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Journal articles on the topic 'Physical therapist and patient'
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O'Keeffe, Mary, Paul Cullinane, John Hurley, Irene Leahy, Samantha Bunzli, Peter B. O'Sullivan, and Kieran O'Sullivan. "What Influences Patient-Therapist Interactions in Musculoskeletal Physical Therapy? Qualitative Systematic Review and Meta-Synthesis." Physical Therapy 96, no. 5 (May 1, 2016): 609–22. http://dx.doi.org/10.2522/ptj.20150240.
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Background Musculoskeletal physical therapy involves both specific and nonspecific effects. Nonspecific variables associated with the patient, therapist, and setting may influence clinical outcomes. Recent quantitative research has shown that nonspecific factors, including patient-therapist interactions, can influence treatment outcomes. It remains unclear, however, what factors influence patient-therapist interaction. Purpose This qualitative systematic review and meta-synthesis investigated patients' and physical therapists' perceptions of factors that influence patient-therapist interactions. Data Sources Eleven databases were searched independently. Study Selection Qualitative studies examining physical therapists' and patients' perceptions of factors that influence patient-therapist interactions in musculoskeletal settings were included. Data Extraction Two reviewers independently selected articles, assessed methodological quality using the Critical Appraisal Skills Programme (CASP), and performed the 3 stages of analysis: extraction of findings, grouping of findings (codes), and abstraction of findings. Data Synthesis Thirteen studies were included. Four themes were perceived to influence patient-therapist interactions: (1) physical therapist interpersonal and communication skills (ie, presence of skills such as listening, encouragement, confidence, being empathetic and friendly, and nonverbal communication), (2) physical therapist practical skills (ie, physical therapist expertise and level of training, although the ability to provide good education was considered as important only by patients), (3) individualized patient-centered care (ie, individualizing the treatment to the patient and taking patient's opinions into account), and (4) organizational and environmental factors (ie, time and flexibility with care and appointments). Limitations Only studies published in English were included. Conclusions A mix of interpersonal, clinical, and organizational factors are perceived to influence patient-therapist interactions, although research is needed to identify which of these factors actually influence patient-therapist interactions. Physical therapists' awareness of these factors could enhance patient interactions and treatment outcomes. Mechanisms to best enhance these factors in clinical practice warrant further study.
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Sutliff, Matthew H. "Team Focus: Physical Therapist." International Journal of MS Care 10, no. 4 (January 1, 2008): 127–32. http://dx.doi.org/10.7224/1537-2073-10.4.127.
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Multiple sclerosis (MS) is a complex neurological disease that requires comprehensive multidiscipli-nary care to maximize patient outcomes. A multidisciplinary health care team treating MS patients often consists of neurologists, physiatrists, nurses, physician assistants or nurse practitioners, and physical and occupational therapists, many of whom are specialists in MS. This article clarifies the role of the physical therapist in the care of patients within a multidisciplinary MS clinic.
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Trummer, Garrett, Richard Stephens, and Nicholas B. Washmuth. "A Physical Therapist Who Swears: A Case Series." Journal of Rehabilitation Medicine - Clinical Communications 6 (April 27, 2023): jrmcc010277. http://dx.doi.org/10.2340/jrmcc.v6.10277.
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Objective: Swearing deserves attention in the physical therapy setting due to its potential positive psychological, physiological, and social effects. The purpose of this case series is to describe 2 cases in which a physical therapist swears in the clinical setting and its effect on therapeutic alliance.Patients: Case 1 is a 19-year-old male treated for a hamstring strain, and case 2 is a 23-year-old male treated post-operatively for anterior cruciate ligament reconstruction. The physical therapist utilized social swearing in the clinic with the goal of motivating the patient and enhancing the social connection with the patient, to improve therapeutic alliance.Results: The patient in case 1 reported a decrease in therapeutic alliance after the physical therapist began swearing during physical therapy treatments, whereas the patient in case 2 reported an increase in therapeutic alliance. Both patients disagreed that physical therapist swearing is unprofessional and disagreed that swearing is offensive, and both patients agreed physical therapists should be able to swear around their patients.Conclusion: Physical therapist swearing may have positive and negative influences in the clinic setting and may not be considered unprofessional. These are, to our knowledge, the first published cases of a physical therapist swearing in the clinical setting. LAY ABSTRACTSwearing produces positive effects that cannot be achieved with any other forms of language. Quite simply, swearing is powerful and deserves attention in the physical therapy setting. Swearing can lead to tighter human bonds, thereby enhancing the social connection between a patient and a physical therapist. This case series describes 2 cases where a physical therapist swears with patients in the clinical setting and its effect on their social connection. While swearing increased the social connection in 1 case, it decreased it in the other case. None of the patients thought that physical therapist swearing was unprofessional, and both patients believe physical therapists should be able to swear around their patients. The results of these cases indicate that physical therapist swearing can have positive and negative influences in the clinic. More studies are needed to help determine when, how, and if to swear in the physical therapy setting.
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Baker, Susan M., Helen H. Marshak, Gail T. Rice, and Grenith J. Zimmerman. "Patient Participation in Physical Therapy Goal Setting." Physical Therapy 81, no. 5 (May 1, 2001): 1118–26. http://dx.doi.org/10.1093/ptj/81.5.1118.
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Abstract Background and Purpose. An important part of treatment planning in physical therapy is effective goal setting. The Guide to Physical Therapist Practice recommends that therapists should identify the patient's goals and objectives during the initial examination in order to maximize outcomes. The purpose of this study was to examine whether therapists seek to involve patients in goal setting and, if so, what methods they use. Therapists' attitudes toward participation and patient satisfaction with the examination were also examined. Subjects and Methods. Twenty-two physical therapists audiotaped the initial examination of 73 elderly patients (X̄=76.4 years of age, SD=7.1, range=65–94). The audiotaped examinations were then scored using the Participation Method Assessment Instrument (PMAI) to determine the frequency of attempts made by therapists to involve patients in goal setting. Therapists and patients completed surveys following the examinations. Results. Therapists' use of participation methods during examinations ranged from a minimum of 1 to a maximum of 19 out of 21 possible items on the PMAI. The therapists stated that they believed that it is important to include patients in goal-setting activities and that outcomes will be improved if patients participate. Patients also indicated that participation is important to them. Discussion and Conclusion. In most cases, the therapists did not fully take advantage of the potential for patient participation in goal setting. Patient and therapist education is needed regarding methods for patient participation during initial goal-setting activities.
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Anderson, Lynley, and Clare Delany. "From Persuasion to Coercion: Responding to the Reluctant Patient in Rehabilitation." Physical Therapy 96, no. 8 (August 1, 2016): 1234–40. http://dx.doi.org/10.2522/ptj.20150586.
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AbstractEarly mobilization of patients while in hospital has been demonstrated to provide better outcomes for patients and use fewer resources. Physical therapy–based rehabilitation is central to achieving those goals. Successful rehabilitation requires that patient's and therapist's goals align, and this is commonly the case. However, occasionally, physical therapists will come across patients who are competent but reluctant to mobilize. This situation leaves the physical therapist in an ethical quandary: either accept the patient's right to refuse proposed treatment or utilize other strategies to encourage the patient to adhere to treatment. Practically, physical therapists will use a range of treatment pressures, including persuasion, offering incentives, inducements, possibly threatening or coercing, and even explicitly overriding the patient's wishes (compulsion). Deciding which treatment pressure is ethically acceptable involves the physical therapist balancing his or her therapeutic view of what is in a patient's best interests against the therapist's ethical responsibility to respect patient autonomy. This article evaluates some common strategies used by physical therapists to influence, persuade, or perhaps pressure patients to adhere to rehabilitation. The work of Szmukler and Appelbaum is utilized in analyzing treatment pressures. The authors conclude that there is a spectrum of treatment pressures, with some (persuasion and incentives) being more acceptable than others (threats and compulsion). As physical therapists balance health system pressures for rapid turnover of beds with obligations to benefit patients within limited reimbursement models, while respecting the patients' autonomy, they must be mindful of the effects of treatment pressure on patient care.
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Jensen, Gail M., Jan Gwyer, Katherine F. Shepard, and Laurita M. Hack. "Expert Practice in Physical Therapy." Physical Therapy 80, no. 1 (January 1, 2000): 28–43. http://dx.doi.org/10.1093/ptj/80.1.28.
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Abstract Background and Purpose. The purpose of this qualitative study was to identify the dimensions of clinical expertise in physical therapy practice across 4 clinical specialty areas: geriatrics, neurology, orthopedics, and pediatrics. Subjects. Subjects were 12 peer-designated expert physical therapists nominated by the leaders of the American Physical Therapy Association sections for geriatrics, neurology, orthopedics, and pediatrics. Methods. Guided by a grounded theory approach, a multiple case study research design was used, with each of the 4 investigators studying 3 therapists working in one clinical area. Data were obtained through nonparticipant observation, interviews, review of documents, and analysis of structured tasks. Videotapes made during selected therapist-patient treatment sessions were used as a stimulus for the expert therapist interviews. Data were transcribed, coded, and analyzed through the development of 12 case reports and 4 composite case studies, one for each specialty area. Results. A theoretical model of expert practice in physical therapy was developed that included 4 dimensions: (1) a dynamic, multidimensional knowledge base that is patient-centered and evolves through therapist reflection, (2) a clinical reasoning process that is embedded in a collaborative, problem-solving venture with the patient, (3) a central focus on movement assessment linked to patient function, and (4) consistent virtues seen in caring and commitment to patients. Conclusion and Discussion. These findings build on previous research in physical therapy on expertise. The dimensions of expert practice in physical therapy have implications for physical therapy practice, education, and continued research.
