course dedicated to pediatrics.

Background. Adequate and user-friendly instruments for assessing physical function and disability in older adults are vital for estimating and predicting health care needs in clinical practice. The Late-Life Function and Disability Instrument Computer Adaptive Test (LLFDI-CAT) is a promising instrument for assessing physical function and disability in gerontology research and clinical practice. Objective. The aims of this study were: (1) to translate the LLFDI-CAT to the Dutch language and (2) to investigate its validity and reliability in a sample of older adults who spoke Dutch and dwelled in the community. Design. For the assessment of validity of the LLFDI-CAT, a cross-sectional design was used. To assess reliability, measurement of the LLFDI-CAT was repeated in the same sample. Methods. The item bank of the LLFDI-CAT was translated with a forward-backward procedure. A sample of 54 older adults completed the LLFDI-CAT, World Health Organization Disability Assessment Schedule 2.0, RAND 36-Item Short-Form Health Survey physical functioning scale (10 items), and 10-Meter Walk Test. The LLFDI-CAT was repeated in 2 to 8 days (mean=4.5 days). Pearson's r and the intraclass correlation coefficient (ICC) (2,1) were calculated to assess validity, group-level reliability, and participant-level reliability. Results. A correlation of .74 for the LLFDI-CAT function scale and the RAND 36-Item Short-Form Health Survey physical functioning scale (10 items) was found. The correlations of the LLFDI-CAT disability scale with the World Health Organization Disability Assessment Schedule 2.0 and the 10-Meter Walk Test were -.57 and -.53, respectively. The ICC (2,1) of the LLFDI-CAT function scale was .84, with a group-level reliability score of .85. The ICC (2,1) of the LLFDI-CAT disability scale was .76, with a group-level reliability score of .81. Limitations. The high percentage of women in the study and the exclusion of older adults with recent joint replacement or hospitalization limit the generalizability of the results. Conclusions. The Dutch LLFDI-CAT showed strong validity and high reliability when used to assess physical function and disability in older adults dwelling in the community. [ABSTRACT FROM AUTHOR]

Background. Shoulder pain resulting from subacromial impingement syndrome (SAIS) is a common problem with a relatively poor response to treatment. There is little research exploring physical therapists' perspectives on the management of the syndrome. Objectives. The study objective was to investigate physical therapists' perceptions and experiences regarding the use of exercise in the treatment of patients with SAIS. Design. This was a qualitative focus group study. Methods. Three 60- to 90-minute focus group sessions containing 6 to 8 experienced musculoskeletal physical therapists (total number=20) were conducted. Thematic content analysis was used to analyze transcripts and develop core themes and categories. Results. Exercise was seen as key in the management of SAIS. The overarching theme was the need to "gain buy-in to exercise " at an early stage. The main subtheme was patient education. Therapists identified the need to use education about SAIS etiology to foster buy-in and "sell" self-management through exercise to the patient. They consistently mentioned achieving education and buy-in using visual tools, postural advice, and sometimes a "quick fix" of pain control. Furthermore, experienced practitioners reported including educational interventions much earlier in treatment than when they first qualified. Therapists emphasized the need for individually tailored exercises, including: scapular stabilization; rotator cuff, lower trapezius, and serratus anterior muscle strengthening; and anterior shoulder and pectoralis minor muscle stretching. Quality of exercise performance was deemed more important than the number of repetitions that the patients performed. Limitations. Expanding the geographical area over which the focus groups were conducted and including therapists with less than 5 years of postgraduate experience may have strengthened the findings of this study. Conclusion. Experienced musculoskeletal physical therapists believe that exercise is central in treating patients with SAIS and that gaining patient buy-in to its importance, patient education, promoting self-management, and postural advice are central to the successful treatment of people with SAIS. [ABSTRACT FROM AUTHOR]

