Physical Therapist, Physical Therapist Assistant, and Student Response to Inappropriate Patient Sexual Behavior: Results of a National Survey.

Background: A recent survey found that 84% of physical therapist, physical therapist assistant, and student respondents experienced inappropriate patient sexual behavior (IPSB) over their careers and 47% over the prior 12 months. Prevalence data justify consideration of how to address IPSB. Objective: The objective was to determine how physical therapist clinicians (used here to mean physical therapists, physical therapist assistants, and students) address IPSB and examine strategy impact. Design: The design was observational and cross-sectional. Methods: Several sections of the American Physical Therapy Association and selected education programs fielded the electronic survey. Respondents reported on the frequency and effect of IPSB response strategy. Response-strategy impact was tested for statistical significance. Open-ended comments were analyzed using qualitative methods. Results: Of 1027 respondents, 396 had experienced IPSB over the prior 12 months; 391 provided data on the frequency and effect of response strategies used. Common informal responses included distraction, ignoring IPSB, and altering treatment to avoid physical contact or being alone. Common formal responses included reporting the behavior within the facility and documenting the behavior. Successful strategies included distraction, avoidance, direct confrontation, behavioral contracts, transfer of care, and chaperone use. Experienced clinicians were more likely to be direct, whereas novice clinicians were more likely to engage in unsuccessful actions of ignoring and joking. Limitations: Limitations included self-report, clinician memory, and convenience sampling. Conclusions: The first findings in 20 years on physical therapist, physical therapist assistant, and student response to IPSB provide direction for the profession. Results indicate a need for clear workplace policies coupled with training for managers and supervisors to support clinicians in resolving IPSB. Policies on using behavioral contracts, chaperones, and transfer of care could empower staff to consider these successful options. Professional education and training for all physical therapy professionals on assertive communication and redirection strategies with IPSB appears warranted.

Prevalence and Risk of Inappropriate Sexual Behavior of Patients Toward Physical Therapist Clinicians and Students in the United States.

BACKGROUND: For health care providers in the United States, the risk for nonfatal violence in the workplace is 16 times greater than that for other workers. Inappropriate patient sexual behavior (IPSB) is directed at clinicians, staff, or other patients and may include leering, sexual remarks, deliberate touching, indecent exposure, and sexual assault. Inappropriate patient sexual behavior may adversely affect clinicians, the organization, or patients themselves. Few IPSB risk factors for physical therapists have been confirmed. The US prevalence was last assessed in the 1990s. OBJECTIVE: The objectives of this study were to determine career and 12-month exposure to IPSB among US physical therapists, physical therapist assistants, physical therapist students, and physical therapist assistant students and to identify IPSB risk factors. DESIGN: This was a retrospective and observational study. METHODS: An electronic survey was developed; content validity and test-retest reliability were established. Participants were recruited through physical therapist and physical therapist assistant academic programs and sections of the American Physical Therapy Association. Inappropriate patient sexual behavior risk models were constructed individually for any, mild, moderate, and severe IPSB events reported over the past 12 months. Open-ended comments were analyzed using qualitative methods. RESULTS: Eight hundred ninety-two physical therapist professionals and students completed the survey. The career prevalence among respondents was 84%, and the 12-month prevalence was 47%. Statistical risk modeling for any IPSB over the past 12 months indicated the following risks: having fewer years of direct patient care, routinely working with patients with cognitive impairments, being a female practitioner, and treating male patients. Qualitative analysis of 187 open-ended comments revealed patient-related characteristics, provider-related characteristics, and abusive actions. LIMITATIONS: Self-report, clinician memory, and convenience sampling are limitations of this type of survey research. CONCLUSIONS: The extremely high prevalence of IPSB among physical therapist professionals warrants practitioner and student education as well as clear workplace policy and support.

Influence of a Short-Term Disability Awareness Program on Knowledge and Attitudes of School-Aged Children in Southern Belize: Results of a Community-University Partnership.

Background: Little is known about the attitudes of children living in Central America toward people with disabilities or the effectiveness of a disability awareness program in influencing their knowledge and attitudes. Objective: The study objectives were to evaluate the effectiveness of a disability awareness program in influencing Belizean children's knowledge of and attitudes toward people with disabilities in the immediate short term and to describe the development of a university-community partnership that resulted in the development of a culturally appropriate disability awareness program. Design: This was a single-group pretest-posttest quasi-experimental study with cluster sampling. Methods: Study participants included 247 children (11-14 years old) from 8 primary schools in Toledo District, Belize. A paper-based disability awareness survey measuring knowledge of and attitudes toward people with disabilities was administered before and after an intervention. The intervention was a 90-minute multimodal disability awareness program. Hierarchical linear modeling was used to model the influence of the intervention on knowledge of and attitudes toward people with disabilities. Results: Significant improvements in knowledge of and attitudes toward people with disabilities were evident immediately after the intervention. Limitations: Children were not randomized to a control group. Although this feature was a limitation in terms of study design, the researchers believed that respecting the wishes of the school principals by providing the disability awareness intervention to all students was important. Conclusions: This study provided an example of how a university-community partnership can positively influence community outcomes. Further research is needed to assess long-term changes in Belizean children's knowledge of, attitudes toward, and behaviors toward people with disabilities, as well as the social inclusion and participation of children with disabilities.

Reliability of the ECHOWS Tool for Assessment of Patient Interviewing Skills.

BACKGROUND: History taking is an important component of patient/client management. Assessment of student history-taking competency can be achieved via a standardized tool. The ECHOWS tool has been shown to be valid with modest intrarater reliability in a previous study but did not demonstrate sufficient power to definitively prove its stability. OBJECTIVE: The purposes of this study were: (1) to assess the reliability of the ECHOWS tool for student assessment of patient interviewing skills and (2) to determine whether the tool discerns between novice and experienced skill levels. DESIGN: A reliability and construct validity assessment was conducted. METHODS: Three faculty members from the United States and Australia scored videotaped histories from standardized patients taken by students and experienced clinicians from each of these countries. The tapes were scored twice, 3 to 6 weeks apart. Reliability was assessed using interclass correlation coefficients (ICCs) and repeated measures. Analysis of variance models assessed the ability of the tool to discern between novice and experienced skill levels. RESULTS: The ECHOWS tool showed excellent intrarater reliability (ICC [3,1]=.74-.89) and good interrater reliability (ICC [2,1]=.55) as a whole. The summary of performance (S) section showed poor interrater reliability (ICC [2,1]=.27). There was no statistical difference in performance on the tool between novice and experienced clinicians. LIMITATIONS: A possible ceiling effect may occur when standardized patients are not coached to provide complex and obtuse responses to interviewer questions. Variation in familiarity with the ECHOWS tool and in use of the online training may have influenced scoring of the S section. CONCLUSION: The ECHOWS tool demonstrates excellent intrarater reliability and moderate interrater reliability. Sufficient training with the tool prior to student assessment is recommended. The S section must evolve in order to provide a more discerning measure of interviewing skills.