Search

A clinical practice guideline on telerehabilitation was developed by an American Physical Therapy Association volunteer guideline development group consisting of international physical therapists and physiotherapists, a physician, and a consumer. The guideline was based on systematic reviews of current scientific literature, clinical information, and accepted approaches to telerehabilitation in physical therapist practice. Seven recommendations address the impact of, preparation for, and implementation of telerehabilitation in physical therapist practice. Research recommendations identify current gaps in knowledge. Overall, with shared decision-making between clinicians and patients to inform patients of service delivery options, direct and indirect costs, barriers, and facilitators of telerehabilitation, the evidence supports the use of telerehabilitation by physical therapists for both examination and intervention. The Spanish and Chinese versions of this clinical practice guideline, as well as the French version of the recommendations, are available as supplementary material (Suppl. Materials)., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Physical Therapy Association.)

Purpose: The purpose of the 2019 practice analysis was to identify the elements of contemporary practice as a board-certified pediatric clinical specialist., Methods: Consistent with the processes of the American Board of Physical Therapy Specialties (ABPTS), a subject matter expert panel used consensus-based processes to develop a survey to gather information concerning the knowledge areas, professional roles and responsibilities, practice expectations, and practice demographics of board-certified pediatric clinical specialists. The web-based survey was divided into 3 parts and administered to 3 separate groups of board-certified pediatric clinical specialists., Results: Survey responses from 323 clinical specialists provided data to support confirmation and revision of the Description of Specialty Practice (DSP) for pediatrics., Conclusions: The revised DSP will provide contemporary practice information to inform the ABPTS specialist examination blueprint and the curricula of credentialed residency programs in pediatric physical therapy.

Background: In the domain of academia, the scholarship of research may include, but not limited to, peer-reviewed publications, presentations, or grant submissions. Programmatic research productivity is one of many measures of academic program reputation and ranking. Another measure or tool for quantifying learning success among physical therapists education programs in the USA is 100 % three year pass rates of graduates on the standardized National Physical Therapy Examination (NPTE). In this study, we endeavored to determine if there was an association between research productivity through artifacts and 100 % three year pass rates on the NPTE., Methods: This observational study involved using pre-approved database exploration representing all accredited programs in the USA who graduated physical therapists during 2009, 2010 and 2011. Descriptive variables captured included raw research productivity artifacts such as peer reviewed publications and books, number of professional presentations, number of scholarly submissions, total grant dollars, and numbers of grants submitted. Descriptive statistics and comparisons (using chi square and t-tests) among program characteristics and research artifacts were calculated. Univariate logistic regression analyses, with appropriate control variables were used to determine associations between research artifacts and 100 % pass rates., Results: Number of scholarly artifacts submitted, faculty with grants, and grant proposals submitted were significantly higher in programs with 100 % three year pass rates. However, after controlling for program characteristics such as grade point average, diversity percentage of cohort, public/private institution, and number of faculty, there were no significant associations between scholarly artifacts and 100 % three year pass rates., Conclusions: Factors outside of research artifacts are likely better predictors for passing the NPTE.

Unlabelled: The American Physical Therapy Association's (APTA) Strategic Plan strives to increase the number of APTA credentialed clinical instructors. Available to all health care providers, as of 2012, there were 39,851 credentialed clinical instructors., Objectives: Study purposes were threefold: to determine participants' a. reasons to attend the APTA Credentialed Clinical Instructor Program (CCIP); b. pre-CCIP learning goals; and c. related post-CCIP learning outcomes., Methods: This IRB-approved study was completed with informed consent procedures followed. APTA CCIP credentialed trainers (n=5) developed a survey and pilot tested for face and content validity. The instrument included demographics, forced choice and open-ended questions. The pre/post survey was administered to 301 participants of 21 Florida APTA CCIP courses with 5 trainers from 2009-2011. Quantitative survey data were collated, tabulated, and summarized comparing pre/post data. Narrative data was analyzed for codes and themes, synthesized, re-contextualized and triangulated by trainers then cross-compared with APTA CCIP objectives and trainer expertise. The qualitative insights were presented with resulting primary themes and subthemes., Results: Results informed the study purposes with a clear determination of the reasons participants attend the APTA CCIP, the pre-course goals and post learning outcomes. Participants overwhelmingly recommend the APTA CCIP and most receive support from employers with geographic course location being a prime reason for course selection. Precourse learning goals included 5 over-arching themes, with few sub-themes; while post learning outcomes generated 12 specific themes with numerous subthemes., Conclusions: APTA CCIP-credentialed clinical instructors are achieving numerous learning outcomes immediately applicable for clinical education.

