The role of physical therapists in introducing assistive products for the home-bound elderly disabled

[Purpose] This study explored the roles of physical therapists (PTs) in introducing assistive products, which are essential for living securely and stably at home, and examined how PTs can fulfill these roles more efficiently and effectively. [Subjects and Methods] A questionnaire on introducing assistive products was administered to PTs working at randomly selected hospitals, health-care facilities for the elderly requiring long-term care, home-visit nursing stations, and other such facilities and to PTs providing physical therapy directly to the home-bound elderly disabled. The subjects of the study were 77 PTs who returned valid responses. [Results] For awareness of systems for assistive product’s introduction, PTs were more aware of the system based on the Long-Term Care (LTC) Insurance Act than the system based on the Act on Welfare for the Home-Bound Elderly Disabled. For PTs handling assistive product’s introduction for the home-bound elderly disabled, approximately 91% of the respondents answered that they had handled some cases of assistive product’s introduction, and PTs with longer clinical experience had handled more assistive product’s introduction cases. [Conclusion] The results demonstrated that PTs understand the work involved in introducing assistive products work well and that they handle it. The results, however, also suggested that educational and operational improvements are urgently required for PTs introducing assistive products essential for the lives of the home-bound elderly disabled.Key words: Assistive products, Physical therapists, Home-bound elderly disabled     

Energy cost determination using a portable accelerometer

The purpose of this study was to determine the physical activity of physical therapists during clinical practice. Nineteen physical therapists from three clinical facilities wore portable accelerometers on their waist belts or chest pockets for the duration of their work shifts. The subjects repeated the experiment on the second day. The accelerometer readings (in arbitrary units) were converted to oxygen consumption VO2 and energy expenditure (kcal) values using previously derived regression equations. The PTs worked an average of 7.9 hours during each shift. The total energy expended during the work shift ranged from 933.6 to 1,689.6 kcal. A correlation coefficient of .91 was found between the accelerometer readings (count X hr-1) recorded on day 1 and day 2 of the study. The analysis of variance revealed that the PTs in the three clinical facilities were not significantly different in age, height, and work-shift duration, but were significantly different (p less than .05) in weight, mean accelerometer readings, and estimated VO2 (L X min-1). When the VO2 was expressed in mL X kg-1 X min-1, no significant difference was found between the PTs in the three clinical facilities. The implications and limitations of the findings are discussed.     

A Study on the Necessity of Medical Facilities Safety Design Adoption

[Purpose] The purpose of this study was to investigate the requirements of the introduction of a safety design and certification system for medical facilities. [Subjects] A survey was carried out of one hundred nurses, physical therapists, occupational therapists, speech and language therapists from May to August in 2012. [Methods] The survey was conducted after giving subjects some information about safety design. [Results] The participants were aware of the need for establishing a safety design certification system. Total responses to services, facilities and space were analyzed in order to evaluate the priorities of safety, user characteristics, functionality, convenience and aesthetics. Regarding the application of a safety design certification system to services, items were prioritized in the order of children''s items, household supplies and hospital supplies. For facilities, the priorities were, living space, social welfare and medical facilities; space, they were public and transportation-related places. The requirements for operating a safety design system were in order development of: highly skilled manpower, the legal system, educational promotion and qualifying facilities. [Conclusion] In conclusion, in order to implement safety design in medical facilities, a safety design certification system should be introduced first, and to do this a systematic and comprehensive study is needed.Key words: Safety design, Safety design certification, Medical facilities     

Clinical Reasoning of Physical Therapists regarding In-hospital Walking Independence of Patients with Hemiplegia

[Purpose] Physical therapists must often determine whether hemiparetic patients can walk independently. However, there are no criteria, so decisions are often left to individual physical therapists. The purpose of this study was to explore how physical therapists determine whether a patient with hemiplegia can walk independently in a ward. [Methods] The subjects were 15 physical therapists with experience of stroke patients’ rehabilitation. We interviewed them using semi-structured interviews related to the criteria of the states of walking in the ward of hemiparetic patients. The interviews were transcribed in full, and the texts were analyzed by coding and grouping. [Results] From the results of the interviews, PTs determined patients’ independence of walking in hospital by observation of behavior during walking or treatment. The majority of PTs focused on the patients’ state during walking, higher brain function, and their ability to balance. In addition, they often asked ward staff about patients’ daily life, and self-determination. [Conclusions] We identified the items examined by physical therapists when determining the in-hospital walking independence of stroke patients. Further investigation is required to examine which of these items are truly necessary.Key words: Hemiplegia, Walking, Independence     