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Beattie, Paul F., Mary Beth Pinto, Martha K. Nelson, and Roger Nelson. "Patient Satisfaction With Outpatient Physical Therapy: Instrument Validation." Physical Therapy 82, no. 6 (June 1, 2002): 557–65. http://dx.doi.org/10.1093/ptj/82.6.557.
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Abstract Background and Purpose. Patient satisfaction with physical therapy is used as an outcome variable. The purpose of this study was to develop and test an instrument used to determine which variables are associated with the satisfaction of patients receiving outpatient physical therapy. Subjects. During the pilot study, 191 patients participated, and 1,868 patients then participated in the main phase of this work. Methods. Using a survey instrument developed by the authors, subjects responded to global questions concerning overall satisfaction with physical therapy. Content validation of the instrument was investigated using item correlation, principal components analysis, and factor analysis. Reliability was measured using the standard error of measurement. Concurrent validity was investigated by correlating summary scores of the final survey instrument with global measures of satisfaction. Results. Reliability was best for a 10-item questionnaire. Patient satisfaction was most associated with items that reflected a high-quality interaction with the therapist (eg, time, adequate explanations and instructions to patients). Environmental factors such as clinic location, parking, time spent waiting for the therapist, and type of equipment used were not strongly correlated with overall satisfaction with care. Discussion and Conclusion. Because the time the therapist spent with patients and the behavior of the therapists are important for patient satisfaction, emphasis on cost-cutting, high patient volume, and the use of “care extenders” may jeopardize satisfaction.
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Jamil, Dr Komal. "PHYSICAL THERAPIST PARTICIPATION IN GOAL SETTINGS FOR PATIENT MANAGEMENT." Pakistan Journal of Rehabilitation 11, no. 2 (July 7, 2022): 42–49. http://dx.doi.org/10.36283/pjr.zu.11.2/008.
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Background and Aim: To identify physical therapist participation in goal settings for patient management. Goal setting is an effective method for serving a mentee to develop a strong foundation for future planning. Methodology: Descriptive cross sectional study was conducted at different physical therapy departments, clinics, and hospitals of Karachi. A total of 100 physical therapists were given a validated questionnaire to complete. The questionnaire contains 21 questions related to patient preparation, concerns, and the goal setting process. Data was analyzed by SPSS version 21. Confidentiality of the participants was maintained. Data was coded and subjects were given the rights to willingly participate. Results: Most of the physical therapists indicated that they had been participation in goal settings for patient management. 60% of the physical therapists take part in goal settings for patient management, and the rest of the physical therapists were neutral. It will help the physical therapist for making the goals for the patient recovery. Conclusion: The conclusion of the study is that goal setting is a very satisfactory activity for the patient management. By setting their goals physical therapists recognize their own capability and competence in accomplishing the pretensions that they have set. Goal setting is a major component for the physical therapists for planning the management of the patient and making the goals to attain it because there's a fantastic courting among the aim placing and mission performance. Objective placing consists of the development of a hobby plan deliberate to encourage and direct an person or amassing in the direction of an objectives. This study helps you to organize your time by setting their goals and you fete your own ability and proficiency in attain the goals that you have set. Goal setting helps the physical therapist to know about the history, chances of recovery of the patient and the progress about the patient.
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Cleland, Joshua A., and Jane Walter Venzke. "Dermatomyositis: Evolution of a Diagnosis." Physical Therapy 83, no. 10 (October 1, 2003): 932–45. http://dx.doi.org/10.1093/ptj/83.10.932.
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Abstract Background and Purpose. As direct access evolves, physical therapists will increasingly encounter patients with pathology that might have an underlying systemic origin. The purpose of this case report is to describe the diagnostic process that led a patient's physical therapist to recognize signs and symptoms of dermatomyositis. Case Description. The patient was an 18-year-old woman who was referred for physical therapy by her primary care physician on 3 occasions with 3 separate musculoskeletal diagnoses. During the third episode, the physical therapist recognized signs and symptoms that could be indicative of dermatologic disease and referred the patient to a dermatologist. Outcomes. A rheumatologist diagnosed the patient's condition as dermatomyositis and referred her for physical therapy. The physical therapy plan of care focused on strengthening and stretching, with an emphasis on a home exercise program. The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) indicated that the patient continually made functional improvements over an 18-month period. Discussion. Although diagnosis of diseases such as inflammatory myopathies is not within a physical therapist's scope of practice, this case demonstrates the role a physical therapist can play in recognition of underlying systemic pathology by using the diagnostic process.
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Resnik, Linda, and Dennis L. Hart. "Using Clinical Outcomes to Identify Expert Physical Therapists." Physical Therapy 83, no. 11 (November 1, 2003): 990–1002. http://dx.doi.org/10.1093/ptj/83.11.990.
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Abstract Background and Purpose. Previous studies of expert physical therapists have sampled therapists based on years of clinical experience or reputation, not on their patients' clinical outcomes. The purposes of this study were to identify expert physical therapists by using patient self-reported outcomes and to describe the characteristics of clinicians whose patients with lumbar spine syndromes reported higher health-related quality of life (HRQL) following rehabilitation. Methods. Retrospective data were analyzed on 24,276 patients (mean age=47.8 years, SD=16, range=14–97) with lumbar spine syndromes treated by 930 physical therapists participating in the Focus On Therapeutic Outcomes database in 1999–2000. Physical therapists and staff answered questions concerning years of experience and practice setting when starting their participation in the outcomes system. Patient self-report HRQL data were collected at intake and discharge from outpatient rehabilitation. Discharge HRQL data were risk adjusted using patient characteristics. Data were aggregated by physical therapist. Risk-adjusted discharge HRQL scores were used to classify physical therapists whose patients reported mean HRQL improvement above the 90th percentile as experts and physical therapists whose patients reported mean HRQL improvement between the 45th and 55th percentiles as average. Results. Therapists classified as expert had fewer patients in the database than did therapists classified as average (X̄±SD) (19±17 versus 29±22). Mean treatment duration was different between groups (32±11 days for the expert group versus 31±8 days for the average group). Discussion and Conclusion. The results challenge assumptions that extensive clinical experience is necessary to achieve superior patient outcomes, and they provide information about the relationship between therapist characteristics and patient outcomes.
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Dierckx, Katreine, Myriam Deveugele, Philip Roosen, and Ignaas Devisch. "Implementation of Shared Decision Making in Physical Therapy: Observed Level of Involvement and Patient Preference." Physical Therapy 93, no. 10 (October 1, 2013): 1321–30. http://dx.doi.org/10.2522/ptj.20120286.
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BackgroundShared decision making (SDM) reduces the asymmetrical power between the therapist and the patient. Patient involvement improves patient satisfaction, adherence, and health outcomes and is a prerequisite for good clinical practice. The opportunities for using SDM in physical therapy have been previously considered.ObjectiveThe objective of this study was to examine the status of SDM in physical therapy, patients’ preferred levels of involvement, and the agreement between therapist perception and patient preferred level of involvement.DesignThis was an observational study of real consultations in physical therapy.MethodsIn total, 237 consultations, undertaken by 13 physical therapists, were audiorecorded, and 210 records were analyzed using the Observing Patient Involvement (OPTION) instrument. Before the consultation, the patient and therapist completed the Control Preference Scale (CPS). Multilevel analysis was used to study the association between individual variables and the level of SDM. Agreement on preferences was calculated using kappa coefficients.ResultsThe mean OPTION score was 5.2 (SD=6.8), out of a total score of 100. Female therapists achieved a higher OPTION score (b=−0.86, P=0.01). In total, 36.7% of the patients wanted to share decisions, and 36.2% preferred to give their opinion before delegating the decisions. In the majority of cases, therapists believed that they had to decide. The kappa coefficient for agreement was poor at .062 (95% confidence interval=−.018 to .144).LimitationsOnly 13 out of 125 therapists who were personally contacted agreed to participate.ConclusionShared decision making was not applied; although patients preferred to share decisions or at least provide their opinion about the treatment, physical therapists did not often recognize this factor. The participating physical therapists were more likely to make decisions in the best interest of their patients; that is, these therapists tended to apply a paternalistic approach rather than involving the patient.
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An, Qi, Yuki Ishikawa, Wen Wen, Shu Ishiguro, Koji Ohata, Hiroshi Yamakawa, Yusuke Tamura, Atsushi Yamashita, and Hajime Asama. "Skill Abstraction of Physical Therapists in Hemiplegia Patient Rehabilitation Using a Walking Assist Robot." International Journal of Automation Technology 13, no. 2 (March 5, 2019): 271–78. http://dx.doi.org/10.20965/ijat.2019.p0271.
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Improving the walking functions of hemiplegia patients after a stroke or brain injury is an important rehabilitation challenge. Recently, walking assist robots have been introduced in advanced rehabilitation facilities as a way to improve the efficiency of patient rehabilitation and restore their walking functions. Expert therapists can apply this device on different patients; however, such application mainly depends on the therapist’s tacit knowledge. Thus, it is often harder for novice therapists to apply such devices on different types of patients. Consequently, effective use of a walking assist robot has become a new patient rehabilitation skill. Taking rehabilitation as a service provided by medical doctors or therapists to their patients, this study aims to improve the quality of the rehabilitation service. In particular, the objective of this study is to abstract the rehabilitation skill of expert therapists in using a walking assist robot by applying a service science methodology known as skill education. Skill abstraction was performed by interviewing an expert therapist. From this interview, it was found that the expert therapist classified hemiplegia patients into four different classes. Using videos of patients walking, further analysis revealed the expert’s tacit knowledge, which was indicated by differences observed among these four groups in particular phases of the patients’ walking patterns. This study shows that by successfully obtaining explicit knowledge of part of a rehabilitation skill by using a walking assist robot (which until now was a tacit knowledge of experts), and then organizing the acquired explicit knowledge, even non-experts can easily reproduce the skill of experts in new patient rehabilitation.
