Acceptance of the 'Assessment of Physiotherapy Practice (Chinese)' as a standardised evaluation of professional competency in Chinese physiotherapy students: an observational study.

BACKGROUND: Development of an entry-level physiotherapy curriculum in China currently follows the World Confederation for Physical Therapy (WCPT) guidelines, however there is no standard, validated, assessment tool for physiotherapy practice in use in China. This article reports the process of translation of the "Assessment of Physiotherapy Practice" (APP), a validated assessment instrument adopted by all universities in Australia and New Zealand, into Chinese (APP-Chinese) and its implementation by Chinese physiotherapy clinical educators (CEs) and students during clinical placements. METHODS: The process of forward and backward translation of the APP was undertaken by a team of academics from universities in Shanghai, Hong Kong, United States and Australia. An APP-Chinese version was produced and used for assessment of the clinical performance of 4th year students at a university in Shanghai. Feedback on the implementation of the APP-Chinese was solicited from students and CEs using the same two questionnaires employed to assess implementation of the original APP. RESULTS: All CEs agreed that the rules used to score the APP-Chinese were helpful in assessing student performance. Over 90% of the CEs considered the APP-Chinese was pragmatic for use in the clinical environment in China. All students agreed with the rating of their performance on the APP-Chinese marked by their educators, and that the performance indicators were useful in guiding their expected performance behaviour. CONCLUSION: The APP-Chinese is the first standardised assessment tool for evaluation of clinical performance of physiotherapy students in China and was shown to be well accepted by both students and CEs in the clinical education unit and university involved in this study.

Assessment of the awareness, adherence, and barriers to low back pain clinical practice guidelines by practicing physiotherapists in a low-resourced country.

BACKGROUND AND OBJECTIVES: Many clinical practice guidelines (CPGs) for low back pain (LBP) management have been developed, but adherence to CPGs seems to be challenging as developing them in the first place. This cross-sectional survey study was carried out to determine the awareness level, the level of adherence, and barriers to adherence to CPGs of LBP among physiotherapists in Nigeria. METHODS: A total of 189 participants were recruited for this study using the convenience sampling technique. The data were collected using researcher-designed questionnaires, the data were analysed using SPSS Version 20, and barriers to adherence to CPGs of LBP was analysed using simple thematic analysis. Descriptive statistics, frequency, and percentage were used to summarize the data, whereas inferential statistic of chi square and Fisher's exact were used to test the association between sociodemographic variables and adherence. RESULTS: The results obtained showed that only a small percentage (27.50%) of the respondents adhered to LBP CPGs, whereas higher percentage (78.80%) was aware to the LBP CPGs. There were no significant associations between age (p = .90, χ2 = 0.72), certification courses (p = .476, χ2 = 0.508), place of practice (p = .380, χ2 = 0.845), and adherence to CPGs of LBP, respectively. However, there was a statistical significant association between specialization (p = .009, χ2 = 16.725), political zone (p = .007, χ2 = 15.243), awareness (p = .003, χ2 = 8.957), and adherence to CPGs of LBP, respectively. CONCLUSION: Small proportions of the respondents adhered to the LBP CPGs, whereas higher population were aware of the LBP CPGs, and some of the characteristics of the physiotherapists influence adherence to LBP CPGs.

National quality assessment questionnaire for physiotherapy centres: a pilot study in Lebanon.

BACKGROUND: Lebanon still lacks a unified platform upon which private physiotherapy practitioners can base and apply their knowledge and practice. Accreditation of physiotherapy centres would promote collaboration, boost consistency and enhance quality of services. The Order of Physiotherapists in Lebanon is called on to provide a high quality of service by focusing on standards. AIMS: The aim of this study was to assess the feasibility and applicability of a standard for the quality assessment of physiotherapy centres, and to assess the current status of a sample of centres in Lebanon. METHODS: A questionnaire was developed by a panel of experts based on a review of international and national requirements in physiotherapy centres. A set of 14 items was generated covering 3 categories: qualifications of the team, facility and environmental status, and data collection and analysis. A pilot study was conducted from December 2013 to February 2014 in 6 Lebanese physiotherapy centres. Descriptive statistics are reported. RESULTS: The highest median score and compliance score for the 6 centres were reported for the "Facility and environmental status" category (median = 8.0) and the lowest were reported in the "Data collection and analysis" category (median = 5.0). CONCLUSIONS: Further studies are needed to validate the quality assessment in physiotherapy centres questionnaire, and to implement it as a primary tool for assessing quality standards and for accreditation of physiotherapy centres.

Effect of Payment Model on Patient Outcomes in Outpatient Physical Therapy.

