Proprietary physical therapy service in entry-level physical therapy curricula

The purposes of this study were to 1) assess the value of including an expanded business administration unit that would include proprietary practice issues in an entry-level physical therapy curriculum and 2) organize topics by priority that could be included in such a unit. Twenty-seven physical therapists (100%) in private practice in Montana responded to the questionnaire. Ninety-three percent of the respondents stated that such an expansion would be valuable in the entry-level physical therapy curriculum. Topics of greatest priority were 1) Self-analysis of Resources, 2) Reimbursement, and 3) Contracting Services and Referral Sources. Topics of least priority were 1) City and State Tax and Licensure Requirements, 2) Computers and Computer Programs, and 3) Insurance Planning. Further research and development are needed to formulate methods and objectives for such an expansion.     

The importance of physical activity and health for physical therapy

Background: The aims of physical therapy are to develop, maintain, and restore optimal movement and functional ability throughout the lifespan for individuals and populations. Physical activity is a key concept within physical therapy.

Objectives: To describe concepts of importance, dose–response relationship between physical activity and health, the scientific background for health-enhancing recommendations, and the measurements for assessing physical activity.

Major findings: There is strong evidence for an inverse and curve–linear relationship between physical activity dose, all-cause mortality and chronic disease prevention. The effects of physical activity for disease treatment are also clear. Nonetheless, there is a scarcity of studies determining the dose–response relationship between physical activity and health in relation to disease. Physical activity recommendations are based on current knowledge regarding the dose–response relationship between physical activity and health and are set at an approximate 30% risk reduction for the prevention of lifestyle-related diseases. In order to recommend an optimal physical activity dose, evaluate interventions as well as establish the prevalence of physical activity in the population, it is necessary that physical activity is measured in a reliable and valid way.

Conclusions: People with chronic disease or functional limitations are at great risk of being insufficiently active and are therefore in need of physical therapy interventions and support to enhance or maintain their physical activity level. The health benefits of increasing physical activity level among the physically inactive or those active at a very low level are potentially greater than those achieved by increasing activity level among already active individuals.     

Let's get physical

There is growing recognition and understanding of the inextricable interrelationship between physical and mental health. In mental health care, the physical health of consumers is now acknowledged as a serious problem requiring urgent action. This issue is undoubtedly related to negative symptoms and the lifestyle of people with mental illness. Much of the burden is also clearly linked with the detrimental side effects of psychotropic medications and deficits in the knowledge, skill, and confidence of mental health clinicians in relation to physical health matters. This paper highlights the problem of physical health in mental health care and presents recommendations to address this issue. The benefits of exercise on mental health in particular are explored. The authors argue that mental health nurses must play an active role in health promotion, primary prevention, and the early detection and management of physical health problems in all areas of clinical practice.     

Nutrition-focused physical assessment

Although it may seem that the nutrition-focused physical examination adds more time to the visit, the exam can be done in less time than a complete physical assessment. With practice, it can be built into your routine visit without adding significant additional visit time. The benefit of this type of examination will more than pay off in determining a baseline assessment that will allow a comprehensive plan of care to be developed. In the long-term, initial and continual assessment of a patient's nutritional status and progression toward appropriate outcomes will actually help your patient and you save you time and money and will result in less complications and better outcomes.     

Impact of role stress on physical therapists' emotional and physical well-being

This study examined the relationship between role stress and the physical and emotional well-being of 187 physical therapists practicing in the state of Missouri. Data collected via survey research established a significant relationship between role conflict (conflict between organizational demands and personal and professional values) and emotional exhaustion (r = .50) and between role conflict and somatic and job-induced tension (r = .43 and r = .44, respectively). Role ambiguity created by an uncertain organizational climate was related significantly to emotional exhaustion (r = .26) and to somatic and job-induced tension (r = .21 and r = .29, respectively). Perceived improper allocation of time, inadequate staff or resources, and receipt of incompatible demands were identified as significant role stressors and predictors of diminished emotional and physical well-being. Physical therapy directors and individual therapists should work within their organizations to reduce role stress and its detrimental effects, to align professional and organizational values, and to maintain personal and professional standards.     

Leisure-time physical activity and secondary conditions in women with physical disabilities

Purpose: To examine the relationship between secondary conditions and leisure-time physical activity participation (LTPA) in women with physical disabilities.

Method: A survey was conducted in a metropolitan urban USA area of women (n = 170) with physical disabilities including MS, CP, polio, arthritis, TBI, and CVA among others and aged 21 - 65 years. Outcome measures were LTPA, secondary conditions (numbers and severity), and functional status.

Results: Respondents experienced 11.99 ( ± 6.05) secondary conditions in the past year, self-rated their severity as 'moderate problems', and reported moderate levels of functional impairment. LTPA participation (excluding calisthenics/exercise) was reported to be 2.90 ( ± 5.12) times/week with 39.4% reporting no participation. After controlling for the interaction between severity of secondary conditions and functional status, the secondary conditions of physical deconditioning and isolation were significantly and inversely related to LTPA participation (r = - 0.164, p = 0.036; r = - 0.156, p = 0.045, respectively).

