Work Engagement Among Physical Therapists and Physical Therapist Assistants.

AIMS: Work engagement is an important component of occupational wellness. The purpose of this study was to compare work engagement between physical therapists (PTs) and physical therapist assistants (PTAs) and to analyze relationships with participant demographics. METHODS: An online survey was emailed to all licensed PTs and PTAs in Texas, with 975 completed surveys returned. The survey consisted of demographic information and the Utrecht Work Engagement Scale-9. RESULTS: PTs and PTAs had similar levels of work engagement. Participants with a productivity requirement and those intending to leave their position had decreased work engagement, while American Physical Therapy Association (APTA) members had increased work engagement. CONCLUSION: The presence of a productivity requirement was associated with decreased work engagement and intent to leave one's position. To promote work engagement, organizations should assess productivity expectations and ensure job resources are adequate.

Intellectual Humility: How Recognizing the Fallibility of Our Beliefs and Owning Our Limits May Create a Better Relationship Between the Physical Therapy Profession and Disability.

Despite the many advancements over the history of the profession, physical therapy remains in a somewhat paradoxical relationship with disability. The physical therapist profession values disability as diversity but continues to focus on the normalization of body functions as the primary means to promote functionality in people with disability. This focus, consistent with a medicalized view of disability, may prevent physical therapists from empowering individuals with disability to explore alternative, yet effective, perceptual-motor strategies to achieve their functional goals. Additionally, recent research documents implicit, negative biases of physical therapists and physical therapist assistants toward people with disability, again consistent with the medicalized view that disability is the product of an imperfectly functioning body. Dominant underlying beliefs in any profession are often difficult to counter because they are so pervasive, and those beliefs can be reinforced and made stronger when challenged. The purpose of this Perspective article is to introduce physical therapists to a rising construct in psychology-intellectual humility-that may help to facilitate the profession's relationship with disability. Intellectual humility is predicated on recognizing the fallibility of one's beliefs and related practices. Intellectual humility is a promising construct for physical therapy to address the disability paradox and confront implicit attitudes that have served as the basis for many dominant ideas about disability. This Perspective synthesizes views and evidence from the behavioral and social sciences, philosophy, and critical disability studies to contribute to the ongoing evolution of the profession with respect to disability. IMPACT: The development of enhanced intellectual humility in physical therapy may help to challenge long-held beliefs among physical therapists about disability-many of which are unnoticed, unquestioned, and difficult to counter.

Practice patterns of physical therapists and physical therapist assistants treating patients with breast cancer related lymphedema.

Clinical Practice Guidelines (CPGs) aim to improve patient outcomes through implementation of proven interventions and decrease variation in practices. The relevance of this article is to describe the current state practice of physical therapists who diagnose and treat patients with Breast Cancer Related Lymphedema (BCRL). It also provides a description of physical therapist-reported adherence to the BCRL CPG recommendations which establishes the need for implementation interventions to improve adherence. PURPOSE: The purpose of this study is to describe practice patterns of physical therapists (PT) and physical therapist assistants (PTA) who treat patients with breast cancer-related lymphedema and determine if they are adherent to best evidence recommendations for lymphedema diagnosis and intervention. METHODS: An electronic survey to collect practice pattern data of PTs and PTAs who treat patients with BCRL was distributed. A descriptive and quantitative statistical analysis was performed. RESULTS: Twenty-six percent of respondents read the American Physical Therapy Association sponsored lymphedema diagnosis clinical practice guideline (CPG) and 20% read the lymphedema intervention CPG. Lymphoscintigraphy was the only diagnosis or intervention tool with a significant difference in use between therapists who read versus did not read the CPGs. Adherence to "should do" recommendations was variable: bioimpedance (18.2%), volume calculation (49.3%), ultrasound (0%), patient reported outcome tools (64.9%), compression garments (43.9%), exercise (87.2%), and compression bandaging (56.8%). CONCLUSIONS: There is variability in adherence to recommendations for both the lymphedema diagnosis and intervention CPGs. Interventions to improve implementation and adherence to CPG recommendations are warranted.

Job Satisfaction and Productivity Requirements Among Physical Therapists and Physical Therapist Assistants.

