Do Chosen Learning Strategies Predict Academic Performance in First-Year DPT Anatomy Students?

INTRODUCTION: The purpose of this study was to identify predictors of anatomy final course grades from first-year physical therapist students' characteristics and chosen learning strategies, as indicated on the Motivated Strategies for Learning Questionnaire (MSLQ). Identifying factors that contribute to success in content intensive classes may aid in coaching successful learning strategies as students transition from undergraduate coursework to Doctor of Physical Therapy (DPT) programs. REVIEW OF LITERATURE: Previous studies show that first-year graduate students use ineffective learning strategies that are insufficient for graduate-level study. The MSLQ correlates with academic performance at several educational levels. To date, only one study has examined the correlation of MSLQ with physical therapist students' academic performance for an anatomy course. SUBJECTS: Thirty-nine first-year physical therapist students participated in the study (27 from a hybrid program, 12 from a traditional program). METHODS: This study analyzed MSLQ scores for the total instrument, each domain, and each subscale using regression analyses to determine predictors of final anatomy grades. RESULTS: The subscales of Self-Efficacy and Test Anxiety had significant predictive value for anatomy grades (R2 = 0.455, F = 5.203, P = .029). Test Anxiety had an inverse relationship to anatomy grades, meaning lower test anxiety scores correlated with higher anatomy grades. The combination of Self-Efficacy, Test Anxiety, and Critical Thinking subscales resulted in a significant prediction of anatomy grades (R2 = 0.603, F = 6.659, P = .014). DISCUSSION AND CONCLUSION: This study found moderate correlations between MSLQ Motivation subscales and final grades in DPT anatomy classes. Self-Efficacy and Test Anxiety subscales had the strongest correlations and were significantly predictive of anatomy grades. Faculty may benefit from using inventories like the MSLQ for first-year physical therapist students to identify motivational characteristics associated with success and to remediate students' learning strategies to prevent academic failure.

Unlocking Patient Voices: Advancing Physical Therapist Practice with Discrete Choice Experiments.

As health care moves away from volume-based to value-based delivery, the role of the patient in determining value in health care is now paramount. Thus, health care should be aligned with what matters most to patients. Ascertaining patient preferences is therefore critical if we are to provide patients with care that is meaningful to them. However, preferences are difficult to measure and traditional methods of preference measurement in physical therapy face challenges when attempting to measure such. This perspective makes a case for greater use of the discrete choice experiment (DCE) in physical therapy as a research method to measure patient preferences. The DCE is a research method used to elicit preferences for services or goods. This article addresses the importance of eliciting patient preferences as part of person-centered care in the value-based space, the challenges faced in preference measurement in physical therapy, and how the discrete choice experiment can alleviate some of those challenges. It also provides examples of the discrete choice experiment in health care and suggests ways in which it can be effectively used in physical therapist practice to improve the delivery of meaningful rehabilitation services to patients. Implementing greater use of the DCE in physical therapy can improve person-centered physical therapist service delivery and inform policy development that creates cost-effective care which is meaningful to patients. It can further help to highlight the value of physical therapy to population health, and to policy makers as health care moves towards more value-based models.

Rasch analysis of the Jefferson Teamwork Observation Guide to improve student reflection after interprofessional education.

Interprofessional education is expanding and emerging as a focus of health profession education. The development of instruments to identify competency of students is needed to improve interprofessional collaboration in patient care. Our purpose was to investigate the individual Jefferson Teamwork Observation Guide (JTOG) to determine its psychometric properties. Health profession student data (814 surveys) were analyzed using Rasch Modeling to determine the item and person statistics, unidimensionality, scaling performance, and local independence. The psychometric properties of the instrument were strong, but the current model produced a significant ceiling effect. Adaptations to the instrument were recommended to improve the instruments ability to identify competency and provide individual feedback on performance using a Rasch model. The adapted JTOG has strong psychometric properties to help facilitate reflection and to promote collaborative practice competency.

Predictors of National Physical Therapy Examination Failure in Graduates of a Blended Doctor of Physical Therapy Program.