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Hendriks, Erik JM, Jan J. Kerssens, Joost Dekker, Roger M. Nelson, Rob AB Oostendorp, and Jouke van der Zee. "One-Time Physical Therapist Consultation in Primary Health Care." Physical Therapy 83, no. 10 (October 1, 2003): 918–31. http://dx.doi.org/10.1093/ptj/83.10.918.
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Abstract Background and Purpose. One-time physical therapist consultation, prior to possible referral for physical therapy intervention, may enhance the quality of patient care, particularly if the referring physician is uncertain as to whether intervention by a physical therapist will be beneficial. The purpose of this study was to describe the use of consultation by a group of primary care physicians (PCPs) who could refer patients for a one-time consultation. Subjects and Methods. A 7-month observational study was conducted in the Netherlands with 59 pairs of randomly selected PCPs and physical therapists practicing in primary health care. Data were collected for the PCPs, the physical therapists, and the patients. Self-administered questionnaires (completed at the start and at the completion of the study), consultation request and report forms, and treatment referral records from health insurance agencies were used to obtain data. National reference data on patients referred by PCPs for intervention by a physical therapist were used to compare the data of patients referred by PCPs for a one-time consultation. The number and nature of consultation requests were determined as well as patient characteristics. The PCPs' satisfaction with the outcome and process of a one-time consultation and its impact on PCPs' management decisions also were described. Results. The number of referrals for a one-time consultation was 352 (X̄=5.9 per PCP, SD=5.4, range=0–20), resulting in a mean referral rate of 4.7 per 1,000 patients (SD=4.6). Characteristics of patients referred for a one-time consultation differed from national reference data of patients referred by their PCP for intervention by a physical therapist. Discussion and Conclusion. The results show that PCPs used the opportunity for a one-time physical therapist consultation and were satisfied with the outcome and process of consultation. The findings suggest that a one-time consultation is an appropriate and beneficial component of PCPs' patient management process.
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Kadivar, Zahra, Alexis English, and Brian D. Marx. "Understanding the Relationship Between Physical Therapist Participation in Interdisciplinary Rounds and Hospital Readmission Rates: Preliminary Study." Physical Therapy 96, no. 11 (November 1, 2016): 1705–13. http://dx.doi.org/10.2522/ptj.20150243.
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Abstract Background Providing patients with optimal discharge disposition and follow-up services could prevent unplanned readmissions. Despite their qualifications, physical therapists are rarely represented on the interdisciplinary team. Objective This study aimed to determine the relationship between the participation of physical therapists in interdisciplinary discharge rounds and readmission rates. Methods In this retrospective observational study, patients discharged by 2 interdisciplinary teams with or without a physical therapist's participation were followed for 5 months. Adherence to the physical therapist's recommendations for follow-up services and unplanned 30-day readmissions were tracked. Multiple logistic regression and random forest models were used to determine factors contributing to 30-day readmission rates. Results The odds of 30-day readmissions were 3.78 times greater when a physical therapist was absent from the interdisciplinary team compared with the odds of 30-day readmissions when a physical therapist participated in the interdisciplinary team. In addition, the odds of 30-day readmission for patients discharged to their home were 2.47 times greater than those who were not discharged to their home. An increased lack of postdischarge services was noted when a physical therapist was not included in the interdisciplinary team. Limitations The nonrandom selection of patients into groups, the small sample size, and the inability to adjust risk for unknown factors (eg, medical diagnoses, comorbidities, funding, and functional measures) limited interpretation of the results. Conclusion Significantly higher readmission rates were noted for patients whose interdisciplinary team did not have a physical therapist and for those patients who were discharged to their home. These preliminary findings suggest that discharge from the acute care setting is an elaborate process and should be designed carefully. In order to identify the optimal discharge process, future research should account for patient complexities in addition to the composition of the interdisciplinary discharge team.
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Nalette, Ernest. "Constrained Physical Therapist Practice: An Ethical Case Analysis of Recommending Discharge Placement From the Acute Care Setting." Physical Therapy 90, no. 6 (June 1, 2010): 939–52. http://dx.doi.org/10.2522/ptj.20050399.
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Background and PurposeConstrained practice is routinely encountered by physical therapists and may limit the physical therapist's primary moral responsibility—which is to help the patient to become well again. Ethical practice under such conditions requires a certain moral character of the practitioner. The purposes of this article are: (1) to provide an ethical analysis of a typical patient case of constrained clinical practice, (2) to discuss the moral implications of constrained clinical practice, and (3) to identify key moral principles and virtues fostering ethical physical therapist practice.CaseThe case represents a common scenario of discharge planning in acute care health facilities in the northeastern United States.MethodsAn applied ethics approach was used for case analysis.ResultsThe decision following analysis of the dilemma was to provide the needed care to the patient as required by compassion, professional ethical standards, and organizational mission.Discussion and ConclusionsConstrained clinical practice creates a moral dilemma for physical therapists. Being responsive to the patient's needs moves the physical therapist's practice toward the professional ideal of helping vulnerable patients become well again. Meeting the patient's needs is a professional requirement of the physical therapist as moral agent. Acting otherwise requires an alternative position be ethically justified based on systematic analysis of a particular case. Skepticism of status quo practices is required to modify conventional individual, organizational, and societal practices toward meeting the patient's best interest.
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Escorpizo, Reuben, Gerold Stucki, Alarcos Cieza, Kandace Davis, Teri Stumbo, and Daniel L. Riddle. "Creating an Interface Between the International Classification of Functioning, Disability and Health and Physical Therapist Practice." Physical Therapy 90, no. 7 (July 1, 2010): 1053–63. http://dx.doi.org/10.2522/ptj.20090326.
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The American Physical Therapy Association (APTA) has endorsed the International Classification of Functioning, Disability and Health (ICF) as a framework to be integrated into physical therapist practice. The ICF is a universal and inclusive platform for the understanding of health and disability and a comprehensive classification system for describing functioning. The APTA's Guide to Physical Therapist Practice was designed to guide patient management, given the different settings and health conditions that physical therapists encounter in their daily clinical practice. However, physical therapists may be unclear as to how to concretely apply the ICF in their clinical practice and to translate the application in a way that is meaningful to them and to their patients. This perspective article proposes ways to integrate the ICF and the Guide to Physical Therapist Practice to facilitate clinical documentation by physical therapists.
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Chevan, Julia, and Esther M. Haskvitz. "Do As I Do: Exercise Habits of Physical Therapists, Physical Therapist Assistants, and Student Physical Therapists." Physical Therapy 90, no. 5 (May 1, 2010): 726–34. http://dx.doi.org/10.2522/ptj.20090112.
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BackgroundPhysical therapy practitioners are among the many health care professionals who can counsel their patients to address the public health care concern of physical inactivity. Health care providers who are physically active themselves are more likely to counsel patients on the benefits of activity.ObjectiveThe purposes of this study were: (1) to examine the leisure-time physical activity habits of physical therapists, physical therapist assistants, and student physical therapists in the United States using Centers for Disease Control and Prevention and American College of Sports Medicine (CDC-ACSM) recommendations and (2) to compare these habits with those of the general population and other health care professionals.DesignA cross-sectional survey design was used.MethodsThere were 2 data sources. A random sample of American Physical Therapy Association members completed an online survey that included questions about physical activity habits worded in same manner as the leisure-time activities section of the 2005 National Health Interview Survey (NHIS). The final study sample comprised 1,238 participants: 923 physical therapists, 210 student physical therapists, and 105 physical therapist assistants. The 2005 NHIS public use data files were the source for the same information about the general US population and for a subset of health care professionals. Rates of participation in vigorous and moderate physical activity were analyzed.ResultsPhysical therapists, physical therapist assistants, and student physical therapists exercised at higher rates than adults and health-diagnosing professionals in the 2005 NHIS.LimitationsThe study may be limited by sampling and response bias.ConclusionsThis study identified that physical therapists, physical therapist assistants, and student physical therapists are meeting CDC-ACSM physical activity guidelines at higher rates than the US adult population and health-diagnosing professionals. These rates exceed the physical activity targets set for adults in Healthy People 2010.
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Biggs, Jennifer. "The Impact of Level of Physical Therapist Assistant Involvement on Patient Outcomes Following Stroke." Physical Therapy 100, no. 12 (September 4, 2020): 2165–73. http://dx.doi.org/10.1093/ptj/pzaa158.
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Abstract Objective This study investigates if higher utilization of physical therapist assistants adversely affects patient outcomes in the acute rehabilitation setting for patients following a cerebrovascular accident (CVA). Methods Participants were admitted to 1 of 5 inpatient rehabilitation facilities following a CVA from 2008 to 2010. High physical therapist assistant use was defined as ≥20% of the physical therapist visits being provided by the physical therapist assistant for an episode of care. Multivariable regression techniques examined differences in functional outcome, discharge location, and length of stay between high and low physical therapist assistant use groups. Propensity scoring methods supplemented findings of the regression analyses. Results Of the 1561 participants, 496 (32%) had high physical therapist assistant involvement. Baseline participant characteristics such as age, sex, baseline motor function, and comorbidities did not differ between high and low physical therapist assistant use groups. After adjusting for patient characteristics, rehabilitation facility, and year, higher physical therapist assistant use did not adversely affect functional outcome or length of stay. Fewer conclusions can be drawn regarding discharge location, although there was no significant difference in discharge location between groups with high and low physical therapist assistant utilization. Propensity scoring methods supported the findings of the regression analyses. Conclusions Higher physical therapist assistant involvement in the rehabilitation of patients following CVA did not adversely affect functional outcome, increase length of stay, or reduce the likelihood of discharge to home from an inpatient rehabilitation facility. Impact The results demonstrate the value of the physical therapist assistant in the provision of physical therapy for patients with stroke in the inpatient rehabilitation setting. Higher involvement of the physical therapist assistant may provide cost savings while maintaining patient outcomes for this setting and population.
