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.     

Perceptions of physical therapy competencies in rheumatology. Physical therapists versus rheumatologists

The purpose of this article is to report the differences in perceptions among three groups of respondents who assessed the importance of 80 competencies for entry-level physical therapists who treat patients with arthritis. Nonparametric statistics were used to analyze the responses of physical therapists and rheumatologists who completed a questionnaire regarding the competencies. I used the Kruskal-Wallis one-way analysis of variance to make group comparisons and the Mann-Whitney U test to complete pair-wise comparisons. The results revealed significant differences of opinion among the groups (p = .007) for 20 of the 80 competencies. The significant differences in opinion were among physical therapy clinical educators (n = 100), physical therapy arthritis health professionals (n = 108), and rheumatologists (n = 80). Although the results suggested that some groups perceived certain physical therapy competencies in rheumatology to be useful but not essential for the entry-level physical therapist to perform, considerable variability existed within groups. Despite the variance in opinions, teaching of these competencies should be included in the entry-level physical therapy curriculum or in clinical settings.     

Obstetrics in the physical therapy curriculum

We report the status of obstetric education in physical therapy curricula. A questionnaire was sent to 83 accredited physical therapy education programs. Of the respondents from 69 programs, 47 (68%) included a specific unit or information on obstetrics in their program. The reporting programs averaged 7.5 hours for obstetric education. The unit was required in 45 of the 47 programs. Topics covered included anatomy and physiology, psychology, labor and delivery sequence, relaxation techniques, breathing techniques, prenatal and postpartum exercises, body mechanics, nutrition, fetal development, and birthing alternatives. Fifty-three percent of the units were taught by a physical therapist and combination of other professionals including a nurse, physician, nutritionist, psychiatric social worker, physiologist, or anatomist. We present behavioral objectives, required readings, and audiovisual aids used in the units.     

Student adaptation to problem-based learning in an entry-level master's physical therapy program

The purpose of this study was to describe physical therapy students' perceptions of how they were adapting to problem-based learning in an entry-level Master's program. Fifty-one students wrote weekly journal entries about their learning during their first academic unit. Three faculty members independently read and coded the entries and worked together to form categories and themes. Member checking was used to further verify the data interpretation. Tutorial sessions, evaluations, clinical experiences, and accessing resources were the most frequently mentioned learning events. The students were initially overwhelmed by the program demands, but quickly developed strategies to deal with each new challenge. In the process, they gained confidence and, by the end of the unit, acknowledged their significant accomplishments. The themes associated with the adaptation to problem-based learning included the students' need to: establish their own learning structure, learn more efficient and effective means of accessing information, develop ways of coping with stress, and receive confirmation of their learning. Additional themes were: students' awareness of group dynamics, the difficulty and value of giving and receiving feedback, and the value of the educational process to both their learning and to the practice of physical therapy.     

Leadership, administration, management, and professionalism (LAMP) in physical therapy: a Delphi study

BACKGROUND AND PURPOSE: The knowledge and skills needed by physical therapists entering practice in the areas of leadership, administration, management, and professionalism (LAMP) are not known. Using the LAMP components identified by American Physical Therapy Association's Section on Administration, this study sought to define the range of LAMP content pertinent to physical therapy clinical management and to explore LAMP knowledge and skills required of physical therapists upon entry into the profession. SUBJECTS AND METHODS: Thirty-four physical therapist managers participated in a Delphi study to (1) create a comprehensive list of defined LAMP components, (2) determine the perceived importance of each component in the management of clinical practices, and (3) identify the level of knowledge and skill for each component believed to be necessary for a new physical therapist graduate. RESULTS: Respondents agreed that 178 items should be on the LAMP component list. They perceived that almost all LAMP components are important in the management of a clinical practice, and they indicated that new graduates needed moderate to extensive knowledge in 44% of them. They believed that new graduates needed no skill in 29% of the components, whereas they needed at least intermediate skill for 22% of them. Top-ranked component categories across the 3 scales (importance, knowledge, and skill) were communication, professional involvement and ethical practice, delegation and supervision, stress management, reimbursement sources, time management, and health care industry scanning. DISCUSSION AND CONCLUSION: This study provides a basis for further exploration of which LAMP components should be included in professional (entry-level) physical therapist curricula and which components should be learned after graduation.     

