Wisdom and Courage.

Laurita M. (Laurie) Hack, DPT, PhD, MBA, FAPTA: , has contributed to the physical therapy profession as an educator, researcher, and academic leader (Fig. 1 ).

Recommendations From the Common Terminology Panel of the American Council of Academic Physical Therapy.

Background: In 2015, the American Council for Academic Physical Therapy (ACAPT) developed 3 strategic initiative panels to address integrated clinical education, student readiness, and common terminology for physical therapist clinical education. Objective: The purpose of this paper is to describe the results of the work from the Common Terminology Panel. Design: This was a descriptive, consensus-based study. Methods: Using a consensus process and data that were collected from a review of literature, a document analysis of core and historical professional documents, focus group discussions, and an online open comment period, panel members developed a glossary for physical therapist clinical education. Results: The final glossary included 34 terms in 4 categories. The categories included clinical education infrastructure, sites, stakeholders, and assessment. The ACAPT Board of Directors approved the glossary in June 2017, and the ACAPT membership approved the glossary in October 2017. Limitations: The focus of the glossary was on physical therapist clinical education. A future, similar project should be undertaken for physical therapist assistant clinical education. Conclusion: This process resulted in a comprehensive glossary for physical therapist clinical education; changes to several current terms, including "internship" and "full-time clinical education experience"; and the addition of new terms, including "preceptor" and "site coordinator for clinical education." New terminology will provide standard language for consistent communication and a common framework for all stakeholders.

National Study of Excellence and Innovation in Physical Therapist Education: Part 1-Design, Method, and Results.

BACKGROUND: The Carnegie Foundation for the Advancement of Teaching commissioned the Preparation for the Professions Program, a qualitative study of professional education in 5 professions: medicine, nursing, law, engineering, and clergy. These studies identified curricular structures, instructional practices, assessment approaches, and environmental characteristics that support the preparation of professionals and led to educational reforms. The physical therapy profession has not had any in-depth, national investigation of physical therapist education since the Catherine Worthingham studies conducted more than 50 years ago. OBJECTIVES: This research was a Carnegie-type study, investigating elements of excellence and innovation in academic and clinical physical therapist education in the United States. DESIGN: Five physical therapist education researchers from across the United States used a qualitative multiple-case study design. METHODS: Six academic and 5 clinical programs were selected for the study. The academic institutions and clinical agencies studied were diverse in size, institutional setting, geography, and role in residency education. Qualitative case studies were generated from review of artifacts, field observations, and interviews (individual and focus group), and they provided the data for the study. RESULTS: A conceptual framework grounded in 3 major dimensions was generated, with 8 supporting elements: (1) culture of excellence (shared beliefs and values, leadership and vision, drive for excellence, and partnerships), (2) praxis of learning (signature pedagogy, practice-based learning, creating adaptive learners, and professional formation), and (3) organizational structures and resources. CONCLUSION: Building on the work of the Carnegie Foundation's Preparation for the Professions Program, a conceptual model was developed, representing the dimensions and elements of excellence in physical therapist education that is centered on the foundational importance of a nexus of linked and highly valued aims of being learner centered and patient centered in all learning environments, both academic and clinical.

National Study of Excellence and Innovation in Physical Therapist Education: Part 2-A Call to Reform.

This perspective shares recommendations that draw from (1) the National Study of Excellence and Innovation in Physical Therapist Education research findings and a conceptual model of excellence in physical therapist education, (2) the Carnegie Foundation's Preparation for the Professions Program (PPP), and (3) research in the learning sciences. The 30 recommendations are linked to the dimensions described in the conceptual model for excellence in physical therapist education: Culture of Excellence, Praxis of Learning, and Organizational Structures and Resources. This perspective proposes a transformative call for reform framed across 3 core categories: (1) creating a culture of excellence, leadership, and partnership, (2) advancing the learning sciences and understanding and enacting the social contract, and (3) implementing organizational imperatives. Similar to the Carnegie studies, this perspective identifies action items (9) that should be initiated immediately in a strategic and systematic way by the major organizational stakeholders in physical therapist education. These recommendations and action items provide a transformative agenda for physical therapist education, and thus the profession, in meeting the changing needs of society through higher levels of excellence.

Workforce Projections 2010-2020: Annual Supply and Demand Forecasting Models for Physical Therapists Across the United States.