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Leahy, Edmund, Lucy Chipchase, Marlena Calo, and Felicity C. Blackstock. "Which Learning Activities Enhance Physical Therapist Practice? Part 1: Systematic Review and Meta-analysis of Quantitative Studies." Physical Therapy 100, no. 9 (June 11, 2020): 1469–83. http://dx.doi.org/10.1093/ptj/pzaa107.
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Abstract Objective Following graduation from professional education, the development of clinical expertise requires career-long participation in learning activities. The purpose of this study was to evaluate which learning activities enhanced physical therapist practice. Methods Eight databases were searched for studies published from inception through December 2018. Articles reporting quantitative data evaluating the effectiveness of learning activities completed by qualified physical therapists were included. Study characteristics and results were extracted from the 26 randomized controlled trials that met the inclusion criteria. Clinician (knowledge, affective attributes, and behavior) and patient-related outcomes were extracted. Results There was limited evidence that professional development courses improved physical therapist knowledge. There was low-level evidence that peer assessment and feedback were more effective than case discussion at improving knowledge (standardized mean difference = 0.35, 95% CI = 0.09–0.62). Results were inconsistent for the effect of learning activities on affective attributes. Courses with active learning components appeared more effective at changing physical therapist behavior. The completion of courses by physical therapists did not improve patient outcomes; however, the addition of a mentored patient interaction appeared impactful. Conclusion Current evidence suggests active approaches, such as peer assessment and mentored patient interactions, should be used when designing learning activities for physical therapists. Further high-quality research focused on evaluating the impact of active learning interventions on physical therapist practice and patient outcomes is now needed. Impact This study is a first step in determining which learning activities enhance clinical expertise and practice would enable the physical therapy profession to make informed decisions about the allocation of professional development resources.
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Randall, Kenneth E., and Irene R. McEwen. "Writing Patient-Centered Functional Goals." Physical Therapy 80, no. 12 (December 1, 2000): 1197–203. http://dx.doi.org/10.1093/ptj/80.12.1197.
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Abstract Motor learning research, health care policies, reimbursement practices, and the standards of accrediting bodies all support writing patient-centered functional goals of physical therapy. This article defines patient-centered functional goals within the context of the Guide to Physical Therapist Practice and provides a rationale for incorporating functional goals into physical therapy for patients in all areas of practice. The article also describes how physical therapists can collaborate with patients to identify functional goals that are meaningful to them and describes a 5-step process for writing functional goals that are measurable.
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Fruth, Stacie J., and Steve Wiley. "Physician Impressions of Physical Therapist Practice in the Emergency Department: Descriptive, Comparative Analysis Over Time." Physical Therapy 96, no. 9 (September 1, 2016): 1333–41. http://dx.doi.org/10.2522/ptj.20150306.
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Abstract 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.
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Perlow, Ellen, Niamh Tunney, and Ann Lucado. "Integrating Safe Patient Handling Into Physical Therapist Education: Reducing the Incidence of Physical Therapist Injury and Improving Patient Outcomes." Journal of Physical Therapy Education 30, no. 2 (2016): 32–37. http://dx.doi.org/10.1097/00001416-201630020-00007.
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Resnik, Linda, Dawei Liu, Vince Mor, and Dennis L. Hart. "Predictors of Physical Therapy Clinic Performance in the Treatment of Patients With Low Back Pain Syndromes." Physical Therapy 88, no. 9 (September 1, 2008): 989–1004. http://dx.doi.org/10.2522/ptj.20070110.
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Background and Purpose Little is known about organizational and service delivery factors related to quality of care in physical therapy. This study sought to identify characteristics related to differences in practice outcomes and service utilization. Subjects The sample comprised 114 outpatient clinics and 1,058 therapists who treated 16,281 patients with low back pain syndromes during the period 2000–2001. Clinics participated with the Focus on Therapeutic Outcomes, Inc (FOTO) database. Methods Hierarchical linear models were used to risk adjust treatment outcomes and number of visits per treatment episode. Aggregated residual scores from these models were used to classify each clinic into 1 of 3 categories in each of 3 types of performance groups: (1) effectiveness, (2) utilization, and (3) overall performance (ie, composite measure of effectiveness and utilization). Relationships between clinic classification and the following independent variables were examined by multinomial logistic regression: years of therapist experience, number of physical therapists, ratio of physical therapists to physical therapist assistants, proportion of patients with low back pain syndromes, number of new patients per physical therapist per month, utilization of physical therapist assistants, and setting. Results Clinics that were lower utilizers of physical therapist assistants were 6.6 times more likely to be classified into the high effectiveness group compared with the low effectiveness group, 6.7 times more likely to be classified in the low utilization group compared with the high utilization group, and 12.4 times more likely to be classified in the best performance group compared with the worst performance group. Serving a higher proportion of patients with low back pain syndromes was associated with an increased likelihood of being classified in the lowest or middle group. Years of physical therapist experience was inversely associated with being classified in the middle utilization group compared with the highest utilization group. Discussion and Conclusion These findings suggest that, in the treatment of patients with low back pain syndromes, clinics that are low utilizers of physical therapist assistants are more likely to provide superior care (ie, better patient outcomes and lower service use).
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Coronado, Rogelio, Shannon Block, Katelyn Gonzalez, Bethany Rhoten, Carrie Brintz, Lindsey McKernan, Tricia Kirkhart, Stephen Wegener, and Kristin Archer. "512 Patient and physical therapist experiences with integrating an eHealth pain self-management program into clinical care." Journal of Clinical and Translational Science 6, s1 (April 2022): 104–5. http://dx.doi.org/10.1017/cts.2022.306.
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OBJECTIVES/GOALS: eHealth programs centered on cognitive behavior therapy (CBT) can be supported by physical therapists to feasibly deliver psychologically-informed physical therapy (PIPT). This study assessed patient and physical therapist (PT) perspectives of adding a CBT-based eHealth program to physical therapy. METHODS/STUDY POPULATION: In our uncontrolled pilot study, PTs were trained in motivational interviewing (MI) to support patient engagement with a 7-module eHealth CBT-based pain self-management program that accompanied a course of PT. Interviews were conducted with a convenience sample of 13 patients with chronic back and/or neck pain and 9 PTs to evaluate experiences with the eHealth program, perceived benefits, barriers and facilitators to integration, and future recommendations for implementation from both perspectives. Interview data were recorded, transcribed, and analyzed using qualitative content analysis for core themes. RESULTS/ANTICIPATED RESULTS: Patients benefited from the eHealth program, especially relaxation (69% of respondents) and meditation/mindfulness (62%). Time and technology were barriers for eHealth engagement (23% and 15%). Most (92%) patients reported their therapist reviewed eHealth progress, although one-third of patients wanted more discussion and feedback on eHealth content. PTs felt the eHealth program was valuable (67%), user-friendly (56%), and took minimal effort to support (78%). Some (44%) therapists felt more confident after MI training to support patient engagement. PTs recommended offering patients tablets (i.e., iPads) for clinic or home use and additional therapist training in MI. DISCUSSION/SIGNIFICANCE: PTs and patients valued a clinician-supported eHealth program, suggesting an acceptable option for PIPT. Future implementation work aims to identify optimal therapist training in MI and additional strategies to overcome time or technology barriers.
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Takashi, Naoki, Michael J. McCarthy, Rie Suzuki, Kakuya Ogahara, Masako Ono-Kihara, Masahiro Kihara, and Takeo Nakayama. "Association of patient quality of life with the degree of agreement in the perceptions of patient disability within the stroke patient–rehabilitation therapist dyad: a cross-sectional study in postdischarge rehabilitation setting." BMJ Open 11, no. 5 (May 2021): e043824. http://dx.doi.org/10.1136/bmjopen-2020-043824.
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ObjectivesThe purpose of study was to explore the association between patient physical and psychological quality of life (QOL) with the degree of agreement in perceptions of patient disability within the stroke patient–rehabilitation therapist dyad.DesignCross-sectional dyadic study with a tablet-based structured questionnaire.SettingRehabilitation, nursing and long-term care facilities that provide rehabilitation services in the Kanagawa prefecture, Japan.ParticipantsThe 81 dyads of a male patient with stroke living at home and the rehabilitation therapist in charge of the eligible patient were recruited from March 2019 to February 2020.MethodPatient physical and psychological QOL was measured using the WHOQOL BREF. Perceptions of patient disability were measured using the 12-item WHO Disability Assessment Schedule V.2.0 (DAS). DAS scores of patients and therapists were classified into two (high and low) and three (high, medium, low) categories, respectively, and six patterns of agreement about patient function were created and used in the analysis. Generalised estimating equations were used to examine multivariable associations between WHOQOL scores in patients and the degree of agreement within dyads adjusting for other covariates and clustering effects.ResultsAmong 81 enrolled dyads, 48 (59.3%) were classified into one of four disagreement groups (low medium, low high, high medium, high low). When the patient appraised himself as having mild disability, the degree of patient–therapist disagreement was negatively associated with patient’s physical and psychological QOL. When the patient appraised himself as having severe disability, his physical and/or psychological QOL was poorer, regardless of the degree of agreement.ConclusionsDisagreement in the perception of disability within patient–rehabilitation therapist dyad could be associated with patient’s poor QOL, especially when the patient perceives himself as having mild disability. Reaching an agreement about patient disability is needed in the delivery of rehabilitation care for patients with stroke living at home to improve their QOL.