INTRODUCTION: Passing the National Physical Therapy Examination (NPTE) is a necessary step in progressing into a professional career. The purpose of this study was to identify student factors that predicted failure on the first attempt of the NPTE in graduates of a blended Doctor of Physical Therapy (DPT) program. REVIEW OF LITERATURE: Student factors that may affect NPTE outcomes have been studied in traditional physical therapist education programs but have not been studied in blended programs. Blended instruction is a delivery format that combines distance asynchronous learning and face-to-face synchronous learning in a complementary way. SUBJECTS: Two hundred ten graduates from 6 consecutive cohorts of a DPT program taught in a blended format. METHODS: Retrospective observational cohort design. Demographic, preadmission, and in-program academic data and NPTE pass/fail status were collected. Variables were analyzed with forward stepwise logistic regression for their ability to predict first-time NPTE failure. Receiver operating characteristic curves were plotted to determine cut points of predictive variables. RESULTS: Two regression analyses were conducted. First, an analysis of all variables identified 3 significant predictors: comprehensive examination score, cumulative third-year grade point average, and Graduate Record Examination Verbal Reasoning (GRE-V) score, which explained 43.2% of the variance. The second analysis excluded variables occurring late in matriculation to identify early occurring predictors. This yielded 2 early predictive variables, GRE-V score and academic difficulty, which explained 29.5% of the variance. DISCUSSION AND CONCLUSION: To our knowledge, this is the first study of predictors of NPTE outcomes in blended DPT program graduates. Like previous studies, a mix of preadmission and in-program factors predicted first-time NPTE failure. These findings may help inform admissions policies, academic advising processes, and academic warning policies in blended programs. Future research is needed to explore factors unique to blended educational settings and the qualities of the students they attract.

Shoulder-Specific Patient-Reported Outcome Measures for Use in Patients With Head and Neck Cancer: An Assessment of Reliability, Construct Validity, and Overall Appropriateness of Test Score Interpretation Using Rasch Analysis.

OBJECTIVES: The purpose of this study was to investigate the construct validity and overall appropriateness of test score interpretation of 4 shoulder-related patient-reported outcome (PRO) measures for use in a population of patients with head and neck cancer using Rasch analysis. METHODS: One hundred eighty-two individuals who had received a neck dissection procedure within the past 2 weeks to 18 months were recruited for this cross-sectional psychometric study. Rasch methodologies were used to investigate scale dimensionality, scale hierarchy, response scale structure, and reliability of Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH, Shoulder Pain and Disability Index (SPADI), and Neck Dissection Impairment Index (NDII). RESULTS: DASH did not meet criteria for unidimensionality and was deemed inappropriate for use in this sample. The QuickDASH, SPADI, and NDII were all determined to be unidimensional. All scales had varying issues with person and item misfit, differential item functioning, coverage of ability levels, and optimal rating scale requirements. The NDII met most requirements. All measures were found to meet thresholds for person and item separation as well as reliability statistics. CONCLUSIONS: Rasch analysis indicates the NDII is the most appropriate measure studied for this population. The QuickDASH and SPADI are recommended with reservation, whereas the DASH is not recommended. IMPACT: This study demonstrates the use of objective methodologies, using Rasch analysis, to validate PRO recommendations provided by clinical experts in forums such as the Evaluation Database to Guide Effectiveness (EDGE) TaskForce, which are based upon a comprehensive literature review, consideration of published psychometric properties, and expert consensus. Use of Rasch methodologies demonstrates weaknesses in this model and provides opportunities to strengthen recommendations for clinicians.

Scapular movement impairments in individuals with subacromial pain syndrome based on scapular assistance test and scapula reposition test outcomes.