BACKGROUND: Job satisfaction is a concern within many professions and may lead to decreased employee recruitment and retention. The purpose of this study was to compare the level of job satisfaction in PTs and PTAs and to analyze relationships between job satisfaction, demographics, and productivity requirements. METHODS: 245 PTs and PTAs in Washington state completed a survey consisting of demographic information and the Job Satisfaction Survey (JSS), which measures job satisfaction within nine subscales. RESULTS: PTs and PTAs had similar levels of job satisfaction, and participants had higher total job satisfaction than established norms. 60% of subjects had a productivity standard, with an average standard of 82.1%. Participants with a productivity standard had lower job satisfaction, and lower satisfaction regarding rewards, operating conditions, nature of work, and communication. Significant negative correlations were found between productivity standards, total job satisfaction, and satisfaction regarding pay, supervision, benefits, rewards, and communication. CONCLUSIONS: PTs and PTAs with a productivity standard and those seeking employment should be aware that productivity standards may negatively impact job satisfaction. Organizations should evaluate policies regarding productivity requirements to ensure adequate levels of employee job satisfaction are maintained and to potentially improve employee recruitment and retention.

Physical Therapists and Physical Therapist Assistants' Knowledge and Use of the STEADI for Falls Risk Screening of Older Adults in Physical Therapy Practice in the United States.

Fall-risk screening and prevention is within the scope of physical-therapy practice. Prior research indicates United States-based physical therapists (PTs) and physical-therapist assistants (PTAs) use the Centers for Disease Control and Prevention's STEADI (Stopping Elderly Accidents, Deaths, and Injuries) toolkit for community-based fall-risk screenings of older adults. However, clinically based fall-risk screenings and knowledge and use of the STEADI by PTs and PTAs is unknown. We conducted a cross-sectional survey distributed to a convenience sample of PTs and PTAs in the United States through email blasts and social media. PTs and PTAs (N = 425) who responded to the survey and worked in clinical settings with older adults were included. Eighty-nine percent of respondents reported conducting clinical fall-risk screening. Approximately 51% were 'familiar' to 'very familiar' with the STEADI, and 21.7% of the overall sample were not familiar at all. Only 26.1% utilize the STEADI for clinical fall-risk screening. Of the respondents who were 'very familiar' with the STEADI (n = 132, 31.1%), 84.1% (n = 111) reported using the STEADI in clinical practice. Seventy-six percent of respondents who use the STEADI implemented it by choice even though the majority (52.1%, n = 63) did not have it embedded in their documentation/workflow. Some PTs/PTAs can and do manage falls using the STEADI, but there is a gap in knowledge and use of the STEADI for falls management among PTs and PTAs in the United States. Further research is needed to identify the tools PTs use for multifactorial-fall screening and management and the impact of PTs' use of the STEADI on patient outcomes.

Explicit and implicit disability attitudes of occupational and physical therapy assistants.

BACKGROUND: Reduction of explicit and implicit bias in healthcare providers is a critical issue faced by our society in moving toward more equitable and culturally appropriate health and rehabilitation care. Because resources for OT and PT services are limited and shortages in these professions exist, direct care provision by occupational and physical therapist assistants (OTA/PTA) is on the rise and valued in comprehensive rehabilitation practice. It is important to consider attitudes and biases of OTA/PTA, as they are directly involved in provision of rehabilitation services for people with disabilities. OBJECTIVE: This study examined the explicit and implicit disability attitudes of a large cross-section of OTA/PTA. METHODS: Secondary data analysis was completed using data from 6113 OTA/PTA from the Project Implicit Disability Attitudes Implicit Association Test. Implicit attitudes were calculated and OTA/PTA explicit and implicit disability attitudes were compared. Results were further categorized using an adapted version of Son Hing et al.'s two-dimensional model of prejudice. RESULTS: Findings revealed the majority of OTA/PTA reported having no explicit preference for people with disabilities or nondisabled people. However, the majority of OTA/PTA were aversive ableists, indicating low explicit and high implicit bias. CONCLUSIONS: Though explicit bias is lower in OTA/PTA, implicit bias is strong, indicating that people with disabilities face bias that may influence clinical interactions, and may be reproduced in professional education, practice, and policy. Concrete action must be taken to recognize and address disability bias to reduce health disparities in people with disabilities.

Anti-Fat Biases of Occupational and Physical Therapy Assistants.

Fat people are highly stigmatized, and anti-fat bias is pervasive resulting in stigma, prejudice, and discrimination, including in health care. The aim of this study was to explore occupational and physical therapy assistants' anti-fat biases. We analyzed secondary weight implicit association tests from 5,671 occupational/physical therapy assistants. The overwhelming majority (82%) of occupational/physical therapy assistants were implicitly prejudiced against fat people. Interventions for occupational/physical therapy assistants' anti-fat biases are critical, especially with increasing prevalence and responsibilities of occupational/physical therapy assistants in the provision of rehabilitation services.