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Mayer, Kirby P., Sanjay Dhar, Evan Cassity, Aaron Denham, Johnny England, Peter E. Morris, and Esther E. Dupont-Versteegden. "Interrater Reliability of Muscle Ultrasonography Image Acquisition by Physical Therapists in Patients Who Have or Who Survived Critical Illness." Physical Therapy 100, no. 9 (April 17, 2020): 1701–11. http://dx.doi.org/10.1093/ptj/pzaa068.
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Abstract Objective Previous studies have demonstrated that muscle ultrasound (US) can be reliably performed at the patient bedside by novice assessors with minimal training. The primary objective of this study was to determine the interrater reliability of muscle US image acquisition by physical therapists and physical therapist students. Secondarily, this study was designed to elucidate the process for training physical therapists to perform peripheral skeletal muscle US. Methods This was a cross-sectional observational study. Four novices and 1 expert participated in the study. Novice sonographers engaged in a structured training program prior to implementation. US images were obtained on the biceps brachii, quadriceps femoris, and tibialis anterior muscles in 3 groups: patients in the intensive care unit, patients on the hospital ward, and participants in the outpatient gym who were healthy. Reliability of image acquisition was analyzed compared with the expert sonographer. Results Intraclass correlation coefficient values ranged from 0.76 to 0.97 with an average for all raters and all muscles of 0.903, indicating excellent reliability of image acquisition. In general, the experienced physical therapist had higher or similar intraclass correlation coefficient values compared with the physical therapist students in relation to the expert sonographer. Conclusions Excellent interrater reliability for US was observed regardless of the level of experience, severity of patient illness, or patient setting. These findings indicate that the use of muscle US by physical therapists can accurately capture reliable images in patients with a range of illness severity and different clinical practice settings across the continuum of care. Impact Physical therapists can utilize US to obtain images to assess muscle morphology. Lay Summary Physical therapists can use noninvasive US as an imaging tool to assess the size and quality of peripheral skeletal muscle. This study demonstrates that physical therapists can receive training to reliably obtain muscle images in patients admitted to the intensive care unit who may be at risk for muscle wasting and may benefit from early rehabilitation.
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Gisbert, Robyn, and Margaret Schenkman. "Physical Therapist Interventions for Parkinson Disease." Physical Therapy 95, no. 3 (March 1, 2015): 299–305. http://dx.doi.org/10.2522/ptj.20130334.
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<LEAP> highlights the findings and application of Cochrane reviews and other evidence pertinent to the practice of physical therapy. The Cochrane Library is a respected source of reliable evidence related to health care. Cochrane systematic reviews explore the evidence for and against the effectiveness of appropriate interventions—medications, surgery, education, nutrition, exercise—and the evidence for and against the use of diagnostic tests for specific conditions. Cochrane reviews are designed to facilitate the decisions of clinicians, patients, and others in health care by providing a careful review and interpretation of research studies published in the scientific literature.1Each article in thisPTJseries summarizes a Cochrane review or other scientific evidence on a single topic and presents clinical scenarios based on real patients or programs to illustrate how the results of the review can be used to directly inform clinical decisions. This article focuses on an adult patient with relatively early Parkinson disease.Can physical therapist intervention strategies improve his physical functioning and help him reach his goal of engaging in an exercise program to prevent decline related to progressive Parkinson disease?
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Alghadir, Ahmad, Hamayun Zafar, Zaheen A. Iqbal, and Einas Al-Eisa. "Work-Related Low Back Pain Among Physical Therapists in Riyadh, Saudi Arabia." Workplace Health & Safety 65, no. 8 (January 25, 2017): 337–45. http://dx.doi.org/10.1177/2165079916670167.
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Low back pain (LBP) is a common health problem. Professions like physical therapy (PT), involving frequent lifting, bending, or standing, are at risk for developing LBP. The objective of this study was to determine the prevalence of work-related LBP and factors associated with and consequences of work-related LBP among physical therapists in Riyadh, Saudi Arabia. A self-administered online questionnaire (i.e., demographic data, history of LBP before and after working as a physical therapist, work setting, and effect on daily activities) was sent to 600 members of the Saudi PT association. Data were analyzed using the Pearson chi-square test and Mann-Whitney U test. Eighty-eight percent of potential respondents completed the questionnaire. Of these, 89.65% of the therapists reported LBP after beginning their PT practice, and 35.6% reported LBP at the time of this survey. Gender, PT specialty, and duration of contact with patients were all found to be related to LBP. The prevalence of work-related LBP among physical therapist in Riyadh was high, affecting patient care and daily activities of the therapists. Both primary and secondary prevention strategies (e.g., introduce ergonomics into PT curricula, reduce therapist stress, and promote teamwork) are needed to decrease LBP among therapists, so they can effectively care for patients.
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Plummer, Laura, Sowmya Sridhar, Marianne Beninato, and Kristin Parlman. "Physical Therapist Practice in the Emergency Department Observation Unit: Descriptive Study." Physical Therapy 95, no. 2 (February 1, 2015): 249–56. http://dx.doi.org/10.2522/ptj.20140017.
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Background An upward trend in the number of hospital emergency department (ED) visits frequently results in ED overcrowding. The concept of the emergency department observation unit (EDOU) was introduced to allow patients to transfer out of the ED and remain under observation for up to 24 hours before making a decision regarding the appropriate disposition. No study has yet been completed to describe physical therapist practice in the EDOU. Objective The objectives of this study were: (1) to describe patient demographics, physical therapist management and utilization, and discharge dispositions of patients receiving physical therapy in the EDOU and (2) to describe these variables according to the most frequently occurring diagnostic groups. Design This was a descriptive study of patients who received physical therapist services in the EDOU of Massachusetts General Hospital during the months of March, May, and August 2010. Methods Data from 151 medical records of patients who received physical therapist services in the EDOU were extracted. Variables consisted of patient characteristics, medical and physical therapist diagnoses, and physical therapist management and utilization derived from billing data. Descriptive statistics were used to analyze data. Results The leading EDOU medical diagnoses of individuals receiving physical therapist services included people with falls without fracture (n=30), back pain (n=27), falls with fracture (n=22), and dizziness (n=22). There were significant differences in discharge disposition, age, and total physical therapy time among groups. Limitations This was a retrospective study, so there was no ability to control how data were recorded. Conclusions This study provides information on common patient groups seen in the EDOU, physical therapist service utilization, and discharge disposition that may guide facilities in anticipated staffing needs associated with providing physical therapist services in the EDOU.
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Dahl, Corey S. "Physical Therapist Management of Tuberculous Arthritis of the Elbow." Physical Therapy 81, no. 6 (June 1, 2001): 1253–59. http://dx.doi.org/10.1093/ptj/81.6.1253.
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Abstract Background and Purpose. Tuberculous arthritis is not commonly seen by physical therapists in the United States. The purpose of this case report is to describe a case of tuberculous arthritis of the elbow. Case Description. The patient was a 36-year-old man referred for physical therapist evaluation and intervention for chronic elbow pain. After an evaluation and a trial of physical therapy, the patient was referred back to a primary care provider for additional tests to rule out systemic pathology. An open debridement of the synovium and a biopsy of the capitellum and radial head was positive for acid-fast bacilli, which was later identified as Mycobacterium tuberculosis. Outcomes. The patient was placed on a 4-drug antituberculosis regimen that resolved all patient complaints and restored full elbow function. Discussion. Tuberculous arthritis has characteristic findings during examination and in diagnostic tests. Although tuberculous arthritis is uncommon, it should be considered when patients have chronic or vague musculoskeletal complaints.
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Shirley, Debra, Hidde P. van der Ploeg, and Adrian E. Bauman. "Physical Activity Promotion in the Physical Therapy Setting: Perspectives From Practitioners and Students." Physical Therapy 90, no. 9 (September 1, 2010): 1311–22. http://dx.doi.org/10.2522/ptj.20090383.
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Background Physical inactivity is a major risk factor for chronic disease. Primary health care practitioners are well placed to promote a physically active lifestyle. The perceptions and practice of physical therapists on their role in physical activity promotion are not well known. Objective The objective of this study was to determine the knowledge, confidence, role perception, barriers, feasibility, and counseling practice of physical therapists and physical therapist students regarding the promotion of nontreatment physical activity for better health. Design A cross-sectional survey was conducted. Methods In 2008, 321 (54%) of a random sample of all physical therapists registered in New South Wales, Australia, responded to a survey on their knowledge, confidence, role perception, barriers, feasibility, and counseling practice with regard to promoting a physically active lifestyles to their patients. Physical therapist students (n=279) completed the same survey but without the questions on barriers and counseling practice. Results Physical therapists and physical therapist students consider that it is part of their role to give their patients nontreatment physical activity advice. Overall, they reported having adequate knowledge and skills to undertake this role. Incorporating advice into normal consultations is deemed the most feasible form of lifestyle physical activity promotion in physical therapist practice. Limitations The cross-sectional nature of this study makes it difficult to determine cause and effect relationships. Some selection bias may have occurred, as the physical therapists who completed the questionnaires may have been those most interested in physical activity promotion. Conclusions Physical therapist practice appears to be an excellent avenue for promoting a physically active lifestyle and could potentially play an important public health role.
