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Davis AF, Klima DW, Leonard A, Miller SA. Floor-to-Stand Performance Among People Following Stroke. Phys Ther 2023; 103:pzad122. [PMID: 37690073 DOI: 10.1093/ptj/pzad122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 05/08/2023] [Accepted: 07/16/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES Studies have examined floor-to-stand performance in varied adult populations both quantitatively and qualitatively. Despite an elevated risk of falls and inability to independently return to stand after a fall, few have examined the ability to stand from the floor in patients recovering from stroke. There were 2 objectives of the study: to identify the relationships between floor-to-stand performance using a timed supine-to-stand test (TSS) and physical performance measures of gait, balance, and balance confidence among persons in the subacute phase after stroke; and to analyze descriptive strategies used in the completion of the TSS. METHODS A cross-sectional design was implemented. Fifty-eight adults (mean age = 59.2 [standard deviation (SD) = 13.9] years; 34 [58.6%] men) who were in the subacute phase after ischemic or hemorrhagic stroke and who could stand from the floor with no more than supervision completed the TSS and physical performance assessments. RESULTS The median time to complete the TSS in our sample was 13.0 (interquartile range = 15.5) seconds. TSS time was significantly correlated with physical performance tests, including the Timed "Up & Go" Test (ρ = 0.70), gait speed (ρ = -0.67), Dynamic Gait Index (ρ = -0.52), and Activities-Specific Balance Confidence Scale (ρ = -0.43). Thirty-two percent of the variance in TSS time was attributed to Timed "Up & Go" Test time and the use of the quadruped position to transition to standing. Participants who used a gait device were more likely to use a chair during rise to stand. CONCLUSION The TSS demonstrates concurrent validity with physical performance measures. IMPACT Findings serve to improve functional mobility examination after stroke and to formulate effective treatment interventions to improve floor-to-stand performance.
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Affiliation(s)
- Angela F Davis
- Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, Indiana, USA
| | - Dennis W Klima
- Department of Physical Therapy, University of Maryland Eastern Shore, Princess Anne, Maryland, USA
| | - Amanda Leonard
- Department of Rehabilitation, University of Maryland Rehabilitation & Orthopaedic Institute, Baltimore, Maryland, USA
| | - Stephanie A Miller
- Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, Indiana, USA
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Perron M, Brosseau R, Maltais DB, Piette V, Godbout A, Corriveau H, Hébert LJ. A proposal for a universal physical therapy diagnostic concept. Braz J Phys Ther 2023; 27:100560. [PMID: 37979247 PMCID: PMC10692659 DOI: 10.1016/j.bjpt.2023.100560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/25/2023] [Accepted: 10/25/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND In Canada, as in other countries, the physical therapist (PT) must make a diagnosis to comply with direct access responsibilities. This means making a diagnosis is an entry-to-practice essential competency. However, there is no consensus across physical therapy practice domains and contexts regarding the diagnostic concept, i.e., the classification system, labelling and diagnostic format that should be used. OBJECTIVE To propose a universal diagnostic concept, one a PT could use regardless of their practice domain or context. METHODS The relevant scientific and grey literature (1986-2022) were searched and key information was synthesized. RESULTS Information from 194 retained documents (8506 identified) was synthesized to a list of seven essential criteria that were then used to develop a universal physical therapy diagnostic concept (PT-Dx-C). The PT-Dx-C format consists of three labels in the following order: (1) health problem, (2) primary impairment, and (3) primary activity limitation or participation restriction. Label definitions are those used by the World Health Organization. The specific health problem, impairment, and limitation or restriction making up the diagnosis are determined for each patient using valid tests and measures. CONCLUSIONS The PT-Dx-C is consistent with best practices and could be applied to all patients, in all PT practice domains and contexts. It reflects the PT's expertise in the human movement system and their unique contribution to health care. Furthermore, its use may allow for communication of the PT's conclusions in a manner that can be understood by others thereby facilitating collaborative practice.
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Affiliation(s)
- Marc Perron
- École des sciences de la réadaptation, Université Laval, Quebec City, Canada.