Conclusion: Reported secondary conditions of physical deconditioning and isolation are inversely related to the ability of moderately impaired women with physical disabilities to participate in LTPA when functional status was controlled and should be considered in efforts to increase involvement in this health promoting behaviour.     

Exercise and physical activity in persons aging with a physical disability

The relationship between physical functioning and physical activity isa reciprocal one; physical functioning provides the individual with the capability to engage in physical activities, and physical activity helps to maintain and in some cases improve physical functioning. This reciprocal relationship, coupled with the high prevalence of physical inactivity among persons aging with a disability, has profound implications for rehabilitation practice, especially in evaluating intermediate and long-term outcomes of clinical practice. For rehabilitation to play a role in the long-term maintenance and enhancement of physical functioning among persons with disabilities, increasing participation in various types of physical activity in the community must be part of the recovery and maintenance continuum. There is also a critical need to identify specific doses of physical activity for specific disabilities and secondary conditions. HMOs and other health insurers will require evidence-based outcomes before establishing reimbursement procedures for physical activity programs for persons aging with a physical disability.     

Leisure-time physical activity and secondary conditions in women with physical disabilities

Purpose:?To examine the relationship between secondary conditions and leisure-time physical activity participation (LTPA) in women with physical disabilities.

Method:?A survey was conducted in a metropolitan urban USA area of women (n?=?170) with physical disabilities including MS, CP, polio, arthritis, TBI, and CVA among others and aged 21?–?65 years. Outcome measures were LTPA, secondary conditions (numbers and severity), and functional status.

Results:?Respondents experienced 11.99 (?±?6.05) secondary conditions in the past year, self-rated their severity as ‘moderate problems’, and reported moderate levels of functional impairment. LTPA participation (excluding calisthenics/exercise) was reported to be 2.90 (?±?5.12) times/week with 39.4% reporting no participation. After controlling for the interaction between severity of secondary conditions and functional status, the secondary conditions of physical deconditioning and isolation were significantly and inversely related to LTPA participation (r?=???0.164, p?=?0.036; r?=???0.156, p?=?0.045, respectively).

Conclusion:?Reported secondary conditions of physical deconditioning and isolation are inversely related to the ability of moderately impaired women with physical disabilities to participate in LTPA when functional status was controlled and should be considered in efforts to increase involvement in this health promoting behaviour.     

Decision-making ability of physical therapists: physical therapy intervention or medical referral

BACKGROUND AND PURPOSE: Opponents of direct access to physical therapy argue that physical therapists may overlook serious medical conditions. More information is needed to determine the ability of physical therapists to practice safely in direct-access environments. The purpose of this study was to describe the ability of physical therapists to make decisions about the management of patients in a direct-access environment. SUBJECTS: Of a random sample of 1,000 members of the Private Practice Section of the American Physical Therapy Association, 394 participated. METHODS: A survey included 12 hypothetical case scenarios. For each case, participants determined whether they would provide intervention without referral, provide intervention and refer, or refer before intervention. The percentage of correct decisions for each group of scenarios was calculated for each participant, and participants were classified as having made correct decisions for 100% of cases or less for each group. Three sets of logistic regressions were completed to determine the characteristics of the participants in relation to the decision category. RESULTS: The average percentages of correct decisions were 87%, 88%, and 79% for musculoskeletal, noncritical medical, and critical medical conditions, respectively. Of all participants, approximately 50% made correct decisions for all cases within each group. The odds of making 100% correct decisions if a physical therapist had an orthopedic specialization were 2.23 (95% confidence interval=1.35-3.71) for musculoskeletal conditions and 1.89 (95% confidence interval=1.14-3.15) for critical medical conditions. DISCUSSION AND CONCLUSION: Physical therapists with an orthopedic specialization were almost twice as likely to make correct decisions for critical medical and musculoskeletal conditions.     

Acceptance of physical therapist assistant course work by programs preparing physical therapists

I developed and sent a questionnaire to the directors of entry-level physical therapy programs to determine if course work taken in an associate degree program could be credited toward requirements leading to a higher degree or certificate in physical therapy. I sent 86 questionnaires; 45 were returned. Results of the survey revealed that basic science courses taken by the physical therapist assistant (PTA) students are more likely to be credited (up to half of the respondents replied positively) toward a higher degree or certificate than are technical courses like therapeutic exercise, fundamentals of physical therapy, or physical modalities. Moreover, as many as 79 percent of the respondents reported that PTAs would not be granted transfer credit for their technical courses. Of those respondents whose programs do give credit for the technical courses, the courses are usually considered as elective hours. Although the concept of upward mobility appears to remain viable in the educational philosophy of the American Physical Therapy Association, students who view the associate degree program as an entry point into a physical therapy program must be aware of the problems of acceptance of PTA credits in an entry-level physical therapy program.