BACKGROUND: Health human resources continue to emerge as a critical health policy issue across the United States. OBJECTIVE: The purpose of this study was to develop a strategy for modeling future workforce projections to serve as a basis for analyzing annual supply of and demand for physical therapists across the United States into 2020. DESIGN: A traditional stock-and-flow methodology or model was developed and populated with publicly available data to produce estimates of supply and demand for physical therapists by 2020. METHODS: Supply was determined by adding the estimated number of physical therapists and the approximation of new graduates to the number of physical therapists who immigrated, minus US graduates who never passed the licensure examination, and an estimated attrition rate in any given year. Demand was determined by using projected US population with health care insurance multiplied by a demand ratio in any given year. The difference between projected supply and demand represented a shortage or surplus of physical therapists. RESULTS: Three separate projection models were developed based on best available data in the years 2011, 2012, and 2013, respectively. Based on these projections, demand for physical therapists in the United States outstrips supply under most assumptions. LIMITATIONS: Workforce projection methodology research is based on assumptions using imperfect data; therefore, the results must be interpreted in terms of overall trends rather than as precise actuarial data-generated absolute numbers from specified forecasting. CONCLUSIONS: Outcomes of this projection study provide a foundation for discussion and debate regarding the most effective and efficient ways to influence supply-side variables so as to position physical therapists to meet current and future population demand. Attrition rates or permanent exits out of the profession can have important supply-side effects and appear to have an effect on predicting future shortage or surplus of physical therapists.

Use of a Delphi panel to establish consensus for recommended uses of selected balance assessment approaches.

The Delphi survey is a useful mechanism to make recommendations for clinical judgments in the absence of practice guidelines for evidence-based decision making. Although there is a great deal of literature about the topic of various methods of balance assessment, decisions about application of research evidence for clinical practice may be subject to personal interpretation and/or biases of the reader. In this study, a panel of informed experts was used through a Delphi process to establish consensus regarding the recommended use of selected balance assessment methods based on the literature. Selective recruitment of experienced faculty members with advanced degrees and/or specialist certification in the content area identified seven knowledgeable informants. The panel participated in three rounds of discussion to develop a consensus-based summary of the recommended use of balance assessment methods commonly used in clinical practice and suggest how those measures fit within the framework of the Patient/Client Management Model of physical therapy practice. The outcomes of the Delphi process form a basis for recommended practice in the examination of patients with balance deficits and serve as a starting point in the development of evidence-based practice guidelines.

Gait variability detects women in early postmenopause with low bone mineral density.

BACKGROUND: Women in early postmenopause and with low bone mineral density (BMD) may exhibit early markers for physical frailty as a result of sarcopenia and osteopenia. OBJECTIVE: The purpose of this study was to determine whether women in early postmenopause and with low BMD exhibit decreased physical performance and differences in gait variability and fall and fracture rates. DESIGN: This study was an observational cohort design with participants assigned to groups on the basis of BMD status. METHODS: Fifty-four women, 31 with low BMD and 23 with normal BMD, participated. This study was conducted in a university research facility. Physical performance was measured by assessment of dynamic balance (timed backward tandem walk test), strength (handheld dynamometry of isometric quadriceps muscle force production), and free gait speed. Gait variability was assessed on the basis of the coefficient of variation for temporal-spatial gait characteristics. Falls and fractures were assessed for the year after initial testing. RESULTS: Significant between-group differences were found for step time and stance time variability. LIMITATIONS: The limitations of this study included group assignment on the basis of the results of the most recent bone density scan within the preceding 2 years. CONCLUSIONS: Women in early postmenopause and with low BMD exhibited increased gait variability in step time and stance time but did not exhibit differences in balance, strength, or gait speed. Gait variability may be more sensitive for detecting differences in women in early postmenopause and with or without low BMD than more typical measures of physical performance.

Factors that influence the clinical decision making of physical therapists in choosing a balance assessment approach.

BACKGROUND: Many methods for examining patients with balance deficits are supported by the literature. How or why therapists choose specific balance assessment methods during examination of patients remains unclear. OBJECTIVES: The aims of this study were: (1) to explore decision making during examination of patients with balance deficits, (2) to understand the selection and use of assessment methods from the clinician's perspective, and (3) to explore why specific methods were selected. DESIGN: A qualitative design using a grounded theory approach permitted exploration of clinical decision making. METHODS: Eleven therapists were purposefully selected (6 from outpatient offices, 5 from inpatient rehabilitation settings) to participate in repeated interviews. Credibility of the findings was established through low-inference data, member check, and triangulation among participants and multiple data sources. RESULTS: A highly individualized approach to patient examination based on therapists' practical knowledge emerged from the data, with limited influence of the literature. Movement observation was the primary assessment and diagnostic tool. When selecting assessment approaches for specific patients, the perceived value of information gathered mattered more than testing time. A 3-stage model of assessment decision making portrayed both the process and reasons influencing therapists' choices. CONCLUSIONS: In the context of the complex and busy nature of clinical practice, therapists gathered data that they considered meaningful during patient examination. The findings provide insight into factors influencing assessment decisions and suggest mechanisms to foster translation of research into clinical practice.