Background. Emergency department (ED) use in the United States is expected to rapidly increase. Nearly half of all ED visits are classified as semiurgent or nonurgent, and many fall into the musculoskeletal category. Despite growing international evidence that patients are appropriately and safely managed by ED physical therapists in a time-efficient manner, physical therapist practice in EDs is not widely understood or utilized in the United States. To date, no studies have reported the impressions of ED physicians about this practice. Objectives. The purposes of this study were: (1) to assess ED physicians' impressions of ED physical therapist practice 2 years after practice was initiated and (2) to determine whether physicians' impressions changed 7 years later. Methods. All ED staff physicians and medical residents at a level I trauma hospital were invited to complete a survey in 2004 and 2011. Results. In both years, a majority of physicians reported favorable impressions of ED physical therapist practice. Physical therapists were valued for educating patients about safety and injury prevention, providing appropriate gait training, assisting with disposition planning, and providing interventions as alternatives to pain medication. Many physicians supported standing physical therapist orders for certain musculoskeletal conditions. The most common concern was the additional time that patients spend in the ED for a physical therapist consult. Limitations. The results of this study may not reflect the impressions of physicians in all EDs that employ physical therapists. Conclusions. Emergency department physicians reported favorable impressions of ED physical therapist practice 2 years and 9 years following its implementation in this hospital. This study showed that ED physicians support standing physical therapist orders for certain musculoskeletal conditions, which suggests that direct triage to ED physical therapists for these conditions could be considered. [ABSTRACT FROM AUTHOR]

Background. Chiropractors throughout the world by and large focus on patients with musculoskelctal complaints who are generally in good health. Currently, it is widely accepted that neck pain and low back pain are best understood as biopsychosocial phenomena. Objective. The purpose of this study was to determine whether certain psychosocial factors provide added value for predicting recovery. Design. This was a prospective, multicenter, chiropractic, practice-based cohort study in Belgium and the Netherlands. Methods. A total of 917 participants, 326 with neck pain and 591 with low back pain, completed self-administered questionnaires at baseline and at 3, 6, and 12 months. They provided information on several demographic, biomedical, and psychosocial variables. Lasting perceived recovery was used as the outcome measure, that is, recovery at all follow-up assessments from 3 months on. Twenty-seven potential predictors of outcome were used to build the predictive model. Stepwise, backward generalized estimating equation regression models were used to take into account the clustering of participants within practices. For assessment of the added value of psychosocial variables, 2 model fit indexes were compared. Results. After the addition of psychosocial variables, predictors in the final model for neck pain included occupational status, body mass index, duration of complaints, previous treatment, and participant expectations (the model fit was marginally improved from 0.684 to 0.695 for the area under the curve and from 65.0% to 66.1% for the percentage correctly predicted). In the final model for low back pain, the selected predictors included country of treatment, age, duration of complaints, previous imaging, and somatization (the area under the curve changed from 0.669 to 0.715, and the percentage correctly predicted changed from 68.6% to 69.5%). Only a minority of participants had high scores on psychological variables. Limitations. The reliability and validity of lasting recovery as an outcome measure have not been tested. The cohort needs to be seen as a convenience sample. Selection bias, therefore, not be ruled out. There are no indications, however, that patients with complex psychosocial profiles were excluded from this study. Conclusions. Psychosocial variables provided little added value for predicting outcome in people who had neck pain or low back pain and sought chiropractic care. Therefore, chiropractors should not screen extensively for them at baseline. With regard to the identification of the small subgroup of people with high scores on psychosocial variables and a high risk for chronic pain, further investigation is needed. [ABSTRACT FROM AUTHOR]