BACKGROUND: Individuals with subacromial pain present with a variety of contributing impairments related to the movement problem. The scapular assistance test (SAT) and scapula reposition test (SRT) are proposed to identify shoulder pain related to abnormal scapular movement or position. It remains unknown if scapular movement related impairments are present in those with positive tests. OBJECTIVES: To determine if scapular motion related impairments differ based on the result of the SAT or SRT in individuals with subacromial pain syndrome. DESIGN: Cross-sectional METHOD: Sixty individuals with subacromial pain syndrome were included. Prior to obtaining results of the SAT and SRT, a single examiner measured scapular upward rotation and posterior tilt active and passive motion, pectoralis minor length, and strength of the middle trapezius, lower trapezius, and serratus anterior. Dynamic scapular motion was qualitatively assessed with the Scapular Dyskinesis Test. The Mann-Whitney U test assessed for differences based on the outcome of the SAT and SRT. RESULTS: There was a significant difference (P = .023) in pectoralis minor length for the SAT. Participants with a positive SAT had decreased muscle length compared to those who tested negative. There were no significant differences in scapular motion or strength based on the result of either the SAT or SRT. CONCLUSIONS: A positive SAT was associated with greater pectoralis minor length impairment, but not muscle strength or mobility. The SRT did not identify greater impairments in any of the scapular movement related impairments assessed. Individuals may vary in contributing impairments related to SAT or SRT results.

Rasch analysis of the anterior knee pain scale in adolescents with patellofemoral pain.

OBJECTIVE: The aim of this study was to evaluate the Anterior Knee Pain Scale in a cohort of adolescents being treated conservatively for patellofemoral pain using Rasch analysis. DESIGN: This is a psychometric study. SETTING: Physical therapy clinics of a large pediatric hospital in Columbus, Ohio (United States). SUBJECTS: A total of 646 adolescent patients with patellofemoral pain (76% female, 14.6 ± 1.6 years old). INTERVENTION: Not applicable. MAIN MEASURE: The Anterior Knee Pain Scale. RESULTS: The median Anterior Knee Pain Scale score was 73 (interquartile range 64-81), with scores ranging from 7 to 100 on the 100-point scale. The Rasch person reliability for the Anterior Knee Pain Scale was 0.74 and the Cronbach's alpha was 0.75, representing an acceptable person reliability. Principal component analysis revealed a ratio of 5.2:1 demonstrating acceptable unidimensionality of the Anterior Knee Pain Scale. A significant misfit was observed in the item "Abnormal Painful Kneecap Movements" (Outfit Means Square 2.74, Infit Means Square 1.41). Ordering of item responses was unsatisfactory as only five of the 13 items demonstrated appropriate distinction between each of the responses. There was no differential item functioning for sex or age for all items of the Anterior Knee Pain Scale, based upon the criterion of ⩾ 0.5 logit difference. CONCLUSION: The Anterior Knee Pain Scale does not meet interval-level measurement criteria and should be considered ordinal level data.

Perturbation-Induced Stepping Post-stroke: A Pilot Study Demonstrating Altered Strategies of Both Legs.

Introduction: Asymmetrical sensorimotor function after stroke creates unique challenges for bipedal tasks such as walking or perturbation-induced reactive stepping. Preference for initiating steps with the less-involved (preferred) leg after a perturbation has been reported with limited information on the stepping response of the more-involved (non-preferred) leg. Understanding the capacity of both legs to respond to a perturbation would enhance the design of future treatment approaches. This pilot study investigated the difference in perturbation-induced stepping between legs in stroke participant and non-impaired controls. We hypothesized that stepping performance will be different between groups as well as between legs for post-stroke participants. Methods: Thirty-six participants (20 persons post-stroke, 16 age matched controls) were given an anterior perturbation from three stance positions: symmetrical (SS), preferred asymmetrical (PAS-70% body weight on the preferred leg), and non-preferred asymmetrical (N-PAS-70% body weight on the non-preferred leg). Kinematic and kinetic data were collected to measure anticipatory postural adjustment (APA), characteristics of the first step (onset, length, height, duration), number of steps, and velocity of the body at heel strike. Group differences were tested using the Mann-Whitney U-test and differences between legs tested using the Wilcoxon signed-rank test with an alpha level of 0.05. Results: Stepping with the more-involved leg increased from 11.5% of trials in SS and N-PAS up to 46% in PAS stance position for participants post-stroke. Post-stroke participants had an earlier APA and always took more steps than controls to regain balance. However, differences between post-stroke and control participants were mainly found when stance position was modified. Compare to controls, steps with the preferred leg (N-PAS) were earlier and shorter (in time and length), whereas steps with the non-preferred leg (PAS) were also shorter but took longer. For post-stroke participants, step duration was longer and utilized more steps when stepping with the more-involved leg compared to the less-involved leg. Conclusions: Stepping with the more-involved leg can be facilitated by unweighting the leg. The differences between groups, and legs in post-stroke participants illustrate the simultaneous bipedal role (support and stepping) both legs have in reactive stepping and should be considered for reactive balance training.