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Black, Beth, Beth C. Marcoux, Christine Stiller, Xianggui Qu, and Ronald Gellish. "Personal Health Behaviors and Role-Modeling Attitudes of Physical Therapists and Physical Therapist Students: A Cross-Sectional Study." Physical Therapy 92, no. 11 (November 1, 2012): 1419–36. http://dx.doi.org/10.2522/ptj.20110037.
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BackgroundPhysical therapists have been encouraged to engage in health promotion practice. Health professionals who engage in healthy behaviors themselves are more apt to recommend those behaviors, and patients are more motivated to change their behaviors when their health care provider is a credible role model.ObjectiveThe purpose of this study was to describe the health behaviors and role-modeling attitudes of physical therapists and physical therapist students.DesignThis study was a descriptive cross-sectional survey.MethodsA national sample of 405 physical therapists and 329 physical therapist students participated in the survey. Participants' attitudes toward role modeling and behaviors related to physical activity, fruit and vegetable consumption, abstention from smoking, and maintenance of a healthy weight were measured. Wilcoxon rank sum tests were used to examine differences in attitudes and behaviors between physical therapists and physical therapist students.ResultsA majority of the participants reported that they engage in regular physical activity (80.8%), eat fruits and vegetables (60.3%), do not smoke (99.4%), and maintain a healthy weight (78.7%). Although there were no differences in behaviors, physical therapist students were more likely to believe that role modeling is a powerful teaching tool, physical therapist professionals should “practice what they preach,” physical activity is a desirable behavior, and physical therapist professionals should be role models for nonsmoking and maintaining a healthy weight.LimitationsLimitations of this study include the potential for response bias and social desirability bias.ConclusionsPhysical therapists and physical therapist students engage in health-promoting behaviors at similarly high rates but differ in role-modeling attitudes.
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Delany, Clare M., Ian Edwards, Gail M. Jensen, and Elizabeth Skinner. "Closing the Gap Between Ethics Knowledge and Practice Through Active Engagement: An Applied Model of Physical Therapy Ethics." Physical Therapy 90, no. 7 (July 1, 2010): 1068–78. http://dx.doi.org/10.2522/ptj.20090379.
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Physical therapist practice has a distinct focus that is holistic (ie, patient centered) and at the same time connected to a range of other providers within health care systems. Although there is a growing body of literature in physical therapy ethics knowledge, including clinical obligations and underlying philosophical principles, less is known about the unique ethical issues that physical therapists encounter, and how and why they make ethical decisions. As moral agents, physical therapists are required to make autonomous clinical and ethical decisions based on connections and relationships with their patients, other health care team members, and health institutions and policies. This article identifies specific ethical dimensions of physical therapist practice and highlights the development and focus of ethics knowledge in physical therapy over the last several decades. An applied ethics model, called the “active engagement model,” is proposed to integrate clinical and ethical dimensions of practice with the theoretical knowledge and literature about ethics. The active engagement model has 3 practical steps: to listen actively, to think reflexively, and to reason critically. The model focuses on the underlying skills, attitudes, and actions that are required to build a sense of moral agency and purpose within physical therapist practice and to decrease gaps between the ethical dimensions of physical therapist practice and physical therapy ethics knowledge and scholarship. A clinical case study is provided to illustrate how the ethics engagement model might be used to analyze and provide insight into the ethical dimensions of physical therapist practice.
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Palmatier, Janet. "Review of Hand Surgery." Physical Therapy 86, no. 1 (January 1, 2006): 147. http://dx.doi.org/10.1093/ptj/86.1.147.
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Abstract This book's major focus is on surgical management of the hand and distal upper extremity. This book is intended to serve as a primary resource for hand surgery fellows and as a test preparation for orthopedic and plastic surgery residents (ie, boards, certificate for added qualifications, and residency examinations). In addition, it is intended to serve as a reference for hand surgeons, physical therapists, and occupational therapists involved in the care of patients with hand and distal upper-extremity disorders. For the physical therapist, the text provides insight into the medical and surgical management of the patient with a hand disorder, and, in turn, helps to provide a better understanding and rationale for therapeutic management of this patient population. However, keeping within the scope of hand surgery, this work provides very little substance for the physical therapist looking for specific information on the therapeutic management and rehabilitation of this particular patient population.
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VanWye, William R. "Patient Screening by a Physical Therapist for Nonmusculoskeletal Hip Pain." Physical Therapy 89, no. 3 (March 1, 2009): 248–56. http://dx.doi.org/10.2522/ptj.20070366.
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Background and Purpose Mechanical hip pain and disease-based hip pain can have similar signs and symptoms, thereby presenting a differential diagnostic challenge for clinicians. Hip pain is a common complaint addressed by physical therapists; therefore, it would be advantageous for them to be knowledgeable about differential diagnosis for hip pain, so that they can screen for possible serious conditions outside the realm of physical therapist practice and make the appropriate referral. Case Description A 77-year-old man was referred for physical therapy by his primary care physician (PCP) with diagnoses of lumbar spine and left hip osteoarthritis and possible trochanteric bursitis. After the examination, the physical therapist determined that the patient should return to his PCP for further testing. Findings leading to this conclusion were pain severity out of proportion to the reported injury, the presence of night pain, a positive “sign of the buttock,” and empty end feels of all hip joint motions, which represented a noncapsular pattern of joint restriction. Outcomes The patient was diagnosed later with primary lung adenocarcinoma with widespread metastases. A computerized tomography scan of the left hip revealed a metastatic lesion at the left proximal femur. Discussion Physical therapists’ ability to adequately screen for conditions requiring examination by a physician can lead to a more timely diagnosis of serious medical conditions. Investigators have found published descriptions of end feels, capsular versus noncapsular patterns of restriction, and the sign of the buttock to be beneficial screening tools for use in people with hip, pelvis, or lumbar spine pain.
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Miller, Nancy H., David J. Miller, and Joanna L. Goldberg. "Physical Therapist Examination, Evaluation, and Intervention for a Patient With West Nile Virus Paralysis." Physical Therapy 86, no. 6 (June 1, 2006): 843–56. http://dx.doi.org/10.1093/ptj/86.6.843.
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Abstract Background and Purpose. The incidence of West Nile virus (WNV) has increased in the United States since 1999. A small percentage of people with WNV develop West Nile neuroinvasive disease (WNND) with encephalitis and flaccid paralysis. The purpose of this report is to describe the physical therapist management and outcomes for a patient with WNND and the therapist’s efforts to use an evidence-based practice approach in the management of a patient with this disease. Case Description. The patient was an active 55-year-old woman in excellent health who became acutely ill with asymmetrical lower-extremity weakness. The physical therapist reviewed the available literature, consulted with medical and physical therapist experts and the patient, and elected to use a poliovirus “period of recovery” approach combining intensive strengthening and monitoring of fatigue. Outcomes. The patient progressed from an initial nonambulatory status to ambulation with a single-point cane at week 18 after onset of symptoms. She began to ambulate without an assistive device by week 20. The patient returned to work part-time by week 22 and full-time by week 43. Discussion. These outcomes demonstrate the recovery of a patient with WNND after an intensive strengthening program.[Miller NH, Miller DJ, Goldberg JL. Physical therapist examination, evaluation, and intervention for a patient with West Nile virus paralysis. Phys Ther. 2006;86:843– 856.]
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Zahid, Amna, Muhammad Rizwan, Farjad Afzal, Waqas Latif, and Talha Laique. "Work Related Physical Health Challenges Faced by Physical Therapists." Pakistan Journal of Medical and Health Sciences 15, no. 11 (November 30, 2021): 3216–18. http://dx.doi.org/10.53350/pjmhs2115113216.
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Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Objectives: To find the prevalence of work related musculoskeletal problems among the physical therapist. Study Design: Associational, correlational, causal-comparative. Methodology: The Physical therapists from clinical setups (private and public) in Lahore, Pakistan, were enrolled taking a sample size of 131. The sample size calculated was by keeping margin of error equal to 13% and level of significance equal to 5%. Statistical analysis: Data was analyzed by SPSS software, version 25 as qualitative variables were expressed as frequencies and percentages. Results: There was a significant relation of physical problems related to work of physical therapist as per daily routine of repetitive movements while giving a treatment to the patient. Conclusion: We concluded that experts of the field either switch to the academic side or more preventive nature of job to manage the economic needs along with their profession. Keywords: Work Related Musculoskeletal Disorders and Physical Health Problems.
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Thomas, Susie, Shylie Mackintosh, and Julie Halbert. "Determining Current Physical Therapist Management of Hip Fracture in an Acute Care Hospital and Physical Therapists' Rationale for This Management." Physical Therapy 91, no. 10 (October 1, 2011): 1490–502. http://dx.doi.org/10.2522/ptj.20100310.
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Background Physical therapy has an important role in hip fracture rehabilitation to address issues of mobility and function, yet current best practice guidelines fail to make recommendations for specific physical therapy interventions beyond the first 24 hours postsurgery. Objectives The aims of this study were: (1) to gain an understanding of current physical therapist practice in an Australian acute care setting and (2) to determine what physical therapists consider to be best practice physical therapist management and their rationale for their assessment and treatment techniques. Design and Methods Three focus group interviews were conducted with physical therapists and physical therapist students, as well as a retrospective case note audit of 51 patients who had undergone surgery for hip fracture. Results Beyond early mobilization and a thorough day 1 postoperative assessment, great variability in what was considered to be best practice management was displayed. Senior physical therapists considered previous clinical experience to be more important than available research evidence, and junior physical therapists modeled their behavior on that of senior physical therapists. The amount of therapy provided to patients during their acute inpatient stay varied considerably, and none of the patients audited were seen on every day of their admission. Conclusions Current physical therapist management in the acute setting for patients following hip fracture varies and is driven by system pressures as opposed to evidence-based practice.