Background. Accurate measurement of physical activity and sedentary behavior is an important consideration for health care professionals. The activPAL activity monitor has not been validated against a criterion measure for people with rheumatoid arthritis (RA). Objective. The objective of this study was to determine the criterion validity of the activPAL activity monitor for measuring step counts, transition counts, and time spent in sedentary, standing, and walking behaviors in people with RA. Design. A laboratory-based criterion validation study was conducted. Methods. Participants with a confirmed medical diagnosis of RA were recruited from 2 outpatient rheumatology clinics. The testing procedure consisted of standardized testing components and tasks related to activities of daily living. Participants wore an activPAL activity monitor and were video recorded throughout the testing procedure. Direct observation was used as the criterion measure. Data analysis consisted of validation analysis of the activ PAL activity monitor data and the criterion measure data. Results. Twenty-four people participated in the study. Data from 20 participants were included in the final analysis. The activPAL significantly underestimated step counts by 26% and transition counts by 36%. There was no significant difference between the activPAL activity monitor and the criterion measure for time spent in sedentary, standing or light activity, and walking behaviors. Limitations. Validation of activities of daily living in a laboratory environment is a limitation of this study. Conclusions. The activPAL activity monitor underestimated step and transition counts and, therefore, is not valid for measuring these outcomes in people with RA. Relative to direct observation, the activPAL activity monitor is valid for measuring time spent in sedentary, standing, and walking behaviors in people with RA. [ABSTRACT FROM AUTHOR]

Background. Best practice guidelines for stroke rehabilitation recommend functional electrical stimulation (FES) to improve gait and upper extremity function. Whether these guidelines have been implemented in practice is unknown. Objective. The purposes of this study were: (1) to determine the frequency with which physical therapists use FES to address common therapeutic goals poststroke and (2) to identify the barriers to and facilitators of FES use. Design. This was a cross-sectional, survey study. Methods. A valid and reliable online survey was sent to Canadian physical therapists. Questions about demographic characteristics, FES use, knowledge of FES literature, and barriers and facilitators were posed. Closed-ended questions were analyzed with descriptive statistics and index scoring to produce summary scores. Pearson or point-biserial correlation coefficients correlated FES use with demographic variables. Open-ended questions about barriers and facilitators were analyzed by 3 researchers using a conventional content analysis. Results. Two hundred ninety-eight physical therapists responded. Use of FES for clients with stroke was low for all therapeutic goals queried (improve walking, arm function, muscle strength and endurance, and sensation; prevent shoulder subluxation; and decrease spasticity). However, 52.6% of the respondents stated that they would like to increase their use of FES. More than 40% of the respondents were unsure of the strength of the evidence supporting FES for stroke care. Physical therapists with postgraduate FES training were more likely to use FES (r=.471, P<.001). A lack of access to resources, such as time, equipment, and training, was the most frequently cited barrier to FES use. Limitations. As an observational study, cause-and-effect relationships for FES use cannot be identified. Conclusions. Functional electrical stimulation is not widely used by physical therapists in stroke rehabilitation. Improving access to resources--in particular, continuing education--may facilitate the implementation of FES into clinical practice. [ABSTRACT FROM AUTHOR]

Background. Rotator cuff-related disorders represent the largest subgroup of shoulder complaints. Despite the availability of various conservative and surgical treatment options, the precise indications for these options remain unclear. Purpose. The purpose of this systematic review was to synthesize the available research on prognostic models for predicting outcomes in adults undergoing physical therapy for painful rotator cuff disorders. Data Sources. The MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL, and PEDro databases and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) up to October 2015 were searched. Study Selection. The review included primary studies exploring prognostic models in adults undergoing physical therapy, with or without other conservative measures, for painful rotator cuff disorders. Primary outcomes were pain, disability, and adverse events. Inclusion was limited to prospective investigations of prognostic factors elicited at the baseline assessment. Study selection was independently performed by 2 reviewers. Data Extraction. A pilot-tested form was used to extract data on key aspects of study design, characteristics, analyses, and results. Risk of bias and applicability were independently assessed by 2 reviewers using the Prediction Study Risk of Bias Assessment tool (PROBAST). Data Synthesis. Five studies were included in the review. These studies were extremely heterogeneous in many aspects of design, conduct, and analysis. The findings were analyzed narratively. Limitations. All included studies were rated as at high risk of bias, and none of the resulting prognostic models was found to be usable in clinical practice. Conclusions. There are no prognostic models ready to inform clinical practice in the context of the review question, highlighting the need for further research on prognostic models for predicting outcomes in adults who undergo physical therapy for painful rotator cuff disorders. The design and conduct of future studies should be receptive to developing methods. [ABSTRACT FROM AUTHOR]