The Comparative Effects of Upper Thoracic Spine Thrust Manipulation Techniques in Individuals With Subacromial Pain Syndrome: A Randomized Clinical Trial.

BACKGROUND: Subacromial pain syndrome (SPS) accounts for as much as 44% of shoulder pain encountered by physical therapists. Thoracic spine thrust manipulation (TSTM) is effective in the short term for improving pain and function in individuals with SPS, but its mechanisms remain elusive. Furthermore, it is unknown whether individuals with SPS respond differently based on the TSTM technique received. OBJECTIVES: To compare the immediate effects of a supine TSTM, seated TSTM, and sham manipulation on the primary outcomes of self-reported pain, function, and satisfaction and secondary biomechanical impairments examined in individuals with SPS. METHODS: Participants in this randomized clinical trial were randomized to receive a seated TSTM (n = 20), supine TSTM (n = 20), or sham manipulation (n = 20). The primary outcomes of self-reported pain, function, and satisfaction were measured via the Penn Shoulder Score. Secondary outcomes were changes in scapular upward rotation and posterior tilt; peak force generated in tests for the middle trapezius, lower trapezius, and serratus anterior; and pectoralis minor muscle length. Impairment measures were immediately reassessed, and the Penn Shoulder Score was reassessed after 48 hours. RESULTS: There were no significant between-group differences in immediate or short-term follow-up outcomes. CONCLUSION: Two TSTM techniques resulted in no differences in pain, satisfaction, and function when compared to a sham manipulation. Thoracic spine thrust manipulation did not have an immediate effect on the scapular impairments examined. LEVEL OF EVIDENCE: Therapy, level 1. J Orthop Sports Phys Ther 2019;49(10):716-724. Epub 12 Mar 2019. doi:10.2519/jospt.2019.8484.

Clinical Specialization and Adherence to Evidence-Based Practice Guidelines for Low Back Pain Management: A Survey of US Physical Therapists.

Study Design Electronic cross-sectional survey. Background The American Physical Therapy Association (APTA) evidence-based practice guideline for low back pain (LBP) elaborated on strategies to manage nonspecific LBP in routine physical therapy practice. This guideline described LBP associated with mobility deficit, leg pain and a directional preference, coordination impairment (lumbar instability), and fear-avoidance behavior. Objectives To assess American physical therapists' adherence to the clinical practice guidelines (CPGs) for LBP of the Orthopaedic Section of the APTA, and to compare adherence among physical therapists with different qualifications. Methods The investigators contacted 1861 members of the Orthopaedic Section of the APTA and 1000 members of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). Participants made treatment choices for 4 clinical vignettes: LBP with mobility deficit, coordination impairment, leg pain (directional preference), or fear-avoidance behavior. The investigator used logistic regression analyses to compare guideline adherence among physical therapists with the following qualifications: orthopaedic clinical specialists (PTOs), Fellows of the AAOMPT (PTFs), PTOs and PTFs (PTFOs), and physical therapists without clinical specialization but with a musculoskeletal interest (PTMSs). Results A total of 410 physical therapists completed all sections of the survey (142 PTOs, 110 PTFOs, 74 PTFs, and 84 PTMSs). Adherence to the APTA's CPG was highest for LBP associated with leg pain and a directional preference (72.2%), followed by LBP with mobility deficit (57.1%), LBP with coordination impairment (46.1%), and fear-avoidance behavior (29.5%). Physical therapists who were PTFOs adhered better to the CPG for LBP than did PTMSs for all 4 patient vignettes. Orthopaedic clinical specialists adhered better to the CPG for LBP for the vignettes of mobility deficit and of LBP with fear-avoidance behavior than did PTMSs. Conclusion Physical therapists who were PTFOs and PTOs adhered better to the CPG than did PTMSs. Based on our preliminary results, further education on the CPG for LBP management is needed, particularly for managing LBP with coordination impairment and with fear-avoidance behavior. J Orthop Sports Phys Ther 2017;47(5):347-358. Epub 3 Mar 2017. doi:10.2519/jospt.2017.6561.