Objective: Conduct a pilot study to establish the reliability and validity of a survey instrument that directly measures the objectives and content of the APTA CIECP; and measure the self-reported frequency of use of the behaviors taught in the APTA CIECP., Participants: Eighteen (18) APTA credentialed CIs., Methods: Develop a web-based survey consisting of 58 items representative of the behaviors taught in the APTA CIECP and 8 demographic characteristics. Establish the content validity and reliability of the survey instrument. Conduct a descriptive analysis of the frequency of self-reported use of the behaviors., Results: The APTA Clinical Instructor Education Board (CIEB) reviewed the items and determined that the items matched the objectives and content of the APTA CIECP, thereby establishing content validity. Cronbach's alpha coefficients ranging from 0.79-0.90 confirmed the reliability. The overall mean for all items on a 1-6 scale was 4.81., Conclusions: The content validity and reliability of the survey instrument were established. The outcomes of this pilot study suggest that when measured by a valid and reliable instrument that is representative of the objectives and content of the CIECP, the behaviors taught in the CIECP are being applied in the clinical setting by APTA credentialed clinical instructors.

Background: The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 contain provisions specific to health care quality that apply to physical therapists. Published evidence examining gaps in the quality of physical therapy services is limited., Objective: The primary purpose of this study was to determine the use of quality indicators in physical therapist practice., Design: This was an observational study., Methods: All members of the Orthopaedic and Private Practice sections of the American Physical Therapy Association were invited to participate by completing an electronic survey. The survey included 22 brief patient descriptions, each followed by questions regarding the use of examinations and interventions based on the 2009 list of Medicare-approved quality measures. Separate multivariate logistic regression models were used to determine the odds ratios related to the performance of each examination and intervention on more than 90% of patients, given perceptions of its importance to care, the burden of performing it, and the level of evidence supporting its use., Results: Participants (n=2,544) reported a relatively low frequency of performing examinations and interventions supporting primary and secondary prevention (3.6%-51.3%) and use of standardized measures (5.5%-35.8%). Perceptions of high importance and low burden were associated with greater odds of performing an examination or intervention. Importance and burden were more influential factors than the perceived availability of evidence to support use of identified techniques., Limitations: The survey was not assessed for test-retest reliability. A low response rate was a source of potential bias., Conclusion: The study findings suggest that physical therapists may not see themselves as providers of primary or secondary prevention services. Patient management strategies associated with these types of services also may be perceived as relatively unimportant or burdensome.

Nationally agreed-upon standards for competence are needed for burn physical and occupational rehabilitation therapists (BRTs) to define what constitutes safe and competent burn rehabilitation practice. Currently, consensus regarding the knowledge and skill components needed for the training and evaluation of BRT job performance is lacking. The Rehabilitation Committee of the American Burn Association used a staged, multimethod approach and input from more than 25 experts in the burn rehabilitation community to develop competency standards for BRTs. The result was the "Burn Rehabilitation Therapist Competency Tool" (BRTCT) that defines competency domains required of BRTs to provide physical and occupational therapy to patients with burn injury during their initial acute hospitalization and rehabilitation. This article describes the staged development and validation of the BRTCT. The component parts of the tool itself are presented, and the recommendations for assessment of competence are discussed. The BRTCT provides a common framework and language for expectations of performance in burn rehabilitation. Development of the BRTCT is a critical step in the ongoing process of promoting professional development and consistent practice standards in burn rehabilitation.

The Delphi survey is a useful mechanism to make recommendations for clinical judgments in the absence of practice guidelines for evidence-based decision making. Although there is a great deal of literature about the topic of various methods of balance assessment, decisions about application of research evidence for clinical practice may be subject to personal interpretation and/or biases of the reader. In this study, a panel of informed experts was used through a Delphi process to establish consensus regarding the recommended use of selected balance assessment methods based on the literature. Selective recruitment of experienced faculty members with advanced degrees and/or specialist certification in the content area identified seven knowledgeable informants. The panel participated in three rounds of discussion to develop a consensus-based summary of the recommended use of balance assessment methods commonly used in clinical practice and suggest how those measures fit within the framework of the Patient/Client Management Model of physical therapy practice. The outcomes of the Delphi process form a basis for recommended practice in the examination of patients with balance deficits and serve as a starting point in the development of evidence-based practice guidelines.