Assessment of Professional Quality of Life in the Alabama Physical Therapy Workforce.

OBJECTIVE: The purposes of this study were to 1) determine the level of professional quality of life among physical therapists and physical therapist assistants in Alabama and 2) to identify personal or professional factors that may contribute to compassion satisfaction (CS), burnout, and secondary traumatic stress (STS). METHODS: This study used a cross-sectional design and mixed-methods survey methodology to calculate odds ratios for factors affecting professional quality of life. Respondents completed a survey that included the Professional Quality of Life (ProQOL) scale, an open-ended question regarding their experience with professional burnout, and personal and professional demographics. RESULTS: Of the 742 physical therapists and physical therapist assistants in Alabama who completed the survey, the majority experienced moderate-high levels of CS and moderate-low levels of burnout and STS. Regression analyses indicated clinicians working 40 or more hours per week in patient care had greater odds for low-moderate CS and moderate-high burnout and STS subscale scores. Clinicians in our sample licensed between 6 to 15 or more than 30 years and those working in private outpatient settings had reduced odds of having moderate-high burnout, whereas those working 16 or more years had significantly increased odds for high CS scores. Responses to the open-ended question indicated workload demands and documentation as the top factors contributing to clinician burnout, while the connections with patients and coworkers help minimize such feelings. CONCLUSION: Individuals later in their career may develop protective factors to mitigate feelings of burnout compared to those early in their career. Also, clinicians working 40 or more hours per week may be more vulnerable to experiencing low-moderate CS and moderate-high burnout. Thus, individual clinicians and employers must evaluate personal, occupational, and systemic factors that contribute to reduced professional quality of life to inform preventive strategies for mitigating burnout.

Familiarity with Hereditary Spastic Paraplegia (HSP) and Differentiation of Upper Body Gait Characteristics between Children with HSP and Spastic Diplegic Cerebral Palsy.

AIMS: The aim of this two-part, prospective study was to determine therapist familiarity with HSP and examine diagnostic accuracy between individuals with HSP and those with Spastic Diplegic Cerebral Palsy (SD-CP). METHODS: Part-one surveyed physical therapists (PT) and physical therapist assistants (PTA) throughout Texas to determine familiarity with HSP and its gait deviations. Part-two examined accuracy in differential diagnosis of HSP versus SD-CP using gait analysis and the effects of an educational module on upper body gait deviations observed in individuals with HSP. RESULTS: Both PTs and PTAs indicated a high degree (≥73.2%) of unfamiliarity with HSP. While a majority of respondents (≥88.7%) indicated use of observational gait analysis in clinical practice, ≥92.5% indicated never receiving instruction on HSP or its associated gait deviations. Whole group analysis revealed diagnostic accuracy increased 21.7% post educational module. In addition, individual case diagnostic accuracy yielded significant improvement in 14 out of 20 cases. CONCLUSIONS: Physical and occupational therapists are in a unique position to assist with the identification and distinction of HSP from CP. This study demonstrated that brief instruction on common upper body gait deviations seen in individuals with HSP may improve a clinician's ability to distinguish SD-CP from HSP via gait analysis.

The Impact of Level of Physical Therapist Assistant Involvement on Patient Outcomes Following Stroke.

OBJECTIVE: This study investigates if higher utilization of physical therapist assistants adversely affects patient outcomes in the acute rehabilitation setting for patients following a cerebrovascular accident (CVA). METHODS: Participants were admitted to 1 of 5 inpatient rehabilitation facilities following a CVA from 2008 to 2010. High physical therapist assistant use was defined as ≥20% of the physical therapist visits being provided by the physical therapist assistant for an episode of care. Multivariable regression techniques examined differences in functional outcome, discharge location, and length of stay between high and low physical therapist assistant use groups. Propensity scoring methods supplemented findings of the regression analyses. RESULTS: Of the 1561 participants, 496 (32%) had high physical therapist assistant involvement. Baseline participant characteristics such as age, sex, baseline motor function, and comorbidities did not differ between high and low physical therapist assistant use groups. After adjusting for patient characteristics, rehabilitation facility, and year, higher physical therapist assistant use did not adversely affect functional outcome or length of stay. Fewer conclusions can be drawn regarding discharge location, although there was no significant difference in discharge location between groups with high and low physical therapist assistant utilization. Propensity scoring methods supported the findings of the regression analyses. CONCLUSIONS: Higher physical therapist assistant involvement in the rehabilitation of patients following CVA did not adversely affect functional outcome, increase length of stay, or reduce the likelihood of discharge to home from an inpatient rehabilitation facility. IMPACT: The results demonstrate the value of the physical therapist assistant in the provision of physical therapy for patients with stroke in the inpatient rehabilitation setting. Higher involvement of the physical therapist assistant may provide cost savings while maintaining patient outcomes for this setting and population.