Background. Hand and wrist injuries are one of the most common injuries seen in adults. The Patient-Rated Wrist Evaluation (PRWE) questionnaire has been developed as a patient-report outcome measure of pain and disability to evaluate the outcome after hand and wrist injuries. Objective. The aims of this study -were (1) to evaluate the structural validity of the existing Dutch version of the PRWE (PRWE-NL) in patients with hand or wrist injuries and (2) to investigate the appropriateness of reporting subscale scores. Design. This was a retrospective analysis of cross-sectional data of 368 adult patients. Methods. Patients aged 18 to 65 years and treated either surgically or conservatively for an isolated hand or wrist injury were recruited. Patients were excluded if they were unable to speak or read Dutch. Confirmatory factor analyses were used to investigate structural validity, and Cronbach alpha (α) and omega (ω) coefficients were used to investigate internal consistency. Results. A series of confirmatory factor analyses revealed that all models (ie, a single-factor model, correlated 2- and 3-factor models, and 2 bifactor models) -were associated with adequate model fit. However, inspection of the factor loadings, the explained common variance (ECV), and the different coefficient omega values revealed that the PRWE-NL should be considered a measure of a unidimensional trait. In addition, PRWE-NL subscales were associated with unacceptably low levels of reliability independently of the global PRWE-NL factor. Limitations. Although the sample size was adequate, the response rate was 37.1%. Participants were mainly patients -with fractures of the wrist or hand, predominantly treated nonsurgically. Conclusion. This study suggests that the PRWE-NL measures a unidimensional trait. A single score should be used for the PRWE-NL, without subscale scores. [ABSTRACT FROM AUTHOR]

Background. Discharge from the hospital is a high risk transition period for older adults at risk of falls. Guidelines relevant to physical therapists for managing this risk are well documented, but commonly not implemented. Purpose. This project implemented an intervention to improve physical therapists' adherence to key guideline recommendations for managing risk of falls on discharge from one hospital. Data Sources. A pretest-posttest study design was undertaken and was underpinned by the Theoretical Domains Framework (TDF) to aid in the design of interventions to increase physical therapists' adherence to guideline recommendations and to identify barriers to these interventions. Data Extraction. A multifaceted intervention was implemented, including the establishment of a governance committee, education sessions, development of a "pathway" to guide practice, modification of an existing standardized assessment proforma, development of standardized processes and indicators for handover, increasing availability of educational handouts, audit and feedback processes, and allocation of dedicated staffing to oversee falls prevention within the physical therapy department. Data Synthesis. There were significant improvements in physical therapist behavior leading to key guideline recommendations being met, including: the proportion of patients who were identified to be at risk of falls (6.3% preintervention versus 94.8% postintervention) prior to discharge, an increase in documentation of clinical handover at discharge (68.6% preintervention versus 90.9% postintervention), and improvement in the quality of this documented clinical handover (34.9% of case notes met 5 criteria preintervention versus 92.9% postintervention). Limitations. The approach was resource intensive and consequently may be difficult to replicate at other sites. Conclusions. A multifaceted intervention underpinned by the TDF, designed to modify physical therapists' behavior to improve adherence to guideline recommendations for managing risk of falls on discharge from one hospital, was successful. [ABSTRACT FROM AUTHOR]