| | - Rachel Brosseau
- École de réadaptation, Université de Montréal, Montreal, Canada; Institut de Cardiologie de Montréal, Montreal, Canada
| | - Désirée B Maltais
- École des sciences de la réadaptation, Université Laval, Quebec City, Canada; Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Quebec City, Canada
| | - Vincent Piette
- École des sciences de la réadaptation, Université Laval, Quebec City, Canada; Centre Hospitalier Universitaire de Québec, CHUL, Quebec City, Canada
| | - Alain Godbout
- Institut de réadaptation Gingras-Lindsay de Montréal, Montreal, Canada
| | - Hélène Corriveau
- École de réadaptation, Université de Sherbrooke, Sherbrooke, Canada; Centre de recherche sur le vieillissement du Centre intégré universitaire de santé et services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Canada
| | - Luc J Hébert
- École des sciences de la réadaptation, Université Laval, Quebec City, Canada; Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Quebec City, Canada; Département de radiologie et de médecine nucléaire, Université Laval, Quebec City, Canada
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Lusardi MM. 2023 Carol B. Lewis Distinguished Lecture Address to the APTA Geriatrics Membership Combined Sections Meeting, February 23, 2023 Key Words & Challenges: Defining Our Role in Caring for Older Adults. J Geriatr Phys Ther 2023; 46:93-102. [PMID: 36935462 DOI: 10.1519/jpt.0000000000000378] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
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Kirk-Sanchez NJ, Moore JG, Hartley GW, Wong M. The Use of Movement Scripts for Clinical Reasoning in Physical Therapist Education and Practice. Phys Ther 2022; 102:6586744. [PMID: 35587129 DOI: 10.1093/ptj/pzac061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/02/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022]
Abstract
The purpose of this Perspective is to present an application of script-based reasoning to physical therapist education and practice. Illness script-based reasoning has been described as a cognitive strategy for medical practitioners to diagnose and manage health conditions. Analogous to this medical model of patient management, "movement scripts" can be used by physical therapists in clinical reasoning. Movement scripts use features of the human movement system to recognize, categorize, and substantiate clinical problems and can be used to facilitate the development of master adaptive learners across the spectrum of physical therapist education and practice. Movement scripts are also consistent with the concept of the "human body as teacher" as the signature pedagogy proposed by the National Study of Excellence and Innovation in Physical Therapy Education. Movement of the human body, as captured by the concept of the human movement system, is a vehicle for lifelong adaptive learning for the physical therapist. Script-based learning and practice are consistent with other elements of this model, including practice-based learning and the creation of adaptive expertise. As the role of the movement system as a guide to physical therapist practice continues to evolve, movement scripts can provide a structure to facilitate development of clinical reasoning skills for physical therapist practice and education.
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Affiliation(s)
- Neva J Kirk-Sanchez
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
| | - James G Moore
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
| | - Gregory W Hartley
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
| | - Marlon Wong
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
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Struessel TS, Sleddens NM, Jones KJ. Quality Improvement Content in Physical Therapist Education: A Scoping Review. Phys Ther 2022; 102:6596552. [PMID: 35648123 DOI: 10.1093/ptj/pzac012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/01/2021] [Accepted: 01/05/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to systematically review the literature regarding teaching quality improvement (QI) in physical therapist education based on the Institute of Medicine's 6-element definition of QI. Educational activities in QI methods in physical therapist professional education curricula, their developmental stage, and their level of evaluation were described. METHODS Keywords related to physical therapist students and QI educational activities were used to search studies indexed in PubMed, CINAHL, and ERIC published from 2004 through November 2020. This search yielded 118 studies. After applying inclusion and exclusion criteria, 13 studies were retained for full-text review, which was conducted independently by 2 reviewers. The University of Toronto framework was used to assess developmental stage, and Kirkpatrick's taxonomy was used to assess the evaluation level of 4 retained studies. RESULTS The scope of QI educational activities in the 4 retained studies was limited to 3 of the 6 elements of QI: identifying opportunities for improvement, designing and testing interventions, and identifying errors and hazards in care. None of the studies included educational activities to teach understanding and measuring quality of care. Three of the 4 studies spanned the first 2 stages of the University of Toronto framework (exposure and immersion); 1 study was limited to exposure. None of the studies assessed competence in QI methods. Evaluation of QI education was limited to Kirkpatrick levels 1 (reaction) or 2 (learning). None of the studies evaluated activities at level 3 (transfer of new behaviors) or level 4 (results). CONCLUSION Education in QI methods in professional physical therapist curricula may be limited in scope due to constraints in physical therapist education and the strategic objective of the profession to differentiate itself from other professions. IMPACT Entry-level physical therapists might not be educated to fully participate in interprofessional teams that use QI methods to continuously improve the quality of patient-centered care.