Are Physical Therapy Interns Competent in Patient Management Skills? Assessment of the Views of Clinical and Academic Physical Therapists

[Purpose] This study aimed at evaluating PT interns’ performance from the perspectives of clinical and academic physical therapists (PTs). [Methods] An online questionnaire based on a modified version of the Clinical Internship Evaluation Tool (CIET) was used to evaluate PT interns’ performance in patient management skills. Assessors comprised clinical and academic PTs from Saudi Arabia. The survey aimed at assessing the competency of interns in 25 patient management skills comprising four major domains: clinical examination, patient evaluation, diagnosis and prognosis, and intervention. Assessors were also asked to rank the importance of possessing each skill and evaluating the internship programs at their facilities. A multivariate logistic regression analysis assessed whether the demographic variables between the two groups influenced their views. [Results] A total of 148 participants (112 clinical PTs and 36 academic PTs) responded to the survey. The majority of the participants agreed that interns were competent in all 25 skills. Differences between the two groups of assessors were observed for five out of the 25 skills. Interestingly, skills with the highest means were perceived as the most important skills by both groups of assessors. There was no association between sociodemographic variables and evaluation scores. [Conclusion] There were no differences observed between clinical and academic PTs in their evaluation of PT interns in 20 of the 25 clinical skills. There were indications of a need for further improvement in certain competencies and skills such as clinical examination, evaluation, diagnosis and prognosis, and intervention.Key words: Clinical internship, Physical therapy education, Clinical education     

Occupational therapy practice patterns with older Swedish persons at home

This paper explores and describes occupational therapy practice patterns during two periods for 89 elderly persons living at home. Occupational therapists working in one social welfare district in Stockholm, Sweden documented and reported every occupational therapy intervention provided. The results revealed that the elderly persons who received occupational therapy services during an extended period had an age span of 30 years, with a mean age over 80 years. They had several medical problems and were living in different types of settings. Occupational therapists provided a wide range of interventions, most frequently categorised as treatment, especially related to leisure activities. Irrespective of level of care, the median of interventions per person increased or was the same over time, and 72% of the elderly persons remained at the same level of care. Enabling occupation for elderly disabled person living in their home involves constantly adjusting to the current situation since the clients' capacities, goals and environment change over time. Therefore, occupational therapists need to have a client-centred approach working in home health community services.     

Comparison of Problematic Behavior According to the Ryouiku Techou Standard

[Purpose] We compared problematic behaviors of children according to the severity of their mental retardation (MR) of intellect as categorized by the Ryouiku Techou in this study, to investigate the influence of MR of intellect on children''s problematic behaviors. [Subjects] The subjects were 86 mentally retarded children undergoing physical therapy at hospitals and other facilities. [Methods] The examiners were 13 physical therapists and 8 occupational therapists who worked at the hospital and knew the children well. The examiners individually assessed the subjects using the Japanese version of the Aberrant Behavior Checklist. The subjects were divided into two groups (A and non-A) according to the Ryouiku Techou standard. [Results] No significant differences were observed between the groups except in the items of stereotypy and lethargy. [Conclusion] Problematic behaviors other than stereotypy and lethargy were not influenced by the Ryouiku Techou standard.Key words: The Japanese version of the Aberrant Behavior Checklist, Ryouiku Techou, Problematic behavior     

Use of a Functional Assessment Model for Teaching a Clinical Gerontology Course to Physical Therapists

Faculty from the University of Texas Medical Branch in Galveston were asked to participate in a baccalaureate educational proram for allied health professionalism in the Caribbean. A course on Clinical Gerontology was designed for physical therapists using a functional assessment model; this model was designed to evaluate the impact of age-related change's, pathology, and the living environment on the level of function in elderly clients. Students who applied this model to residents in a Jamaican nursing home concluded that modifications in the living environment to enhance cognitive and social stimuli were needed more than treatment oriented toward specific physical impairments in order to maximize functional independence and quality of life among these residents.     

The Ontario College of Occupational Therapists: a survey.