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Ohtake, Patricia J., Marcilene Lazarus, Rebecca Schillo, and Michael Rosen. "Simulation Experience Enhances Physical Therapist Student Confidence in Managing a Patient in the Critical Care Environment." Physical Therapy 93, no. 2 (February 1, 2013): 216–28. http://dx.doi.org/10.2522/ptj.20110463.
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Background Rehabilitation of patients in critical care environments improves functional outcomes. This finding has led to increased implementation of intensive care unit (ICU) rehabilitation programs, including early mobility, and an associated increased demand for physical therapists practicing in ICUs. Unfortunately, many physical therapists report being inadequately prepared to work in this high-risk environment. Simulation provides focused, deliberate practice in safe, controlled learning environments and may be a method to initiate academic preparation of physical therapists for ICU practice. Objective The purpose of this study was to examine the effect of participation in simulation-based management of a patient with critical illness in an ICU setting on levels of confidence and satisfaction in physical therapist students. Design A one-group, pretest-posttest, quasi-experimental design was used. Methods Physical therapist students (N=43) participated in a critical care simulation experience requiring technical (assessing bed mobility and pulmonary status), behavioral (patient and interprofessional communication), and cognitive (recognizing a patient status change and initiating appropriate responses) skill performance. Student confidence and satisfaction were surveyed before and after the simulation experience. Results Students' confidence in their technical, behavioral, and cognitive skill performance increased from “somewhat confident” to “confident” following the critical care simulation experience. Student satisfaction was highly positive, with strong agreement the simulation experience was valuable, reinforced course content, and was a useful educational tool. Limitations Limitations of the study were the small sample from one university and a control group was not included. Conclusions Incorporating a simulated, interprofessional critical care experience into a required clinical course improved physical therapist student confidence in technical, behavioral, and cognitive performance measures and was associated with high student satisfaction. Using simulation, students were introduced to the critical care environment, which may increase interest in working in this practice area.
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Leemrijse, Chantal J., Ilse CS Swinkels, and Cindy Veenhof. "Direct Access to Physical Therapy in the Netherlands: Results From the First Year in Community-Based Physical Therapy." Physical Therapy 88, no. 8 (August 1, 2008): 936–46. http://dx.doi.org/10.2522/ptj.20070308.
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BackgroundIn 2006, direct access to physical therapy was introduced in the Netherlands. Before this policy measure, evaluation and treatment by a physical therapist were only possible following referral by a physician.ObjectiveThe objectives of this study were to investigate how many patients use direct access and to establish whether these patients have a different profile than referred patients.MethodsElectronic health care data from the National Information Service for Allied Health Care (LiPZ), a nationally representative registration network of 93 Dutch physical therapists working in 43 private practices, were used.ResultsIn 2006, 28% of the patients seen by a physical therapist came by direct access. Patients with non–further-specified back problems, patients with nonspecific neck complaints, and higher-educated patients were more likely to refer themselves to a physical therapist, as were patients with health problems lasting for less than 1 month. Younger patients made more use of direct access. In addition, patients with recurring complaints more often referred themselves, as did patients who had received earlier treatment by a physical therapist. Patients with direct access received fewer treatment sessions. Compared with 2005, there was no increase in the number of patients visiting a physical therapist.LimitationsData came only from physical therapists working on general conditions in general practices. Severity of complaints is not reported.ConclusionsA large, specific group of patients utilized self-referral, but the total number of patients seen by a physical therapist remained the same. In the future, it is important to evaluate the consequences of direct access, both on quality aspects and on cost-effectiveness.
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Cambier, Ziádee, Jill S. Boissonnault, Scott J. Hetzel, and Margaret M. Plack. "Physical Therapist, Physical Therapist Assistant, and Student Response to Inappropriate Patient Sexual Behavior: Results of a National Survey." Physical Therapy 98, no. 9 (June 8, 2018): 804–14. http://dx.doi.org/10.1093/ptj/pzy067.
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Kasven-Gonzalez, Nicole, Regine Souverain, and Susan Miale. "Improving quality of life through rehabilitation in palliative care: Case report." Palliative and Supportive Care 8, no. 3 (September 2010): 359–69. http://dx.doi.org/10.1017/s1478951510000167.
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AbstractObjective:Occupational and physical therapists can have a significant impact on the quality of life of terminally ill cancer patients. In the critical care setting, rehabilitation is often overlooked. However, occupational and physical therapists work with critically-ill patients to create realistic and meaningful goals for improving comfort, mobility, socialization skills, and ability to care for oneself regardless of disease state and medical status. The following case report describes rehabilitation intervention with a young woman diagnosed with osteosarcoma and leukemia during the final stage of her life.Method:This case report highlights the use of patient-centered goals and the importance of close collaboration between the patient, occupational therapist, and physical therapists to achieve a higher quality of life.Results:A collaborative effort by the occupational and physical therapists yielded positive outcomes as defined by the patient, patient family, and the medical staff in the critical care setting.Significance of results:Palliative care patients may benefit from occupational therapy (OT) and physical therapy (PT) intervention. Rehabilitation specialists are skilled at working with patients to set realistic and meaningful functional goals. Further study on rehabilitation treatment to improve quality of life among patients in palliative care is needed.
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Matifat, Eveline, Marianne Méquignon, Caitriona Cunningham, Catherine Blake, Oma Fennelly, and François Desmeules. "Benefits of Musculoskeletal Physical Therapy in Emergency Departments: A Systematic Review." Physical Therapy 99, no. 9 (August 24, 2019): 1150–66. http://dx.doi.org/10.1093/ptj/pzz082.
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Abstract Background Over the past few decades, physical therapists have emerged as key health care providers in emergency departments (EDs), especially for patients with musculoskeletal disorders (MSKD). Purpose The purpose of this review was to update the current evidence regarding physical therapist care for patients with MSKD in EDs and to update current recommendations for these models of care. Data Sources Systematic searches were conducted in 5 bibliographic databases. Study Selection The studies selected presented quantitative data related to the care of patients with MSKD by physical therapists in an ED setting. Data Extraction Raters reviewed studies and used the Effective Public Health Practice Project Quality Assessment Tool to assess their methodological quality. Data Synthesis Fifteen studies were included. Two studies, 1 of weak and 1 of strong quality, demonstrated that physical therapist care in EDs was as effective as or more effective than usual medical care for pain reduction, and 6 studies of varying quality reported that physical therapist care in EDs was as effective as usual care in EDs in reducing disability. Eight studies of varying quality reported that physical therapist care could significantly reduce waiting time in EDs. Four studies of varying quality reported that physical therapists ordered no more, or even fewer, medical images than physicians. In terms of health care costs, 2 studies of moderate to high quality found no significant differences in costs between physical therapist care and usual care in EDs. Finally, 6 studies of varying quality reported that patients were as satisfied or more satisfied with physical therapist care as with usual medical care in EDs. Limitations The roles of physical therapists in EDs vary depending on the setting, legislation, and training of providers. Only a limited number of high-quality studies were identified. Conclusions Although the quality of the evidence is heterogeneous, physical therapist care for patients with MSKD in EDs may be beneficial.
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Vitomskyi, V. V., K. M. Al-Hawamdeh, M. V. Vitomska, and S. V. Gavreliuk. "Comparison of the Therapeutic Alliance Indicators according to the Results of the Survey of Cardiosurgical Patients and their Physical Therapists." Ukraïnsʹkij žurnal medicini, bìologìï ta sportu 5, no. 6 (December 12, 2020): 275–81. http://dx.doi.org/10.26693/jmbs05.06.275.
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The purpose of the study was to determine and compare the indicators of the therapeutic alliance based on the results of a survey of cardiac surgery patients and their physical therapists. Material and methods. The survey involved 100 patients (over 18 years old, without cognitive impairment) who underwent cardiac surgery. The Working Alliance Inventory questionnaire was used to assess the level of therapeutic alliance formation. The SF Hatcher Client form (which consists of 12 questions) was used for the patient. These questions were divided into three groups / domains: "goal items", "task items" and "bond items". The questionnaire was filled in on the seventh postoperative day. The SF Hatcher Client form, which consisted of 12 questions, was used for the patient. Intervention: before surgery, patients received a short consultation with a physical therapist regarding the goals and content of physical therapy, the algorithm for activation after surgery; the postoperative physical therapy protocol included early mobilization, therapeutic gymnastics, the use of respiratory physical therapy techniques, and therapeutic walking under the supervision of a physical therapist. Patients were provided with information and tasks on therapeutic walking, a small set of therapeutic exercises and breathing physical therapy for independent implementation. Results and discussion. The indicators of the therapeutic alliance between physical therapists and cardiac surgery patients confirmed its high level, both according to the results of the questionnaire survey of patients and the results of the survey of specialists. The "goal items" domain had the highest score in the patient's assessment of therapeutic alliance. Since the patient and specialist questionnaires had a different number of questions and a different maximum score, it was decided to make comparisons of the overall estimates of the level of therapeutic alliance after converting them to a percentage of the maximum. A significantly better overall score for the therapeutic alliance was established according to the results of the questionnaire survey of physical therapists: 87.5 (82.5; 95) % of the maximum versus 81.25 (66.67; 89.58) % of the maximum (p = 0.000). Conclusion. Physical therapists rated the therapeutic alliance for a higher score
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Landgraff, Nancy C., Susan L. Whitney, Diane Wrisley, and Jamie Berlin. "Physical Therapist Prediction Accuracy of Discharge Placement from Acute Care." Stroke 32, suppl_1 (January 2001): 380–81. http://dx.doi.org/10.1161/str.32.suppl_1.380-e.