The goal of regenerative medicine is to restore function through therapy at levels such as the gene, cell, tissue, or organ. For many disorders, however, regenerative medicine approaches in isolation may not be optimally effective. Rehabilitation is a promising adjunct therapy given the beneficial impact that physical activity and other training modalities can offer. Accordingly, "regenerative rehabilitation" is an emerging concentration of study, with the specific goal of improving positive functional outcomes by enhancing tissue restoration following injury. This article focuses on one emerging example of regenerative rehabilitation--namely, the integration of clinically based protocols with stem cell technologies following central nervous system injury. For the purposes of this review, the state of stem cell technologies for the central nervous system is summarized, and a rationale for a synergistic benefit of carefully orchestrated rehabilitation protocols in conjunction with cellular therapies is provided. An overview of practical steps to increase the involvement of physical therapy in regenerative rehabilitation research also is provided. [ABSTRACT FROM AUTHOR]

People with Parkinson disease (PD) who show freezing of gait also have dysfunction in cognitive domains that interact with mobility. Specifically, freezing of gait is associated with executive dysfunction involving response inhibition, divided attention or switching attention, and visuospatial function. The neural control impairments leading to freezing of gait have recently been attributed to higher-level, executive and attentional cortical processes involved in coordinating posture and gait rather than to lower-level, sensorimotor impairments. To date, rehabilitation for freezing of gait primarily has focused on compensatory mobility training to overcome freezing events, such as sensory cueing and voluntary step planning. Recently, a few interventions have focused on restitutive, rather than compensatory, therapy. Given the documented impairments in executive function specific to patients with PD who freeze and increasing evidence of overlap between cognitive and motor function, incorporating cognitive challenges with mobility training may have important benefits for patients with freezing of gait. Thus, a novel theoretical framework is proposed for exercise interventions that jointly address both the specific cognitive and mobility challenges of people with PD who freeze. [ABSTRACT FROM AUTHOR]

Background. Cenricogenic headache and migraine are common causes of visits to physicians and physical therapists. Few randomized trials utilizing active physical therapy and progressive therapeutic exercise have been previously published. The existing evidence on active treatment methods supports a moderate effect on cervicogenic headache. Objective. The aim of this study is to investigate whether a progressive, group-based therapeutic exercise program decreases the intensity and frequency of chronic headache among women compared with a control group receiving a sham dose of transcutaneous electrical nerve stimulation (TENS) and stretching exercises. Design. A randomized controlled trial with 6-month intervention and follow-up was developed. The participants were randomly assigned to either a treatment group or a control group. Setting. The study is being conducted at 2 study centers. Patients. The participants are women aged 18 to 60 years with chronic cervicogenic headache or migraine. Intervention. The treatment group's exercise program consisted of 6 progressive therapeutic exercise modules, including proprioceptive low-load progressive craniocervical and cervical exercises and high-load exercises for the neck muscles. The participants in the control group received 6 individually performed sham TENS treatment sessions. Measurements. The primary outcome is the intensity of headache. The secondary outcomes are changes in frequency and duration of headache, neck muscle strength, neck and shoulder flexibility, impact of headache on daily life, neck disability, fear-avoidance beliefs, work ability, and quality of life. Between-group differences will be analyzed separately at 6, 12, and 24 months with generalized linear mixed models. In the case of count data (eg, frequency of headache), Poisson or negative binomial regression will be used. Limitations. The therapists are not blinded. Conclusions. The effects of specific therapeutic exercises on frequency, intensity, and duration of chronic headache and migraine will be reported. [ABSTRACT FROM AUTHOR]