Intrarater reliability of hand held dynamometry in measuring lower extremity isometric strength using a portable stabilization device.

Hand held dynamometry (HHD) is a more objective way to quantify muscle force production (MP) compared to traditional manual muscle testing. HHD reliability can be negatively impacted by both the strength of the tester and the subject particularly in the lower extremities due to larger muscle groups. The primary aim of this investigation was to assess intrarater reliability of HHD with use of a portable stabilization device for lower extremity MP in an athletic population. Isometric lower extremity strength was measured for bilateral lower extremities including hip abductors, external rotators, adductors, knee extensors, and ankle plantar flexors was measured in a sample of healthy recreational runners (8 male, 7 females, = 30 limbs) training for a marathon. These measurements were assessed using an intrasession intrarater reliability design. Intraclass correlation coefficients (ICC) were calculated using 3,1 model based on the single rater design. The standard error of measurement (SEM) for each muscle group was also calculated. ICC were excellent ranging from ICC (3,1) = 0.93-0.98 with standard error of measurements ranging from 0.58 to 17.2 N. This study establishes the use of a HHD with a portable stabilization device as demonstrating good reliability within testers for measuring lower extremity muscle performance in an active healthy population.

MEASURING SPORT-SPECIFIC PHYSICAL ABILITIES IN MALE GYMNASTS: THE MEN'S GYMNASTICS FUNCTIONAL MEASUREMENT TOOL.

PURPOSE/BACKGROUND: Despite the availability of various field-tests for many competitive sports, a reliable and valid test specifically developed for use in men's gymnastics has not yet been developed. The Men's Gymnastics Functional Measurement Tool (MGFMT) was designed to assess sport-specific physical abilities in male competitive gymnasts. The purpose of this study was to develop the MGFMT by establishing a scoring system for individual test items and to initiate the process of establishing test-retest reliability and construct validity. METHODS: A total of 83 competitive male gymnasts ages 7-18 underwent testing using the MGFMT. Thirty of these subjects underwent re-testing one week later in order to assess test-retest reliability. Construct validity was assessed using a simple regression analysis between total MGFMT scores and the gymnasts' USA-Gymnastics competitive level to calculate the coefficient of determination (r2). Test-retest reliability was analyzed using Model 1 Intraclass correlation coefficients (ICC). Statistical significance was set at the p<0.05 level. RESULTS: The relationship between total MGFMT scores and subjects' current USA-Gymnastics competitive level was found to be good (r2 = 0.63). Reliability testing of the MGFMT composite test score showed excellent test-retest reliability over a one-week period (ICC = 0.97). Test-retest reliability of the individual component tests ranged from good to excellent (ICC = 0.75-0.97). CONCLUSIONS: The results of this study provide initial support for the construct validity and test-retest reliability of the MGFMT. LEVEL OF EVIDENCE: Level 3.

The effects of the Nintendo™ Wii Fit on gait, balance, and quality of life in individuals with incomplete spinal cord injury.

