Determining Need for School-Based Physical Therapy Under IDEA: Commonalities Across Practice Guidelines

Effectiveness of school-based physiotherapy intervention for children

PURPOSE

To evaluate the effectiveness of school-based physiotherapy interventions for improving students' participation in school settings.

METHOD

A systematic review was reported using PRISMA guidelines. Four databases were searched for studies investigating physiotherapy outcomes of school-based physiotherapy interventions in children. Studies were categorised by intervention type and evaluated based on evidence level and conduct.

RESULTS

Fifteen intervention types (23 studies) met criteria. Strong positive evidence supported treadmill training without bodyweight support (n = 1), and upper limb interventions (n = 2). Moderate positive evidence supported robotic-assisted gait training (n = 1), Gross Motor Activity Training with Multimodal Education-Based Therapy (GMAT + MET) (n = 2), neurodevelopmental treatment (n = 2), and rock climbing (n = 1). Weak positive evidence supported environmental modifications (n = 1), Ergonomic Health Literacy (n = 3), GMAT (n = 1), GMAT with progressive resistance exercise (GMAT-PRE) (n = 1), hippotherapy (n = 1), MET alone (n = 7), overground gait training (n = 2), treadmill training with partial body-weight support (n = 1), and non-immersive virtual reality (n = 3).

CONCLUSION

There is preliminary supporting evidence for a variety of school-based physiotherapy interventions which is consistent with evidence for interventions with established efficacy in other contexts. The evidence for interventions in school contexts alone is insufficient to guide current practice. Future research should specifically evaluate the effectiveness of physiotherapy approaches in school settings.

School-Based Physical Therapists' Perceptions about Becoming Effective Practitioners through Professional Development

AIMS

The aims of this study were to explore perceptions of school-based physical therapists (SBPTs) about professional development and effective practice and to create a conceptual framework to help understand how SBPTs become effective practitioners who continue to learn and grow professionally as clinicians in an educational setting.

METHODS

Twenty school-based physical therapists completed a demographic questionnaire and a semi-structured interview. Guiding interview questions focused on SBPTs' perceptions of roles and responsibilities, professional development, barriers, and recommendations.

RESULTS

Participants identified roles and personal qualities of effective SBPTs. Three concepts for the process of professional development were developed: educational context and culture, barriers to effective practice, and strategies for professional development.

CONCLUSION

The development of effective practice for SBPTs is a multifaceted, iterative process involving a unique set of knowledge, skills, and behaviors that allow them to fulfill their roles. The process takes time and effort to understand the self within the educational context and culture, recognize barriers to effective practice, and develop strategies for success. A conceptual framework was developed to assist SBPTs in implementing a plan for professional development that leads to effectively providing services to students and functioning as essential members of the educational team.

Regional Differences in School-Based Physical Therapy: Examination of Therapist and Student Characteristics, Service Delivery, Activities, Interventions, and Outcomes

AimsThe aim of this study was to examine regional differences in school-based physical therapy practice focusing on the attributes of the school-based physical therapists and students; service delivery approaches, activities, and interventions; and student outcomes. Recognition of regional practices may decrease unnecessary variations, and assist with therapist clinical decision making and efforts to implement evidence-informed practice.MethodsA secondary data analysis of the PT COUNTS data was performed to compare physical therapist and student attributes; service delivery, activities, and interventions; and student outcomes across the Northeast, Southeast, Central, and Northwest regions of the United States.ResultsDifferences in the physical therapist and student characteristics, service delivery, activities, and interventions existed across the regions. There were no regional differences in outcomes when controlling for student functional level.ConclusionRegional differences in school-based practices may be expected and indicative of the influence of contextual factors including state and local policies and procedures that shape school-based service delivery and the characteristics of the therapists and students. Regional differences in practices may not have been of sufficient clinical magnitude to alter outcomes. Physical therapists can use the findings to reflect upon their individual decision making and practices.

School-Based Physical Therapy Services: Predicting the Gap Between Ideal and Actual Embedded Services

PURPOSE

To ascertain the variables predicting the gap between ideal and actual practice in embedding school-based physical therapy services.

METHODS

School-based physical therapists completed an online survey estimating ideal and actual practice of embedding physical therapy services. Predictive modeling was used to determine whether disability, interventions, goals, families, teachers, workload, billing, and/or contracts predicted the gap between estimated ideal and actual practice.

RESULTS

Data from 410 participants revealed that severity of students' disability, billing, written contracts, and families' preferences predicted the gap between estimated ideal and actual services. Actual practice varied based on region, APTA membership, and Academy of Pediatric Physical Therapy membership.

CONCLUSIONS

Our model predicts the gap between estimates of ideally and actually embedding school-based physical therapy services. While 4 variables predicted the gap, further research is needed to develop a predictive model of actual practice to inform school-based physical therapy practice.

School-Based Physical Therapists' Experiences and Perceptions of How Student Goals Influence Services and Outcomes

Aims: Individualized goals are the foundation for physical therapy services and outcomes. This research describes school-based physical therapists' (PTs) experiences and perceptions of how student goals impact services and outcomes. Methods: Twenty school-based PTs participated in one of five semi-structured focus groups on goal development and use. Therapists were recruited from 113 therapists who participated in a study of school-based physical therapy outcomes. Two researchers conducted thematic analysis of written transcriptions of audio recordings to identify qualitative themes; a third researcher reviewed the analysis. Results: Four themes emerged related to how goals impact services: (1) the nature of services, (2) intervention strategies, (3) teaming, and (4) flexibility of services. Three themes emerged related to how goals impact outcomes: (1) natural linkages among goals, services, and outcomes; (2) goals impact teaming to achieve outcomes; and (3) specifics of the goal matter. Therapists also reported a range of student and environmental factors that impact services and outcomes. Conclusions: Therapists perceive that goals influence services and outcomes in complex ways, especially due to the flexibility and individualization needed in school-based practice. This study helps school-based PTs understand and reflect on how individualized goals influence services and optimize student outcomes.