In 2008, the Hand Therapy Certification Commission (HTCC), in consultation with Professional Examination Service, performed a practice analysis study of hand therapy, the fourth in a series of similar studies performed by HTCC over a 23-year period. An updated profile of the domains, tasks, knowledge, and techniques and tools used in hand therapy practice was developed by subject-matter experts representing a broad range of experiences and perspectives. A large-scale online survey of hand therapists from the United States, Canada, Australia, and New Zealand overwhelmingly validated this profile. Additionally, trends in hand therapy practice and education were explored and compared with the previous studies. The results led to the revision of the test specifications for the Hand Therapy Certification Examination; permitted refinement of the definition and scope of hand therapy; identified professional development and continuing education opportunities; and guided HTCC policy decisions regarding exam and recertification eligibility requirements.

Together with the updated Medicare Physician Fee Schedule Final Rule published in the Federal Register, November 27, 2007, the Center for Medicare and Medicaid Services (CMS) revised the personnel qualification standards for therapy services by amending Medicare Regulation 42 Code of Federal Regulations (CFR), Section 484.4. These new qualifications and grandfathering provisions applied to home health January 1, 2008 and will apply to all settings by December 31, 2009. As stated by CMS, these changes were necessary to have consistent standards for personnel providing therapy services in all settings, to correct outdated terminology related to relevant professional organizations, and to update the licensure, training, and education requirements for all therapists, whether trained in the United States or in a foreign setting. It is important for agencies to review the requirements now because some therapy staff may need the next year to fulfill certain educational and national examination requirements, depending on their state of practice, and to be considered qualified based on the grandfathering provisions.

Background and Purpose: Diagnosis is a complex process that involves clinical decision-making along several dimensions, culminating in the assignment of a label or labels which inform(s) treatment decisions. Much of the attention given to physiotherapy diagnosis has been devoted to specific, disparate classification systems for low back pain. The purpose of the present study was to investigate how physiotherapists view and approach diagnosis in clinical practice in the USA., Method: A survey was developed to collect both quantitative and qualitative data related to diagnostic process and classification in orthopaedic practice. Subjects comprised 253 Board-certified orthopaedic physiotherapy practitioners. A total of 850 surveys were administered; 253 surveys were completed, representing a return rate of 30%., Results: Eighty-four per cent of the respondents report patient care as their primary professional practice area. Seventy-six per cent of the subjects utilized a diagnostic classification system distinct from the medical diagnosis when managing patients with low back pain. Of those, the largest percentage (38%) utilized a general pathophysiological classification system, 32% utilized the McKenzie system and, in decreasing order of frequency, treatment-based classification (9%) and movement impairment classification (7%). Qualitative data suggest considerable variation in how orthopaedic specialists view diagnosis in patient management, with several common themes emerging: physiotherapy diagnosis may incorporate the medical diagnosis, but moves beyond it; physiotherapy diagnosis occurs across multiple levels or systems; physiotherapists tend to view diagnosis as being process-oriented with its primary purpose being to guide treatment decisions., Conclusions: As physiotherapy evolves from a profession that treats by prescription to a doctoring profession it should give serious attention to diagnosis, the foundation of evidence-based practice. Striving for consensus on the role of diagnosis in patient management should become a priority, as well as developing a more standard taxonomy with consistent terminology.