A survey was conducted to examine how familiar Ontario occupational therapists are with the Ontario College of Occupational Therapists (OCOT), and to identify their attitudes concerning self-regulation. A questionnaire was mailed to 100 occupational therapists, 50 non-members and 50 members of the OCOT. Sixty-four (64%) occupational therapists comprised the final sample; 30 members and 34 non-members. The prototypical member is over the age of 30 years, has worked more than ten years, and has graduated from a diploma program in occupational therapy. The prototypical non-member has worked for less than five years, has graduated from a degree program in occupational therapy, and is under the age of 30 years. The results indicated that: (1) both members and non-members work full-time in a hospital setting in the area of adult physical medicine as staff therapists; and (2) are involved in their professional associations, i.e., the Ontario Society of Occupational Therapists (OSOT) and the Canadian Association of Occupational Therapists (C.A.O.T.). Both groups support the concept of a self-regulatory body, however they view its purpose quite differently. The study further suggested that the majority of occupational therapists surveyed are not aware of the many issues surrounding regulation, i.e., provisions asked for by the OCOT under the Health Disciplines Act. The results are discussed with their implications for the OCOT and for Ontario occupational therapists.     

The Effects of Exercise on the Elderly and Implication for Therapy

Physical and occupational therapy activity and exercise programs have historically been directed toward the restoration of function in the disabled elderly. These professions have not focused their attention on the well or mildly impaired elderly. The current research on exercise and the elderly described here documents the positive benefits of physical activity and exercise programs for the well or mildly impaired elderly. The potential for physical and occupational therapists to provide services to the non-disabled elderly population is explored and a model program is offered as an example of this expanded role for therapists.     

Knowledge translation from continuing education to physiotherapy practice in classifying patients with low back pain

Abstract

Objectives:

Physical therapists have used continuing education as a method of improving their skills in conducting clinical examination of patients with low back pain (LBP). The purpose of this study was to evaluate how well the pathoanatomical classification of patients in acute or subacute LBP can be learned and applied through a continuing education format. The patients were seen in a direct access setting.

Methods:

The study was carried out in a large health-care center in Finland. The analysis included a total of 57 patient evaluations generated by six physical therapists on patients with LBP. We analyzed the consistency and level of agreement of the six physiotherapists’ (PTs) diagnostic decisions, who participated in a 5-day, intensive continuing education session and also compared those with the diagnostic opinions of two expert physical therapists, who were blind to the original diagnostic decisions. Evaluation of the physical therapists’ clinical examination of the patients was conducted by the two experts, in order to determine the accuracy and percentage agreement of the pathoanatomical diagnoses.

Results:

The percentage of agreement between the experts and PTs was 72–77%. The overall inter-examiner reliability (kappa coefficient) for the subgroup classification between the six PTs and two experts was 0·63 [95% confidence interval (CI): 0·47–0·77], indicating good agreement between the PTs and the two experts. The overall inter-examiner reliability between the two experts was 0·63 (0·49–0·77) indicating good level of agreement.

Discussion:

Our results indicate that PTs’ were able to apply their continuing education training to clinical reasoning and make consistently accurate pathoanatomic based diagnostic decisions for patients with LBP. This would suggest that continuing education short-courses provide a reasonable format for knowledge translation (KT) by which physical therapists can learn and apply new information related to the examination and differential diagnosis of patients in acute or subacute LBP.     

Knowledge translation from continuing education to physiotherapy practice in classifying patients with low back pain

Objectives:Physical therapists have used continuing education as a method of improving their skills in conducting clinical examination of patients with low back pain (LBP). The purpose of this study was to evaluate how well the pathoanatomical classification of patients in acute or subacute LBP can be learned and applied through a continuing education format. The patients were seen in a direct access setting.Methods:The study was carried out in a large health-care center in Finland. The analysis included a total of 57 patient evaluations generated by six physical therapists on patients with LBP. We analyzed the consistency and level of agreement of the six physiotherapists’ (PTs) diagnostic decisions, who participated in a 5-day, intensive continuing education session and also compared those with the diagnostic opinions of two expert physical therapists, who were blind to the original diagnostic decisions. Evaluation of the physical therapists’ clinical examination of the patients was conducted by the two experts, in order to determine the accuracy and percentage agreement of the pathoanatomical diagnoses.Results:The percentage of agreement between the experts and PTs was 72–77%. The overall inter-examiner reliability (kappa coefficient) for the subgroup classification between the six PTs and two experts was 0.63 [95% confidence interval (CI): 0.47–0.77], indicating good agreement between the PTs and the two experts. The overall inter-examiner reliability between the two experts was 0.63 (0.49–0.77) indicating good level of agreement.Discussion:Our results indicate that PTs’ were able to apply their continuing education training to clinical reasoning and make consistently accurate pathoanatomic based diagnostic decisions for patients with LBP. This would suggest that continuing education short-courses provide a reasonable format for knowledge translation (KT) by which physical therapists can learn and apply new information related to the examination and differential diagnosis of patients in acute or subacute LBP.     