Survey of burn education in entry-level physical therapy programs

We investigated the extent of burn education in entry-level physical therapy curricula and also collected information about oncology instruction. A questionnaire was sent to the directors of 96 entry-level physical therapy curricula, and 76 directors responded. Most of the respondents (98.7%) indicated that burn and cancer management warranted lectures. The programs that quantified instruction averaged 4.8 hours of burn-related medical and surgical lectures and 4.2 hours of burn-related physical therapy procedure lectures. The instructional time devoted to oncology was slightly less. Physicians presented the medical and surgical lectures in 36% of the curricula and provided instruction with physical therapists and nurses in 39% of the curricula. Physical therapists alone presented the lectures on physical therapy procedures in 83% of the curricula. Sixty-three percent of the respondents believed that new graduates could effectively treat both patients with burns and those with cancer, but other respondents attached various qualifiers to their responses. Some respondents thought that new graduates could not adequately treat patients with burns (12%) or cancer (8%). Suggestions for future physical therapy burn education are given.     

Mental imagery and its potential for physical therapy

The purposes of this article are 1) to review the sports and motor-learning literature regarding the effects of mental imagery and mental practice on physical skills and 2) to explore the feasibility of using them as adjunctive techniques in physical therapy. In the area of sports, evidence exists that mental practice can improve motor skills. Research that supports a mind-body relationship is cited, in addition to research using mental imagery from the areas of medicine, biofeedback, psychoneuroimmunology, and physical therapy. Variables that influence the outcome of mental practice such as vividness, kinesthetic imagery, and combining physical and mental practice are examined, and two major variables associated with ineffective results are identified. The advantages and disadvantages of using mental imagery for physical therapy patients are discussed with the conclusion that mental imagery has the potential to be a viable technique for physical therapists.     

Joint mobilization education and clinical use in the United States

Joint mobilization in the physical therapy evaluation and treatment of patients with synovial joint dysfunction has come into general use only within the past decade. The purposes of this study were 1) to collect survey data regarding the education of physical therapists in mobilization techniques, 2) to examine quantitative changes in entry-level curricula from 1970 to 1986, and 3) to examine basic and continuing education opportunities and determine whether physical therapists are making use of these opportunities. Using chi-square analysis, significant changes (p less than or equal to .01) were found in the number of entry-level programs offering instruction in joint mobilization techniques and in the interest in initiating or expanding relevant course work. In the survey of practicing physical therapists, the increase in the number of therapists who have had instruction in mobilization techniques was also found to be significant (p less than or equal to .01). These results would seem to indicate that mobilization techniques are becoming more widely used by physical therapists to treat joint dysfunction and that entry-level physical therapy education programs are making an attempt to prepare students by expanding curricula.     

Review of the postbaccalaureate degree for professional entry into physical therapy

The American Physical Therapy Association has endorsed the postbaccalaureate entry-level degree for the physical therapy profession. This article reviews the purpose of entry-level professional training and contrasts various options of educational systems with degree structures. Professional economic, political, and educational factors are considered. After analysis of these variables, the Master of Physical Therapy degree is my recommendation for the postbaccalaureate entry-level degree for physical therapists.     

Factors related to physical therapy students' decisions to work with elderly patients

The purpose of this study was to determine the factors related to physical therapy students' decisions to work with elderly patients subsequent to graduation. Questionnaires, distributed to students in graduating classes of seven entry-level master's degree programs and seven baccalaureate degree programs, were returned by 326 participants. The questionnaires included 20 questions within four categories--biographical (3), experiential (7), perceived socioeconomic (3), and attitudinal (7) factors--plus 1 question to determine whether students intended to work with elderly patients. Chi-square tests (p less than .05) determined significant relationships between the participants' intentions to work with elderly people and their answers to 10 of the questions (1 biographical, 3 experiential, and 6 attitudinal). The answers to 1 of these experiential questions and 4 of these attitudinal questions were significant at the .001 level. No perceived socioeconomic questions were significant. Our results may help in planning strategies to encourage physical therapy students to work with elderly people.     

The First Physical Therapy Summit on Global Health: implications and recommendations for the 21st century

The First Physical Therapy Summit on Global Health was convened at the 2007 World Confederation for Physical Therapy (WCPT) Congress to vision practice in the 21st century and, in turn, entry-level education and research, as informed by epidemiological indicators, and consistent with evidence-based noninvasive interventions, the hallmark of physical therapy. The Summit and its findings were informed by WHO data and validated through national databases of the countries of the five WCPT regions. The health priorities based on mortality were examined in relation to proportions of physical therapists practicing in the areas of regional priorities and of the curricula in entry-level programs. As a validation check and to contextualize the findings, input from members of the 800 Summit participants was integrated and international consultants refined the recommendations. Lifestyle-related conditions (ischemic heart disease, smoking-related conditions, hypertension, stroke, cancer, and diabetes) were leading causes of premature death across regions. Contemporary definitions of physical therapy support that the profession has a leading role in preventing, reversing, as well as managing lifestyle-related conditions. The proportions of practitioners practicing primarily in these priority areas and of the entry-level curricula based on these priorities were low. The proportions of practitioners in priority areas and entry-level curricula devoted to lifestyle-related conditions warrant being better aligned with the prevalence of these conditions across regions in the 21st century. A focus on clinical competencies associated with effective health education and health behavior change formulates the basis for The Second Physical Therapy Summit on Global Health.     