Unlabelled: The Institute of Medicine (IOM) has recommended instituting clinical education reforms to ensure all health profession graduates acquire five core competencies; providing patient-centered care, working in interdisciplinary teams, employing evidence-based practice, applying quality improvement and utilizing informatics. The IOM has identified 28 specific skills associated with these competencies. This qualitative, exploratory study was conducted to begin to examine the extent to which physical therapy clinical instructors provide students with instruction the students perceived as promoting the acquisition of these skills., Methods: Two groups of physical therapy students enrolled in a 3-year DPT program (7 on a first-year clinical education experience and 17 on a final year experience) maintained journals describing the types of learning activities used by clinical instructors to promote the acquisition of the competencies. The authors employed NVivo qualitative data analysis software to code the journal entries using 28 codes derived from the skills associated with the five core competencies., Results: Of the 327 coded learning activities, just over 50% were related to skills associated with providing patient-centered care (21.4%) and working in interdisciplinary teams (30.0%). The remaining 49.6% of the learning activities cited by students were related to skills associated with employing evidence-based practice (18.3%), applying quality improvement (16.5%) and utilizing informatics (13.8%)., Discussion: Based on student perceptions, physical therapy clinical instructors are providing learning activities that allow students to acquire skills associated with all five of the IOM competencies. However, students reported the least emphasis on instruction pertaining to the competencies of applying quality improvement and utilizing informatics., Conclusion: This study supports the need for the profession of physical therapy to delineate formal and explicit clinical education instructional content and strategies to promote students' acquisition of the IOM core competency skills.

The physical therapy profession's diagnostic dilemma results from its confused response to competing issues that affect the physical therapist's role as a diagnostician. The major components of the diagnostic dilemma are: (1) the competition among new ideas, (2) the complexity of the diagnostic process and language used to describe the outcome, (3) the profession's lack of consensus regarding the diagnostic classification construct to be embraced, and (4) the rapid evolution and impact of new knowledge. The interaction of these 4 components results in "diagnostic disablement." Whether managing a patient, creating a curriculum to educate new physical therapy practitioners, or applying for research funding to study the science or practice of diagnostic classification, physical therapists face a real challenge in understanding and complying with all the current diagnostic requirements of the US health care system and the physical therapy profession. This article traces the 4 components and considers the strategies the profession can use to resolve its diagnostic dilemma. The first step would be to standardize the language that physical therapists use to describe or diagnose phenomena within their scope of practice.

Background and Purpose: Administration and management (A and M) skills are essential to physical therapist practice. This study identified which A and M skills will be most critical for future Doctor of Physical Therapy (DPT) graduates to possess upon entry into clinical practice., Subjects and Methods: Using a 7-point scale, 435 randomly selected American Physical Therapy Association members (physical therapists) rated 121 A and M skills based on expectation of the level of independence required by a new DPT graduate., Results: No differences among respondents based on role, work setting, or experience were found, so the data were combined for factor analyses, producing 16 A and M skill groups. The most independence was expected in skills related to self-management, compliance with rules, ethical behavior, and insurance coding. Skills requiring the most assistance were marketing and strategic planning, financial analysis and budgeting, and environmental assessment., Discussion and Conclusion: This study has identified the level of independence for the A and M skills needed by new DPT graduates, provided empirical evidence suggesting which A and M skills should be included in DPT curricula, and suggested a pattern of A and M skill acquisition that applies first to the new therapist and the patient, then to the organization, and finally to the health care environment.

Background and Purpose: The American Physical Therapy Association (APTA) has identified the Doctor of Physical Therapy (DPT) degree as 1 of 6 elements necessary to transition the physical therapy profession to a fully professionalized discipline. However, there have been no data to determine whether physical therapist students who place importance on the DPT degree perceive physical therapy to be more professionalized or anticipate participation in activities reflecting professionalism more than those who do not place importance on the DPT degree., Subjects: The subjects were 919 professional physical therapist students., Methods: Faculty members at 34 physical therapist education programs distributed questionnaires to 1,172 professional physical therapist students and returned 919 questionnaires, for a response rate of 78.4%. The data were statistically analyzed using chi-square analysis and logistic regression., Results: There were few differences between students who place importance on the DPT degree (DPT-I students) and those who do not place importance on the DPT degree (DPT-NI students) regarding how professionalized they perceive physical therapy to be relative to other health care professions or regarding their anticipated participation in activities reflecting professionalism. The one potential distinction found when controlling for other variables was that DPT-I students were more likely than DPT-NI students to anticipate becoming faculty members., Discussion and Conclusion: When beginning their professional education, there are few differences between DPT-I and DPT-NI students' perceptions of the professionalization of physical therapy or anticipation of activities reflecting professionalism.