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Affiliation(s)
- Tamara S Struessel
- Department of Physical Medicine and Rehabilitation, University of Colorado Physical Therapy Program, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nicole M Sleddens
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Kettle C, McKay L, Cianciolo AM, Kareha SM, Ruggeri CE. A novel movement system screen for primary care providers: a multisite, observational study. J Osteopath Med 2022; 122:159-166. [PMID: 34997837 DOI: 10.1515/jom-2021-0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/08/2021] [Indexed: 11/15/2022]
Abstract
CONTEXT Movement of the human body is essential for the interaction of an individual within their environment and contributes to both physical and emotional quality of life. Movement system disorders (MSDs) are kinesiopathologic conditions that result from either altered movement patterns, trauma, or pathology. A screening tool may facilitate earlier diagnosis and treatment of acute MSDs. This tool could prevent progression to chronic conditions, leading to better patient outcomes and quality of life. OBJECTIVES Our study evaluated whether a screening tool would be able to accurately screen individuals for MSDs, explore comorbidities that may predict the prevalence of MSDs, and identify why people do not discuss these problems with their primary care provider (PCP). METHODS A multisite, observational study in a primary care setting. Data were analyzed to determine the psychometric properties of the screening question. Logistic regression was performed to explore the relationship of comorbidities with MSDs. Thematic analysis was performed to explore why patients do not discuss these issues with their PCP. RESULTS The point prevalence of MSDs was determined to be 78%. The sensitivity of the screening question was determined to be good (70%). Arthritis, obesity, sleep disorders, and gastroesophageal reflux disease (GERD) were significant predictors for an MSD. Thematic analysis regarding why patients do not discuss the MSD with their physician revealed: (1) the perceived lack of importance of the problem; (2) the lack of access to healthcare, and (3) the acuity of the problem. CONCLUSIONS Screening for an MSD and associated comorbidities could prevent the transition of acute conditions to chronic conditions. If PCPs can identify predictors and factors associated with an MSD, they may be able to screen for MSDs more effectively. Earlier identification of MSDs may facilitate earlier treatment and prevent costs associated with resulting chronic disorders and persistent pain and disability.
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Affiliation(s)
- Christine Kettle
- Physical Therapy at St. Luke's, St. Luke's University Health Network, Bethlehem, PA, USA.,Physical Therapy at St. Luke's, St. Luke's University Health Network, Allentown, PA, USA
| | - Lauren McKay
- Department of Internal Medicine, St. Luke's University Health Network, Bethlehem, PA, USA
| | | | - Stephen M Kareha
- Physical Therapy at St. Luke's, St. Luke's University Health Network, Bethlehem, PA, USA.,Department of Physical Therapy, DeSales University, Center Valley, PA, USA
| | - Cara E Ruggeri
- Department of Internal Medicine, St. Luke's University Health Network, Bethlehem, PA, USA.,Clinical Associate Professor (Adjunct), Lewis Katz School of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
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Zarzycki R, Malloy P, Eckenrode BJ, Fagan J, Malloy M, Mangione KK. Application of the 4-Element Movement System Model to Sports Physical Therapy Practice and Education. Int J Sports Phys Ther 2022; 17:18-26. [PMID: 35024205 PMCID: PMC8720250 DOI: 10.26603/001c.30173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 01/20/2023] Open
Abstract
The 4-Element Movement System Model describes primary elements (motion, force, motor control, and energy) essential to the performance of all movements. The model provides a framework or scaffolding which allows for consistent processes to be used in examination and intervention decisions. The process starts with task identification followed by a systematic observation of control, amount, speed, symmetry, and symptoms during movement. Testable hypotheses are generated from the observations which inform the examination and the interventions. This commentary describes the use of the 4-Element Movement System Model in entry level and post-graduate residency educational programs and in clinical care with three common sports-related diagnoses. LEVEL OF EVIDENCE 5.
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Seehafer L, Morrison S, Severin R, Ness BM. A Multi-Systems Approach to Human Movement after ACL Reconstruction: The Cardiopulmonary System. Int J Sports Phys Ther 2021; 17:60-73. [PMID: 35024206 PMCID: PMC8720251 DOI: 10.26603/001c.29451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/01/2021] [Indexed: 11/23/2022] Open
Abstract
The cardiopulmonary system plays a pivotal role in athletic and rehabilitative activities following anterior cruciate ligament reconstruction, along with serving as an important support for the functioning of other physiologic systems including the integumentary, musculoskeletal, and nervous systems. Many competitive sports impose high demands upon the cardiorespiratory system, which requires careful attention and planning from rehabilitation specialists to ensure athletes are adequately prepared to return to sport. Cardiopulmonary function following anterior cruciate ligament reconstruction (ACLR) can be assessed using a variety of methods, depending on stage of healing, training of the clinician, and equipment availability. Reductions in cardiovascular function may influence the selection and dosage of interventions that are not only aimed to address cardiopulmonary impairments, but also deficits experienced in other systems that ultimately work together to achieve goal-directed movement. The purpose of this clinical commentary is to present cardiopulmonary system considerations within a multi-physiologic systems approach to human movement after ACLR, including a clinically relevant review of the cardiopulmonary system, assessment strategies, and modes of cardiopulmonary training to promote effective, efficient movement. LEVEL OF EVIDENCE 5.
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Affiliation(s)
| | - Scot Morrison
- PhysioPraxis PLLC; Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona
| | - Rich Severin
- Doctor of Physical Therapy Program, Baylor University; Department of Physical Therapy, College of Applied Health Sciences, University of Illinois
| | - Brandon M Ness
- Doctor of Physical Therapy Program, Tufts University School of Medicine
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