Work-related musculoskeletal disorders among physical therapists: an online survey

Purpose: To evaluate the rates and characteristics of musculoskeletal disorders (MSDs) in physical therapists (PTs) according to their specialty and setting. Method: Participants completed an online questionnaire including 15 demographic questions, 7 work-related and 8 injury-related questions for 9 different body parts. Results: Complete responses were obtained from 121 PTs; 96% reported MSD symptoms during the previous 12 months, 64% affecting at least 3 body parts. The body parts with the highest prevalence of symptoms were the low back (66%) and the neck (61%). For PTs specialized in acute care, geriatrics and pediatrics, the body part most commonly affected was the low back, while for PTs specialized in orthopedics and neurology, the body part most commonly affected was the neck. Regarding work settings, the low back was the most commonly affected for PTs working in skilled nursing facilities, outpatient clinics and hospitals, and the neck in PTs working in academic and home health settings. Conclusions: MSDs are common among PTs; the body parts most often affected were the low back and neck. The prevalence and body parts affected varied by practice setting and specialty area. The findings can help informing the design of evidence-based rehabilitation, prevention, training and educational programs.

• Implications for Rehabilitation

• Rehabilitation of injured physical therapists needs to address the symptoms of the multiple body parts that are usually affected (e.g. back, wrists and hands).

• Rehabilitation of injured physical therapists needs to take into consideration their job demands, practice setting and specialty area.

• The findings can inform the design of rehabilitation, prevention, training and educational programs for physical therapists.

     

The Reliability and Validity of the Clinical Competence Evaluation Scale in Physical Therapy

[Purpose] To examine the internal consistency, criterion-related validity, factorial validity, and content validity of the Clinical Competence Evaluation Scale in Physical Therapy (CEPT). [Subjects] The subjects were 278 novice physical therapy trainees and 119 tutors from 21 medical facilities. [Methods] The trainees self-evaluated their clinical competences and the tutors evaluated trainee competences using the CEPT. Overall trainee autonomy was evaluated using a visual analog scale (VAS) for self-evaluation and the trainees were also evaluated by their tutors. The content validity of the CEPT was examined by asking if the CEPT could evaluate the competence of novice physical therapists on a four-point scale. [Results] Cronbach’s alpha of the CEPT was 0.96 for the trainees and 0.97 for the tutors. The correlation coefficient between the total score of the CEPT and whole competence by VAS was 0.83 for the trainees and 0.87 for the tutors. Factor analysis identified two factors, “the specialty of the physical therapist” and “the essential competence of a health professional”. Ninety percent or more of the trainees and the tutors answered that the CEPT could sufficiently evaluate the competence of novice physical therapists. [Conclusion] The CEPT is a reliable and valid scale for clinical competence evaluation of novice physical therapists.Key words: Clinical competence, Reliability, Validity     

Job satisfaction traits of Nigerian physical therapists

In recent years emigration of highly trained health personnel has caused manpower shortages that were of real concern to the developing countries. This study was designed to (1) determine whether physical therapists (PTs) in Nigeria were satisfied with their jobs, and (2) assess whether Nigerian PTs practicing in the United States (U.S.) were more satisfied with their jobs than the PTs in Nigeria. A questionnaire was administered to PTs in Nigeria ( N = 110) and Nigerian PTs based in the US ( N = 31). The questionnaire consisted of two parts: Part 1 sought demographic information and Part 2 consisted of ten statements relating to paperwork, job challenge, physical demand, job autonomy, fulfillment, and stress. Overall, these cohorts of PTs were satisfied with the clinical practice aspects of their jobs. The two groups were comparable except in areas relating to stress, paperwork, and physical demand. Nigerian PTs practicing in the U.S. were not more satisfied than their counterparts in Nigeria. The study suggests that factors other than those related to clinical practice aspects of physical therapy were responsible for the wave of emigration of PTs from Nigeria in the past decade.     