Claim Costs, Musculoskeletal Health, and Work Exposure in Physical Therapists, Occupational Therapists, Physical Therapist Assistants, and Occupational Therapist Assistants: A Comparison Among Long-Term Care Jobs.

BACKGROUND: Patient/resident-handling tasks are physically demanding and associated with musculoskeletal disorders (MSDs) among nursing personnel. The routine performance of such tasks by physical therapists and occupational therapists during treatment can cause similar problems. OBJECTIVE: This study characterized the magnitude of MSDs and the risk factors for MSDs in physical therapists, occupational therapists, physical therapist assistants, and occupational therapist assistants (collectively called "therapy personnel" for this study) and compared them with those of other nursing home workers, especially nursing staff. DESIGN: This was a cross-sectional study. METHODS: Workers' compensation claim (WCC) data from 1 year of experience in a long-term care company were used to compute claim rates by body region, nature, and cause of injury, and the costs per case and per full-time-equivalent employee. Data regarding musculoskeletal symptoms, use of patient/resident-lifting equipment, and perceived physical and psychological job demands were obtained from a concurrent cross-sectional survey of workers from 24 long-term care facilities. RESULTS: About 80% of the WCCs were related to musculoskeletal incidents in nursing aides and therapy personnel. WCC costs paid per case for therapy personnel were more than twice those for nursing staff for both ergonomic and resident-handling incidents. Prevalence of low back pain in therapy personnel was the same as in nursing aides (48%) but involved more chronic, milder pain. About half of therapy personnel reported "never" or "rarely" using patient/resident-lifting equipment. Therapy personnel, nursing aides, and housekeeping/dietary/maintenance personnel reported the highest physical job demands. LIMITATIONS: Causal inference cannot be determined due to the cross-sectional nature of the survey data. Study findings are relevant only to therapy work in long-term care settings because exposures vary in other health care settings (hospitals, outpatient, and others). CONCLUSIONS: MSD prevalence and claim costs in therapy personnel are high enough to deserve more attention. The low use of patient/resident-lifting equipment in therapy could increase the risk for MSDs. Future studies with comprehensive ergonomic analysis of therapist tasks and recommendations to reduce injuries are warranted.

Increasing Mobility via In-hospital Ambulation Protocol Delivered by Mobility Technicians: A Pilot Randomized Controlled Trial.

BACKGROUND: Ambulating medical inpatients may improve outcomes, but this practice is often overlooked by nurses who have competing clinical duties. OBJECTIVE: This study aimed to assess the feasibility and effectiveness of dedicated mobility technician-assisted ambulation in older inpatients. DESIGN: This study was a single-blind randomized controlled trial. SETTING: Patients aged ≥60 years and admitted as medical inpatients to a tertiary care center were recruited. INTERVENTION: Patients were randomized into two groups to participate in the ambulation protocol administered by a dedicated mobility technician. Usual care patients were not seen by the mobility technician but were not otherwise restricted in their opportunity to ambulate. MEASUREMENTS: Primary outcomes were length of stay and discharge disposition. Secondary outcomes included change in mobility measured by six-clicks score, daily steps measured by Fitbit, and 30-day readmission. RESULTS: Control (n = 52) and intervention (n = 50) groups were not significantly different at baseline. Of patients randomized to the intervention group, 74% participated at least once. Although the intervention did not affect the primary outcomes, the intervention group took nearly 50% more steps than the control group (P = .04). In the per protocol analysis, the six-clicks score significantly increased (P = .04). Patients achieving ≥400 steps were more likely to go home (71% vs 46%, P = .01). CONCLUSIONS: Attempted ambulation three times daily overseen by a dedicated mobility technician was feasible and increased the number of steps taken. A threshold of 400 steps was predictive of home discharge. Further studies are needed to establish the appropriate step goal and the effect of assisted ambulation on hospital outcomes.