PURPOSE: To assess the effects of virtual reality using the NintendoTM Wii Fit on balance, gait, and quality of life in ambulatory individuals with incomplete spinal cord injury (iSCI). RELEVANCE: There is a need for continued research to support effective treatment techniques in individuals with iSCI to maximize each individual's potential functional performance. SUBJECTS: Five males with a mean age of 58.6 years who had an iSCI and were greater than one-year post injury. METHODS: An interrupted time series design with three pre-tests over three weeks, a post-test within one week of the intervention, and a four-week follow up. Outcome measures: gait speed, timed up and go (TUG), forward functional reach test (FFRT) and lateral functional reach test (LFRT), RAND SF-36. Intervention consisted of one-hour sessions with varied games using the Nintendo Wii Fit twice per week for seven weeks. Survey data was also collected at post-test. Results There were statistically significant changes found in gait speed and functional reach. The changes were also maintained at the four-week follow up post-test. Survey reports suggested improvements in balance, endurance, and mobility with daily tasks at home. CONCLUSION: All subjects who participated in training with the NintendoTM Wii Fit demonstrated statistically significant improvements in gait speed and functional reach after seven weeks of training. Given the potential positive impact that the NintendoTM Wii Fit has on functional reach and gait speed in patients with iSCI, physical therapists may want to incorporate these activities as part of a rehabilitation program.

Upper extremity strength characteristics in female recreational tennis players with and without lateral epicondylalgia.

STUDY DESIGN: Descriptive, cross-sectional. OBJECTIVES: To compare static strength characteristics of the upper extremity musculature in female recreational tennis players with lateral epicondylalgia to those of nonsymptomatic tennis players and a control group of women who did not play tennis. BACKGROUND: There is a paucity of research describing the relationship between lateral epicondylalgia and strength characteristics of the upper extremity musculature, despite the functional relationship between the shoulder, elbow, and wrist. METHODS: Sixty-three women were recruited into 3 groups (n = 21 per group): symptomatic tennis players (STP) with lateral epicondylalgia, nonsymptomatic tennis players, and controls. Data collection was performed during a single session, during which the strength of selected muscle groups of the dominant upper extremity was measured using a combination of force transducers. Strength ratios of selected muscle groups were then calculated. RESULTS: The STP group reported median pain level of 3/10 on a numeric pain rating scale and a symptom duration of 16 weeks. The STP group had weaker lower trapezius strength (mean difference, -9.0 N; 95% confidence interval [CI]: -13.5, -4.4) and wrist extensor strength (-12.7 N; 95% CI: -24.4, -1.1), and a higher shoulder internal/external rotation strength ratio (0.19; 95% CI: 0.02, 0.35) and upper/lower trapezius strength ratio (1.32; 95% CI: 0.41, 2.23), compared to those of the nonsymptomatic group. Compared to the control group, the STP group demonstrated a significantly higher shoulder internal/external rotation strength ratio (0.21; 95% CI: 0.04, 0.38) and wrist flexion/extension strength ratio (0.14; 95% CI: 0.01, 0.27). CONCLUSION: In this group of recreational female tennis players, significant differences in strength and strength ratio characteristics were identified. Although the design of the study precludes establishing a cause-and-effect relationship, the results suggest further study and treatment of the muscle groups of interest.

A combined sEMG and accelerometer system for monitoring functional activity in stroke.

Remote monitoring of physical activity using body-worn sensors provides an alternative to assessment of functional independence by subjective, paper-based questionnaires. This study investigated the classification accuracy of a combined surface electromyographic (sEMG) and accelerometer (ACC) sensor system for monitoring activities of daily living in patients with stroke. sEMG and ACC data (eight channels each) were recorded from 10 hemiparetic patients while they carried out a sequence of 11 activities of daily living (identification tasks), and 10 activities used to evaluate misclassification errors (nonidentification tasks). The sEMG and ACC sensor data were analyzed using a multilayered neural network and an adaptive neuro-fuzzy inference system to identify the minimal sensor configuration needed to accurately classify the identification tasks, with a minimal number of misclassifications from the nonidentification tasks. The results demonstrated that the highest sensitivity and specificity for the identification tasks was achieved using a subset of four ACC sensors and adjacent sEMG sensors located on both upper arms, one forearm, and one thigh, respectively. This configuration resulted in a mean sensitivity of 95.0%, and a mean specificity of 99.7% for the identification tasks, and a mean misclassification error of < 10% for the nonidentification tasks. The findings support the feasibility of a hybrid sEMG and ACC wearable sensor system for automatic recognition of motor tasks used to assess functional independence in patients with stroke.