Background. Hyperkyphosis negatively affects health status, physical mobility, and quality of life, but there is no standard protocol for treating people with hyperkyphosis. Treatment options include targeted exercise. Objectives. This single-site randomized controlled trial (RCT) will determine the efficacy of a targeted multimodal spine-strengthening exercise program, compared with no exercise intervention, among community-dwelling men and women aged ≥60 years. Design. The RCT is a parallel-group design, with 1:1 randomization to exercise and attentional control groups. Setting. The study will be conducted at one primary site (one academic medical center partnered with one local community medical center). Participants. One hundred men and women, aged ≥60 years, with thoracic kyphosis ≥40 degrees will be randomized. Intervention. The targeted multimodal spine-strengthening exercise intervention includes exercise and postural training delivered by a physical therapist in a group of 10 participants, 3 times a week for 6 months. Controls receive monthly health education meetings in a group of 10 participants and monthly calls from the study coordinator to monitor physical activity and any adverse events. Measurements. The primary outcome is change in Cobb angle of kyphosis measured from lateral spine radiographs at baseline and 6 months. Secondary outcomes include change in physical function (assessed with the modified Physical Performance Test, Timed "Up & Go" Test, timed loaded standing, 4-m walk, and Six-Minute Walk Test) and health-related quality of life (assessed with the modified Scoliosis Research Society instrument [SRS-30] self-image domain and Patient Reported Outcomes Measurement Information System [PROMIS] global health and physical function indexes). Additional secondary outcomes include pain, physical activity level, spinal flexion and extension muscle strength, paraspinal extensor muscle density, and adverse events. Limitations. Blinding of the participants and instructors providing the intervention is not possible. Conclusions. The efficacy of a high-quality, adequately powered exercise intervention in men and women with kyphosis ≥40 degrees will be evaluated to determine whether targeted multimodal spine-strengthening exercise reduces hyperkyphosis in older adults and improves important secondary outcomes of physical function and health-related quality of life. [ABSTRACT FROM AUTHOR]

Background. An effective compensatory stepping response is the first line of defense for preventing a fall during sudden large external perturbations. The biomechanical factors that contribute to heightened fall risk in survivors of stroke, however, are not clearly understood. It is known that impending sensorimotor and balance deficits poststroke predispose these individuals to a risk of fall during sudden external perturbations. Objective. The purpose of this study was to examine the mechanism of fall risk in survivors of chronic stroke when exposed to sudden, slip-like forward perturbations in stance. Design. This was a cross-sectional study. Methods. Fourteen individuals with stroke, 14 age-matched controls (AC group), and 14 young controls (YC group) were exposed to large-magnitude forward stance perturbations. Postural stability was computed as center of mass (COM) position (...COM/BOS) and velocity (XCOM/BOS) relative to the base of support (BOS) at first step lift-off (LO) and touch-down (TD) and at second step TD. Limb support was quantified as vertical hip descent (Zhip) from baseline after perturbation onset. Results. All participants showed a backward balance loss, with 71% of the stroke group experiencing a fall compared with no falls in the control groups (AC and YC groups). At first step LO, no between-group differences in XCOM/BOS and ... COM/BOS were noted. At first step TD, however, the stroke group had a significantly posterior XCOM/BOS and backward ... COM/BOS compared with the control groups. At second step TD, individuals with stroke were still more unstable (more posterior XCOM/BOS and backward ... COM/BOS) compared with the AC group. Individuals with stroke also showed greater peak Zhip compared with the control groups. Furthermore, the stroke group took a larger number of steps with shorter step length and delayed step initiation compared with the control groups. Limitations. Although the study highlights the reactive balance deficits increasing fall risk in survivors of stroke compared with healthy adults, the study was restricted to individuals with chronic stroke only. It is likely that comparing compensatory stepping responses across different stages of recovery would enable clinicians to identify reactive balance deficits related to a specific stage of recovery. Conclusions. These findings suggest the inability of the survivors of stroke to regain postural stability with one or more compensatory steps, unlike their healthy counterparts. Such a response may expose them to a greater fall risk resulting from inefficient compensatory stepping and reduced vertical limb support. Therapeutic interventions for fall prevention, therefore, should focus on improving both reactive stepping and limb support. [ABSTRACT FROM AUTHOR]