Physical Therapy Management of Adults with Mild Traumatic Brain Injury.

Rehabilitation for individuals after mild traumatic brain injury (mTBI) or concussion requires emphasis on both cognitive and physical rest, with a gradual return to activity including sports. As the client becomes more active, the rehabilitation professional should pay close attention to symptoms associated with mTBI, such as headache, dizziness, nausea, and difficulty concentrating. The systematic approach to return to play provided by the Berlin Consensus Statement on Concussion in Sport can apply to adults with mTBI. This protocol calls for gradually increasing the intensity of physical activity while attending to postconcussion symptoms. During the incident that led to an mTBI, the injured individual may incur injuries to the vestibular and balance system that are best addressed by professionals with specific training in vestibular rehabilitation, most commonly physical therapists. Benign paroxysmal positional vertigo is a condition in which otoconia particles in the inner ear dislodge into the semicircular canals, resulting in severe vertigo and imbalance. This condition frequently resolves in a few sessions with a vestibular physical therapist. In conditions such as gaze instability, motion sensitivity, impaired postural control, and cervicogenic dizziness, improvement is more gradual and requires longer follow-up with a physical therapist and a home exercise program. In all of the above-stated conditions, it is essential to consider that a patient with protracted symptoms of mTBI or postconcussion syndrome will recover more slowly than others and should be monitored for symptoms throughout the intervention.

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.

An audit of the utilization of physiotherapy assistants in the musculoskeletal outpatients setting within a primary care physiotherapy service.

BACKGROUND: Physiotherapy assistants account for approximately 20% of the physiotherapy workforce across a community health service in North Staffordshire. Although their job descriptions state that the post is primarily clinical, their role depends heavily on the qualified physiotherapists and how they utilize their clinical skills. METHODS: An audit of the physiotherapy assistants' tasks was carried out to reveal whether the physiotherapy assistants' time spent on clinical tasks complied with their job descriptions. Using the audit improvement cycle, pathway mapping of specific anatomical areas was performed to identify which parts of treatment can be carried out by physiotherapy assistants, clarify the physiotherapy assistants' clinical role and standardize treatments. A competences and training needs analysis was completed and physiotherapy assistants were trained before the pathways were implemented. Finally, the physiotherapy assistants' practice was re-audited and job satisfaction questionnaires were redistributed after the pathways were implemented. RESULTS: The results showed that, following the implementation of the pathways, the amount of working time that physiotherapy assistants spent treating patients increased from 9% to 16%. Their job satisfaction changed from 11% prior to the implementation of the pathways to 100% post-implementation. CONCLUSIONS: Using defined pathways in the treatment of musculoskeletal conditions of the peripheral joints provides the framework to standardize delegation of clinical tasks from qualified physiotherapists to physiotherapy assistants. However, the utilization of such pathways needs to be examined further, to clarify the clinical and cost effectiveness of delegating clinical work to physiotherapy assistants, and also the perceptions of qualified physiotherapists.

DPT Student Perceptions of the Physical Therapist Assistant's Role: Effect of Collaborative Case-Based Learning Compared to Traditional Content Delivery and Clinical Experience.

INTRODUCTION: Doctor of physical therapy (DPT) student learning about role delineation of physical therapist assistants (PTAs) is essential to ethical and legal practice. METHODS: Survey assessment of three DPT student cohorts compared collaborative interprofessional case-based learning with PTA students to traditional curriculum delivery strategies. Control cohorts were assessed one time. The intervention group was assessed pre-intervention, immediately post-intervention, and after completing a full-time clinical experience. The case-based learning covered 46% of survey content, allowing for the assessment of content-specific material and potential learning through collaboration. RESULTS: Following the educational intervention, the intervention group improved significantly in areas inside and outside the case-based study content, outscoring both control groups on 25-34% of the survey items. Following the clinical experience, the intervention group declined answer accuracy for patient evaluation and treatment implementation, suggesting unlearning. Improvement in the administrative section was observed after the clinical experience. Perceptions of the tasks within the PTA role were diminished while tasks outside the scope of practice appeared clarified following the clinical experience. CONCLUSION: While case-based collaborative intraprofessional learning proves effective in student learning about the PTA role, changes following the clinical experience raise questions about the influence of the clinical environment on learning and the practical application of recently learned knowledge.