Factors affecting the interest of rehabilitation professionals indirectly supporting preventive care projects

[Purpose] To identify the factors affecting the interest of rehabilitation professionals who indirectly support preventive care projects. [Participants and Methods] Rehabilitation professionals (physical therapists, occupational therapists, and speech-language-hearing therapists) working in 617 hospitals and other health facilities in A Prefecture, Japan. On the basis of their degree of interest in the activities of their respective preventive care projects, the professionals were classified into three groups after evaluating their responses to a self-reporting questionnaire (1,851 parts in total). The subsequent comparisons were performed among the three groups and their responses to the remaining questions. [Results] Analysis of the responses provided by 354 of the 374 rehabilitation professionals who answered the questionnaire revealed the following factors affecting their degree of interest in the preventive care projects indirectly supported by them: advanced age; abundant years of experience practicing; being speech-language-hearing-therapists; experience in post-graduate training; and considering the scope of support as a part of the community. Furthermore, the vast majority of individuals in the group showing superior interest had experience in activities related to indirect support. [Conclusion] Confirmation of the extent to which indirect support by rehabilitation professionals is effective for preventive care services is essential, since such support is difficult to demonstrate, unlike direct support.     

The use of crafts in occupational therapy for the physically disabled

In this article, the historical use of crafts in occupational therapy for the physically disabled patient is reviewed and the results of a survey aimed at describing current craft use is presented. A questionnaire was sent to a random sample of 250 occupational therapists throughout the United States who chose physical disabilities as their specialty section. Results demonstrated that, while most therapists use crafts to some degree in their therapy programs, other treatment modalities such as therapeutic exercise and activities of daily living were used a greater percentage of the time. Reasons for using crafts, problems with justification of craft use, and participation of certified occupational therapy assistants in craft programs are discussed. Questions are raised concerning the role of therapeutic crafts in the past and present practice of occupational therapy for the physically disabled. Recommendations are made for future research.     

Therapeutic approaches to fibromyalgia syndrome in the United Kingdom: a survey of occupational therapists and physical therapists.

BACKGROUND AND PURPOSE: This study sought information from occupational therapists (OTs) and physical therapists (PTs) working in rheumatology in the UK on their usual methods of treatment and management of patients with fibromyalgia syndrome (FMS). METHODS. Data were gathered by self-completion questionnaire on: work setting; referrals of FMS patients; usual treatment objectives; assessment and treatment approaches; perceived responsiveness of patients; and other perceptions of the management of FMS. Most data were in the form of frequency counts, with some ordinal scales and open responses. RESULTS: Responses were obtained from 142 therapists (71% response rate), of whom 47 OTs and 39 PTs managed patients with FMS. The foremost therapeutic objective was increased functional ability for OTs, and increased exercise tolerance and general fitness for PTs. Pain reduction or management was rated as the second objective for both groups. An endurance-based exercise program and energy conservation techniques were the most frequently utilized interventions. Patients with FMS were thought to be 'moderately responsive' to physical management. Predictors of outcome were considered to be largely psychosocial, rather than physical, in nature. CONCLUSION: These data provide a preliminary profile of current practice in the management of FMS among UK therapists and indicate certain differences in approach between OTs and PTs.     

Televideo assessment using Functional Reach Test and European Stroke Scale

This study explored the equivalence of physical function assessment by physical therapists (PTs) during face-to-face and remote administration of the European Stroke Scale (ESS) and the Functional Reach Test (FRT) to 26 subjects with a history of stroke. Patients were randomized to remote or face-to-face administration groups. Each patient was simultaneously rated by both the face-to-face and remote PTs. The PTs were blinded to each other's results. Equivalence was set at the 95% limits of agreement. When the face-to-face PT directed the patient, the two PTs reported equivalent values in more than 90% of the patients for the FRT and for all ESS components, with the exception of gait (83%) and maintaining leg position (85%). When the remote PT directed the patient, the two PTs reported equivalent values in more than 90% of the patients for the FRT and more than 83% for all ESS components. Televideo assessment of function by PTs is substantially equivalent to a face-to-face encounter.     

Independence: the ultimate goal of rehabilitation for spinal cord-injured persons

During the late 1960s and early 1970s, a new concept related to rehabilitation and improvements in quality of life began to emerge and be expressed by people with spinal cord injuries and other disabilities. This concept, independent living, is the foundation of the independent living movement, which has helped to overcome the barriers to a higher quality of life for disabled people. Of the many organizations and programs set up to provide support for disabled people living in the community, the independent living program seems to be comparatively successful at facilitating independence by people with spinal cord injuries. Independent living programs provide the kind of community-based support services necessary to expand the range of living options for disabled people beyond those traditionally available in most communities. The role of occupational therapists in the independent living stage of the rehabilitation process can be similar in some respects to their role during earlier phases of medical rehabilitation. However, the definition of independence as a "mind process" leads to considerable expansion of the therapist's role beyond the focus on physical skills, which are usually key priorities during medical rehabilitation. Occupational therapists typically possess knowledge and skills that equip them well for assisting clients in the independent living stage of the rehabilitation process.