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P228 Background: The clinical impression of the Physical Therapist is requested in the determination of patient placement after an acute stroke. There is little evidence to determine if physical therapists are accurately making these recommendations. Also, there is little consensus regarding factors physical therapists consider when making these decisions. It is unknown if years of clinical experience affects placement judgment. The purpose of this retrospective chart review was to address the following questions: How accurate were the physical therapists in predicting placement and did experience affect the accuracy of the prediction? Methods: A retrospective chart review of 64 medical records of persons admitted to The University of Pittsburgh Medical Center Stroke Institute during 1999 was conducted. Data collected included client demographics, elements of the medical and social history, and measures obtained from the initial evaluation and the therapist s recommendation for discharge placement. Results: Spearman rank correlation coefficients were calculated between the predicted and actual discharge location, and to determine the association of the accuracy of prediction and other factors from the client s history or evaluation.An accurate prediction was made 73 % of the time. A moderate correlation was found between the predicted and actual discharge location. (r =.655). Fair but significant correlations were found between the accuracy of prediction and the following factors: the extent of brain damage (r=-.423), bowel and bladder function (r= .357), National Institutes of Health Stroke Scale score (r=.391), and the client s abilities to perform balance (r=.399), sit to stand (r=.483), and locomotion (r=.411). No significance was found between the therapist s years of experience and correct placement decisions. Physical therapists with a minimum of 3 years of experience evaluated 77% of the patients.. Conclusions: In this retrospective chart review, physical therapists were accurate in their predictions of placement location for persons with an acute stroke. The physical therapists years of experience did not appear to significantly affect accuracy
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Kosson, Zofia, Marek Paśnicki, and Marcin Kołacz. "The Role of Physical Therapy in the Intensive Care Unit." Emergency Medical Service 8, no. 3 (2021): 171–78. http://dx.doi.org/10.36740/emems202103108.
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Recent years have seen intensive development of ICU treatment protocols. Today it is possible to treat patients who in the past would not have had a chance of survival. People under the care of the unit typically suffer from cardiovascular or respiratory failure. Therefore, the aim of this paper is to discuss the basic techniques used by physiotherapeutic staff and the contribution they make to the treatment of patients at the ICU. In our article, we analyzed the risks associated with long-term hospitalization and the characteristics of the ICU patient, and presented the ways in which a physical therapist can improve the patient’s health. We have identified the main goals of ICU physical therapy and specified the intention with which specific physiotherapeutic procedures are introduced. The physical therapist should be part of a medical team whose goal is for the patient recover as quickly as possible. The role of the physical therapist in the ICU is not only to help the patient to improve in the shortest time possible, but also to prevent the undesirable effects of hypokinesia and long-term treatment in the ICU.
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Sakai, Yasunari, Shuhei Yamamoto, Tatsunori Karasawa, Masaaki Sato, Kenichi Nitta, Mayumi Okada, Kanako Takeshige, Shota Ikegami, Hiroshi Imamura, and Hiroshi Horiuchi. "Effects of early rehabilitation in sepsis patients by a specialized physical therapist in an emergency center on the return to activities of daily living independence: A retrospective cohort study." PLOS ONE 17, no. 3 (March 31, 2022): e0266348. http://dx.doi.org/10.1371/journal.pone.0266348.
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Background Early rehabilitation allows patients to better perform the activities of daily living after hospital discharge. A specialized physical therapist has been assigned as part of the early rehabilitation, but the effectiveness of the program remains unclear. We investigated how early rehabilitation provided by a specialized physical therapist affects ADL in patients with sepsis. Methods This was a retrospective cohort study. This study’s subjects were sepsis patients who entered the advanced emergency critical care center of Shinshu University Hospital between April 2014 and March 2020. Electronic medical records were reviewed to obtain information on demographic characteristics, severity score, primary source of infection, therapeutic medication, the number of days after hospital admittance until rehabilitation begins, length of hospital stay, discharge to home, and an assessment of daily living activities for each patient. The patients were divided into two groups based on whether they were treated before or after a specialized physical therapist had been hired by the advanced emergency critical care center. Results Assigning a physical therapist to a patient significantly shortened the number of days until rehabilitation began. In a multivariable model, the strongest predictors of return to independent living after hospital discharge were (1) assigning a specialized physical therapist (odds ratio = 2.40; 95% confidence interval = 1.09–5.79; P = 0.050) and (2) the number of days until rehabilitation started (odds ratio = 0.24; 95% confidence interval = 0.08–0.76; P = 0.014). Conclusions Assigning a specialized physical therapist to sepsis patients at an advanced emergency critical care center significantly shortened the number of days until a patient can begin rehabilitation after hospital admittance and improved activities of daily living after hospital discharge. Trial registration Trial registration [University Hospital Medical Information Network Clinical Trials Registry, number UMIN000040570 (2020/5/28).]
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Troyer, Mark R. "Differential Diagnosis of Endometriosis in a Young Adult Woman With Nonspecific Low Back Pain." Physical Therapy 87, no. 6 (June 1, 2007): 801–10. http://dx.doi.org/10.2522/ptj.20060141.
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Background and PurposeEndometriosis is a common gynecological disorder that can cause musculoskeletal symptoms and manifest as nonspecific low back pain.Case DescriptionThe patient was a 25-year-old woman who reported the sudden onset of severe left-sided lumbosacral, lower quadrant, buttock, and thigh pain. The physical therapist examination revealed findings suggestive of a pelvic visceral disorder during the diagnostic process. The physical therapist referred the patient for medical consultation, and she was later diagnosed by a gynecologist with endometriosis and a left ovarian cyst.OutcomesThe patient underwent laser laparoscopy and excision of the ovarian cyst followed by a regimen of gonadotropin-releasing hormone agonists. The intervention resulted in abolition of the lower quadrant pain and a significant reduction of the back and leg pain that enabled the patient to return to her normal activities.DiscussionA thorough physical therapist examination that considers all of the musculoskeletal, visceral, and psychosocial components is essential to identify pelvic disorders such as endometriosis and other disease processes during the differential diagnosis of nonspecific low back pain. Medical consultation is necessary to provide proper diagnosis and intervention of endometriosis, but physical therapists also may have an important role in the identification of endometriosis and the management of the musculoskeletal aspects of the disorder.
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Boissonnault, William G., and Karen Lovely. "Hospital-Based Outpatient Direct Access to Physical Therapist Services: Current Status in Wisconsin." Physical Therapy 96, no. 11 (November 1, 2016): 1695–704. http://dx.doi.org/10.2522/ptj.20150540.
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Abstract Background Direct access to physical therapist services is available in all 50 states, with reported benefits including reduced health care costs, enhanced patient satisfaction, and no apparent compromised patient safety. Despite the benefits and legality of direct access, few data exist regarding the degree of model adoption, implementation, and utilization. Objectives The purposes of the study were: (1) to investigate the extent of implementation and utilization of direct access to outpatient physical therapist services in Wisconsin hospitals and medical centers, (2) to identify barriers to and facilitators for the provisioning of such services, and (3) to identify potential differences between facilities that do and do not provide direct access services. Design A descriptive survey was conducted. Methods Eighty-nine survey questionnaires were distributed via email to the directors of rehabilitation services at Wisconsin hospitals and medical centers. The survey investigated facility adoption of the direct access model, challenges to and resources utilized during model implementation, and current barriers affecting model utilization. Results Forty-seven (52.8%) of the 89 survey questionnaires were completed and returned. Forty-two percent of the survey respondents (20 of 47) reported that their facility offered direct access to physical therapist services, but fewer than 10% of patients were seen via direct access at 95% of the facilities offering such services. The most frequently reported obstacles to model implementation and utilization were lack of health care provider, administrator, and patient knowledge of direct access; its legality in Wisconsin; and physical therapists' differential diagnosis and medical screening abilities. Limitations Potential respondent bias and limited generalizability of the results are limitations of the study. These findings apply to hospitals and medical centers located in Wisconsin, not to facilities located in other geographic regions. Conclusions Respondents representing direct access organizations reported more timely access to physical therapist services, enhanced patient satisfaction, decreased organizational health care costs, and improved efficiency of resource utilization as benefits of model implementation. For organizations without direct access, not being an organizational priority, concerns from referral sources, and concerns that the physician-patient relationship would be negatively affected were noted as obstacles to model adoption.
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Schenkman, Margaret, Judith E. Deutsch, and Kathleen M. Gill-Body. "An Integrated Framework for Decision Making in Neurologic Physical Therapist Practice." Physical Therapy 86, no. 12 (December 1, 2006): 1681–702. http://dx.doi.org/10.2522/ptj.20050260.
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Abstract Decision-making frameworks are used by clinicians to guide patient management, communicate with other health care providers, and educate patients and their families. A number of frameworks have been applied to guide clinical practice, but none are comprehensive in terms of patient management. This article proposes a unifying framework for application to decision making in the management of individuals who have neurologic dysfunction. The framework integrates both enablement and disablement perspectives. The framework has the following attributes: (1) it is patient-centered, (2) it is anchored by the patient/client management model from the Guide for Physical Therapist Practice, (3) it incorporates the Hypothesis-Oriented Algorithm for Clinicians (HOAC) at every step, and (4) it proposes a systematic approach to task analysis for interpretation of movement dysfunction. This framework provides a mechanism for making clinical decisions, developing clinical hypotheses, and formulating a plan of care. Application of the framework is illustrated with a case example of an individual with neurologic dysfunction.