Although the literature has well recognized the effectiveness of physical therapy for treating musculoskeletal injuries, reimbursement is evolving towards value-based or alternative payment models and away from procedure orientated, fee-for-service in the outpatient setting. Alternative models include cased-based clinics, pay-for-performance, out-of-network services, accountable care organizations, and concierge practices. There is the possibility that alternative payment models could produce different and even superior patient outcomes. Physical therapists should be alert to this possibility, and research is warranted in this area to conclude if outcomes in patient care are related to method of reimbursement.

Relative and Absolute Reliability of the Professionalism in Physical Therapy Core Values Self-Assessment Tool.

Development of professional behaviors in Doctor of Physical Therapy (DPT) students is an important part of professional education. The American Physical Therapy Association (APTA) has developed the Professionalism in Physical Therapy Core Values Self-Assessment (PPTCV-SA) tool to increase awareness of personal values in practice. The PPTCV-SA has been used to measure growth in professionalism following a clinical or educational experience. There are few studies reporting psychometric properties of the PPTCV-SA. The purpose of this study was to establish properties of relative reliability (intraclass correlation coefficient, iCC) and absolute reliability (standard error of measurement, SEM; minimal detectable change, MDC) of the PPTCV-SA. in this project, 29 first-year students in a DPT program were administered the PPTCVA-SA on two occasions, 2 weeks apart. Paired t-tests were used to examine stability in PPTCV-SA scores on the two occasions. iCCs were calculated as a measure of relative reliability and for use in the calculation of the absolute reliability measures of SEM and MDC. Results of paired t-tests indicated differences in the subscale scores between times 1 and 2 were non-significant, except for three subscales: Altruism (p=0.01), Excellence (p=0.05), and Social Responsibility (p=0.02). iCCs for test-retest reliability were moderate-to-good for all subscales, with SEMs ranging from 0.30 to 0.62, and MDC95 ranging from 0.83 to 1.71. These results can guide educators and researchers when determining the likelihood of true change in professionalism following a professional development activity.

A Novel and Cost-Effective Method for Evaluating Cardiopulmonary Auscultation Skills in Student Physical Therapists.

Sophisticated high-fidelity human simulation (HFHS) manikins allow for practice of both evaluation and treatment techniques in a controlled environment in which real patients are not put at risk. However, due to high demand, access to HFHS by students has been very competitive and limited. In the present study, a basic CPR manikin with a speaker implanted in the chest cavity and internet access to a variety of heart and breath sounds was used. Students were evaluated on their ability to locate and identify auscultation sites and heart/breath sounds. A five-point Likert scale survey was administered to gain insight into student perceptions on the use of this simulation method. Our results demonstrated that 95% of students successfully identified the heart and breath sounds. Furthermore, survey results indicated that 75% of students agreed or strongly agreed that this manner of evaluation was an effective way to assess their auscultation skills. Based on performance and perception, we conclude that a simulation method as described in this paper is a viable and cost-effective means of evaluating auscultation competency in not only student physical therapists but across other health professions as well.

The characteristics of stroke units in Ontario: a pan-provincial survey.

BACKGROUND: Previous studies have demonstrated that organized, multidisciplinary care is the cornerstone of current strategies to reduce the death and disability caused by stroke. Identification of stroke units and an understanding of their composition and operation would provide insight for the further actions required to improve stroke care. The objective of this study was to identify and survey stroke units in Canada's largest province, Ontario (population of 13 million) in order to describe availability, structure, staffing, processes of care, and type of population stroke units serve. METHODS: The Ontario Stroke Network (2011) list of stroke units and snowball sampling was used to identify all stroke units. During 2013 - 2014 an interviewer conducted telephone surveys with the stroke unit managers using closed and semi-open ended questions. Descriptive statistics were used to summarize survey responses. RESULTS: The survey identified 32 stroke units, and a respondent from every stroke unit (100% response rate) was interviewed. Twenty one were acute stroke units, 10 were integrated stroke units and one was classified as a rehabilitation stroke unit. Stroke units were available in all 14 Local Health Integration Networks except Central West. The estimated average number of stroke patients served per stroke unit was 604 with six-fold variation (242 to 1480) across the province. The typical population served in stroke units were patients with either ischemic or hemorrhagic stroke. Data consistently reported on the processes of stroke care, including the availability of multidisciplinary staff, specific diagnostic imaging, use of validated assessment tools, and the delivery of patient education. Details about the core components of stoke care were provided by 16 stroke units (50%). CONCLUSIONS: This study demonstrates the heterogeneous structure of stroke units in Ontario and signaled potential disparity in access to stroke units. Many core components are in place, but half of the stroke units in Ontario do not meet all criteria. Areas for potential improvement include stroke care training for the multidisciplinary team, provision of individualized rehabilitation plans, and early discharge assessment.

Selectivity of physiotherapist programs in the United States does not differ by institutional funding source or research activity level.