Purpose: The purpose of this article is to present a case study that documents how management science techniques (in particular data envelopment analysis) can be applied to performance improvement initiatives in an inpatient physical therapy setting., Design/methodology/approach: The data used in this study consist of patients referred for inpatient physical therapy following total knee replacement surgery (at a medium-sized medical facility in the Midwestern USA) during the fiscal year 2002. Data envelopment analysis (DEA) was applied to determine the efficiency of treatment, as well as to identify benchmarks for potential patient improvement. Statistical trends in the benchmarking and efficiency results were subsequently analyzed using non-parametric and parametric methods., Findings: Our analysis indicated that the rehabilitation process was largely effective in terms of providing consistent, quality care, as more than half of the patients in our study achieved the maximum amount of rehabilitation possible given available inputs. Among patients that did not achieve maximum results, most could obtain increases in the degree of flexion gain and reductions in the degree of knee extension., Research Limitations/implications: The study is retrospective in nature, and is not based on clinical trial or experimental data. Additionally, DEA results are inherently sensitive to sampling: adding or subtracting individuals from the sample may change the baseline against which efficiency and rehabilitation potential are measured. As such, therapists using this approach must ensure that the sample is representative of the general population, and must not contain significant measurement error. Third, individuals who choose total knee arthroplasty will incur a transient disability. However, this population does not generally fit the World Health Organization International Classification of Functioning, Disability and Health definition of disability if the surgical procedure is successful. Since the study focuses on the outcomes of physical therapy, range of motion measurements and circumferential measurements were chosen as opposed to the more global measures of functional independence such as mobility, transfers and stair climbing. Applying this technique to data on patients with different disabilities (or the same disability with other outcome variables, such as Functional Independence Measure scores) may give dissimilar results., Practical Implications: This case study provides an example of how one can apply quantitative management science tools in a manner that is both tractable and intuitive to the practising therapist, who may not have an extensive background in quantitative performance improvement or statistics., Originality/value: DEA has not been applied to rehabilitation, especially in the case where managers have limited data available.

Background and Purpose: Little research has been done regarding the attitudes and behaviors of physical therapists relative to the use of evidence in practice. The purposes of this study were to describe the beliefs, attitudes, knowledge, and behaviors of physical therapist members of the American Physical Therapy Association (APTA) as they relate to evidence-based practice (EBP) and to generate hypotheses about the relationship between these attributes and personal and practice characteristics of the respondents., Methods: A survey of a random sample of physical therapist members of APTA resulted in a 48.8% return rate and a sample of 488 that was fairly representative of the national membership. Participants completed a questionnaire designed to determine beliefs, attitudes, knowledge, and behaviors regarding EBP, as well as demographic information about themselves and their practice settings. Responses were summarized for each item, and logistic regression analyses were used to examine relationships among variables., Results: Respondents agreed that the use of evidence in practice was necessary, that the literature was helpful in their practices, and that quality of patient care was better when evidence was used. Training, familiarity with and confidence in search strategies, use of databases, and critical appraisal tended to be associated with younger therapists with fewer years since they were licensed. Seventeen percent of the respondents stated they read fewer than 2 articles in a typical month, and one quarter of the respondents stated they used literature in their clinical decision making less than twice per month. The majority of the respondents had access to online information, although more had access at home than at work. According to the respondents, the primary barrier to implementing EBP was lack of time., Discussion and Conclusion: Physical therapists stated they had a positive attitude about EBP and were interested in learning or improving the skills necessary to implement EBP. They noted that they needed to increase the use of evidence in their daily practice.

The Hand Therapy Certification Commission, Inc., in consultation with the Professional Examination Service, completed a practice analysis of hand therapy in 2001. One goal was to obtain information about the competencies shown by therapists at specific points of experience. Six competency areas were identified and included in the final survey: scientific knowledge, clinical judgment/clinical reasoning, technical skills, interpersonal and communication skills, professionalism, and resource management. Certified Hand Therapists (CHTs) in the United States and Canada participated in the survey. All six competencies were rated moderately or highly critical to professional effectiveness. Thirty hypothesized behavioral progressions (from novice to expert) were included; 27 were validated by the results, indicating that CHTs show competence that is unique and increases over time. Potential uses of these results by CHTs and hand therapy organizations are proposed, especially in regard to candidate eligibility, self-assessment by CHTs, and planning for continuing education.