Background. The attainment of walking is a focus of physical therapy intervention in children with cerebral palsy (CP) and may affect their independence in mobility and participation in daily activities. However, knowledge of determinants of independent walking to guide physical therapists' decision making is lacking. Objective. The aim of this study was to identify child factors (postural control, reciprocal lower limb movement, functional strength, and motivation) and family factors (family support to child and support to family) that predict independent walking 1 year later in young children with CP at Gross Motor Function Classification System (GMFCS) levels II and III. Design. A secondary data analysis of an observational cohort study was performed. Methods. Participants were 80 children with CP, 2 through 6 years of age. Child factors were measured 1 year prior to the walking outcome. Parent-reported items representing family factors were collected 7 months after study onset. The predictive model was analyzed using backward stepwise logistic regression. Results. A measure of functional strength and dynamic postural control in a sit-to-stand activity was the only significant predictor of taking ≥3 steps independently. The positive likelihood ratio for predicting a "walker " was 3.26, and the negative likelihood ratio was 0.74. The model correctly identified a walker or "nonwalker " 75% of the time. Limitations. Prediction of walking ability was limited by the lack of specificity of child and family characteristics not prospectively selected and measurement of postural control, reciprocal lower limb movement, and functional strength 1 year prior to the walking outcome. Conclusions. The ability to transfer from sitting to standing and from standing to sitting predicted independent walking in young children with CP. Prospective longitudinal studies are recommended to determine indicators of readiness for independent walking. [ABSTRACT FROM AUTHOR]

Background and Purpose. A hospital-based pediatric outpatient center, wanting to weave evidence into practice, initiated an update of knowledge, skills, and documentation patterns with its staff physical therapists and occupational therapists who treat people with congenital muscular torticollis (CMT). This case report describes 2 cycles of implementation: (1) the facilitators and barriers to implementation and (2) selected quality improvement outcomes aligned with published clinical practice guidelines (CPGs). Case Description. The Pediatric Therapy Services of St Joseph's Regional Medical Center in New Jersey has 4 full-time, 1 part-time, and 3 per diem staff. Chart audits in 2012 revealed variations in measurement, interventions, and documentation that led to quality improvement initiatives. An iterative process, loosely following the knowledge-to-action cycle, included a series of in-service training sessions to review the basic anatomy, pathokinesiology, and treatment strategies for CMT; reading assignments of the available CPGs; journal review; documentation revisions; and training on the recommended measurements to implement 2 published CPGs and measure outcomes. Outcomes. A previous 1-page generic narrative became a 3-page CMT-specific form aligned with the American Physical Therapy Association Section on Pediatrics CMT CPG recommendations. Staff training on the Face, Legs, Activity, Cry, Consolability (FLACC) pain scale, classification of severity, type of CMT, prognostication, measures of cervical range of motion, and developmental progression improved documentation consistency from 0% to 81.9% to 100%. Clinicians responded positively to using the longer initial evaluation form. Discussion. Successful implementation of both clinical and documentation practices were facilitated by a multifaceted approach to knowledge translation that included a culture sup- portive of evidence-based practice, administrative support for training and documentation redesign, commitment by clinicians to embrace changes aimed at improved care, and clinical guidelines that provide implementable recommendations. [ABSTRACT FROM AUTHOR]

Policy studies are a recent addition to the American Physical Therapy Association's Research Agenda and are critical to our understanding of various federal, state, local, and organizational policies on the provision of physical therapist services across the continuum of care. Policy analyses that help to advance the profession's various policy agendas will require relevant theoretical frameworks to be credible. The purpose of this perspective article is to: (1) demonstrate the use of a policy-making theory as an analytical framework in a policy analysis and (2) discuss how sound policy analysis can assist physical therapists in becoming more effective change agents, policy advocates, and partners with other relevant stakeholder groups. An exploratory study of state agency policy responses to address work-related musculoskeletal disorders is provided as a contemporary example to illustrate key points and to demonstrate the importance of selecting a relevant analytical framework based on the context of the policy issue under investigation. [ABSTRACT FROM AUTHOR]