The First Physical Therapy Summit on Global Health: Implications and Recommendations for the 21st century

The First Physical Therapy Summit on Global Health was convened at the 2007 World Confederation for Physical Therapy (WCPT) Congress to vision practice in the 21st century and, in turn, entry-level education and research, as informed by epidemiological indicators, and consistent with evidence-based noninvasive interventions, the hallmark of physical therapy. The Summit and its findings were informed by WHO data and validated through national databases of the countries of the five WCPT regions. The health priorities based on mortality were examined in relation to proportions of physical therapists practicing in the areas of regional priorities and of the curricula in entry-level programs. As a validation check and to contextualize the findings, input from members of the 800 Summit participants was integrated and international consultants refined the recommendations. Lifestyle-related conditions (ischemic heart disease, smoking-related conditions, hypertension, stroke, cancer, and diabetes) were leading causes of premature death across regions. Contemporary definitions of physical therapy support that the profession has a leading role in preventing, reversing, as well as managing lifestyle-related conditions. The proportions of practitioners practicing primarily in these priority areas and of the entry-level curricula based on these priorities were low. The proportions of practitioners in priority areas and entry-level curricula devoted to lifestyle-related conditions warrant being better aligned with the prevalence of these conditions across regions in the 21st century. A focus on clinical competencies associated with effective health education and health behavior change formulates the basis for The Second Physical Therapy Summit on Global Health.     

Critical thinking and learning styles of students in a problem-based,master's entry-level physical therapy program

The purpose of this study was to compare critical thinking ability and critical thinking disposition of physical therapy students in year 1 and year 2 of an entry-level Master's program, and determine the association between critical thinking and preferred learning styles. Fifty year 1 and 44 year 2 students were tested for critical thinking ability on the California Critical Thinking Skills Test (CCTST), critical thinking disposition on the California Critical Thinking Disposition Inventory (CCTDI), and learning style on the Kolb Learning Style Inventory (LSI). Repeat testing of the critical thinking tests was done 8 months later. Two-way repeated measures analyses of variance (ANOVA) were used to compare students between years and times. Associations between variables were determined by means of Pearson's or Spearman's correlations. The mean scores of the CCTST (year 1: 20.7 ± 3.96, year 2: 20.2 ± 3.08) and total CCTDI (year 1: 314.6 ± 22.57, year 2: 315.2 ± 23.37) were not significantly different between years, and did not change over time. The ANOVA revealed significant effects for three subscales of the CCTDI: truth-seeking—year 2 greater than year 1, self-confidence—significant time effect, and systematicity—significant year × group interaction effect. None of the CCTDI scores was significantly correlated with CCTST. Critical thinking scores were not different among the four LSI categories. LSI scores did not predict change in critical thinking. Master's entry-level physical therapy students did not have major changes in their critical thinking ability or disposition during the program.     

Educational preparedness for physical therapists and occupational therapists in burn care.

The background of physical therapy (PT) and occupational therapy (OT) students in burn care training may be variable during their professional education. The purpose of this study was to evaluate whether professional programs in PT and OT are meeting the burn care educational needs of their students. PTs and OTs currently practicing in burn care were asked to give their opinion of the most important curricular topics related to burn care, report their perception of their own entry-level preparedness for burn care, recount therapy interns preparation for burn care internships, and recommend topics that should be included in a therapy program burn care curriculum. Therapists felt prepared in basic sciences and somewhat prepared in specific burn care practice topics. Study participants felt more prepared for burn practice if they completed an internship in burn care. Enhancing content on burn-related treatment interventions was the most common suggestion for curricular revision.     

Factors influencing the use of outcome measures in physical therapy practice

Use of outcome measures in physical therapy practice is central to evaluating the effectiveness of treatment interventions, providing accountability and addressing quality of physical therapy programs. There is limited discussion on barriers and facilitators to using outcome measures in physical therapy practice. The purpose of this study was to identify factors that influence a physical therapist when deciding to use outcome measures in clinical practice. Participants were 21 physical therapists, seven each from skilled nursing facilities, outpatient clinics, and inpatient rehabilitation facilities. A grounded theory approach was used for interview and data collection. Common themes were determined from the data and a theory developed to explain the rationale behind physical therapists' decisions to use or not use outcome measures in clinical practice. Three overlapping themes related to (1) concepts of time, (2) knowledge, and (3) facility culture were indentified as factors influencing the use of outcome measures. A fourth encompassing theme, professionalism, identified the value placed on the use of outcome measures in practice. Data revealed that therapists require more information on the outcome measures available, and this information needs to be easily accessible within the workplace. Therapists value information generated by using outcome measures in the clinical setting, but need information on what measures are available and psychometric properties. Information must be easily accessible and measures easy to use. Newer graduates and recent learners have a foundation in the use of outcome measures, but more needs to be done in the clinic and through continuing education to promote increased use and understanding.     

Development of the physical therapy outpatient satisfaction survey (PTOPS)

BACKGROUND AND PURPOSE: The purposes of this 3-phase study were (1) to identify the underlying components of outpatient satisfaction in physical therapy and (2) to develop a test that would yield reliable and valid measurements of these components. SUBJECTS: Three samples, consisting of 177, 257, and 173 outpatients from 21 facilities, were used in phases 1, 2, and 3, respectively. METHODS AND RESULTS: In phase 1, principal component analyses (PCAs), reliability checks, and correlations with social desirability scales were used to reduce a pool of 98 items to 32 items. These analyses identified a 5-component model of outpatient satisfaction in physical therapy. The phase 2 PCA, with a revised pool of 48 items, indicated that 4 components rather than 5 components represented the best model and resulted in the 34-item Physical Therapy Outpatient Satisfaction Survey (PTOPS). Factor analyses conducted with phase 2 and phase 3 data supported this conclusion and provided evidence for the internal validity of the PTOPS scores. The 4-component scales were labeled "Enhancers," "Detractors," "Location," and "Cost." Responses from subsamples of phase 3 subjects provided evidence for validity of scores in that the PTOPS components of "Enhancers," "Detractors," and "Cost" appeared to differentiate overtly satisfied patients from overtly dissatisfied patients. "Location" and "Enhancer" scores discriminated subjects with excellent attendance at scheduled physical therapy sessions from those with poor attendance. CONCLUSION AND DISCUSSION: In this study, we identified components of outpatient satisfaction in physical therapy and used them to develop a test that would yield valid and reliable measurements of these components.     

Preparation of physical therapists to work with handicapped infants and their families: current status and training needs

The purposes of this study were to determine the current status of physical therapists' preparation to work with handicapped and at-risk infants and their families and to identify needs for infant- and family-focused training materials and curricula. Results of a telephone survey of 73 physical therapy programs and a follow-up mail survey of 14 physical therapy programs with infancy specialization options are presented. Students in entry-level programs and postprofessional master's degree programs with infancy specializations commonly received instruction in infancy-related topics. Many students received minimal or no exposure to family-related content. Family assessment and intervention were identified as the areas of highest priority for development of training materials and curricula. The results of this study provide direction for the design of infant- and family-focused training materials and curricula in physical therapy.     

Adult physical dysfunction content in professional curricula

This study examined the content of occupational therapy professional curricula as it pertains to adult physical dysfunction and the opinions and perceptions of faculty responsible for this content area. Survey results from 28 of 66 academic institutions offering professional-level education were received and analyzed. A great diversity in content and emphasis was reflected in the areas of medical conditions, general approaches to evaluation and treatment, specific evaluations, and specific treatment techniques and modalities. Most of the respondents were pleased with students' performances in physical dysfunction Level II fieldwork, believed that course work was applicable to local clinical settings, and agreed that courses were constantly changing to reflect evolving occupational therapy theory. Approximately 30% of the respondents believed that they had inadequate time to prepare students for entry-level practice, and about half agreed that their department had the necessary equipment to teach evaluation and treatment content.     

Clinical reasoning strategies in physical therapy

BACKGROUND AND PURPOSE: Clinical reasoning remains a relatively under-researched subject in physical therapy. The purpose of this qualitative study was to examine the clinical reasoning of expert physical therapists in 3 different fields of physical therapy: orthopedic (manual) physical therapy, neurological physical therapy, and domiciliary care (home health) physical therapy. SUBJECTS: The subjects were 6 peer-designated expert physical therapists (2 from each field) nominated by leaders within the Australian Physiotherapy Association and 6 other interviewed experts representing each of the same 3 fields. METHODS: Guided by a grounded theory method, a multiple case study approach was used to study the clinical practice of the 6 physical therapists in the 3 fields. RESULTS: A model of clinical reasoning in physical therapy characterized by the notion of "clinical reasoning strategies" is proposed by the authors. Within these clinical reasoning strategies, the application of different paradigms of knowledge and their interplay within reasoning is termed "dialectical reasoning." DISCUSSION AND CONCLUSION: The findings of this study provide a potential clinical reasoning framework for the adoption of emerging models of impairment and disability in physical therapy.