PURPOSE: This study aimed to compare selectivity characteristics among institution characteristics to determine differences by institutional funding source (public vs. private) or research activity level (research vs. non-research). METHODS: This study included information provided by the Commission on Accreditation in Physical Therapy Education (CAPTE) and the Federation of State Boards of Physical Therapy. Data were extracted from all students who graduated in 2011 from accredited physical therapy programs in the United States. The public and private designations of the institutions were extracted directly from the classifications from the 'CAPTE annual accreditation report,' and high and low research activity was determined based on Carnegie classifications. The institutions were classified into four groups: public/research intensive, public/non-research intensive, private/research intensive, and private/non-research intensive. Descriptive and comparison analyses with post hoc testing were performed to determine whether there were statistically significant differences among the four groups. RESULTS: Although there were statistically significant baseline grade point average differences among the four categorized groups, there were no significant differences in licensure pass rates or for any of the selectivity variables of interest. CONCLUSION: Selectivity characteristics did not differ by institutional funding source (public vs. private) or research activity level (research vs. non-research). This suggests that the concerns about reduced selectivity among physiotherapy programs, specifically the types that are experiencing the largest proliferation, appear less warranted.

An innovative peer assessment approach to enhance guideline adherence in physical therapy: single-masked, cluster-randomized controlled trial.

BACKGROUND: Clinical practice guidelines (CPGs) are not readily implemented in clinical practice. One of the impeding factors is that physical therapists do not hold realistic perceptions of their adherence to CPGs. Peer assessment (PA) is an implementation strategy that aims at improving guideline adherence by enhancing reflective practice, awareness of professional performance, and attainment of personal goals. OBJECTIVE: The purpose of this study was to compare the effectiveness of PA with the usual case discussion (CD) strategy on adherence to CPGs for physical therapist management of upper extremity complaints. DESIGN: A single-masked, cluster-randomized controlled trial with pretest-posttest design was conducted. INTERVENTION: Twenty communities of practice (n=149 physical therapists) were randomly assigned to groups receiving PA or CD, with both interventions consisting of 4 sessions over 6 months. Both PA and CD groups worked on identical clinical cases relevant to the guidelines. Peer assessment focused on individual performance observed and evaluated by peers; CD focused on discussion. OUTCOMES: Guideline adherence was measured with clinical vignettes, reflective practice was measured with the Self-Reflection and Insight Scale (SRIS), awareness of performance was measured via the correlation between perceived and assessed improvement, and attainment of personal goals was measured with written commitments to change. RESULTS: The PA groups improved more on guideline adherence compared with the CD groups (effect=22.52; 95% confidence interval [95% CI]=2.38, 42.66; P=.03). The SRIS scores did not differ between PA and CD groups. Awareness of performance was greater for the PA groups (r=.36) than for the CD groups (r=.08) (effect=14.73; 95% CI=2.78, 26.68; P=.01). The PA strategy was more effective than the CD strategy in attaining personal goals (effect=0.50; 95% CI=0.04, 0.96; P=.03). LIMITATIONS: Limited validity of clinical vignettes as a proxy measure of clinical practice was a limitation of the study. CONCLUSIONS: Peer assessment was more effective than CD in improving adherence to CPGs. Personal feedback may have contributed to its effectiveness. Future research should address the role of the group coach.

Student perceived competence in direct access to physical therapy in a doctor of physical therapy program at a historically black university.

Physical therapists provide care via direct access in many states. Greater perceived competence with direct access among graduating physical therapists is critical. The purpose of this study was to assess student physical therapists' perceived competence with direct access.A survey instrument was created to determine levels of perceived competence at three phases of the physical therapy curriculum. The Friedman two-way ANOVA by ranks was used to assess differences between year one, year two, and year three responses for each individual survey question and the overall survey score.Total survey score demonstrated significant increased student perceived competence with direct access to physical therapy care direct access from year one total to year two (p = .018), year one to year three (p = .005), and year two to year three (p = .016).More favorable attitudes among graduating physical therapists may have an influence on primary care for musculoskeletal conditions.

Why peer assessment helps to improve clinical performance in undergraduate physical therapy education: a mixed methods design.

BACKGROUND: Peer Assessment (PA) in health professions education encourages students to develop a critical attitude towards their own and their peers' performance. We designed a PA task to assess students' clinical skills (including reasoning, communication, physical examination and treatment skills) in a role-play that simulated physical therapy (PT) practice. Students alternately performed in the role of PT, assessor, and patient. Oral face-to-face feedback was provided as well as written feedback and scores.This study aims to explore the impact of PA on the improvement of clinical performance of undergraduate PT students. METHODS: The PA task was analyzed and decomposed into task elements. A qualitative approach was used to explore students' perceptions of the task and the task elements. Semi-structured interviews with second year students were conducted to explore the perceived impact of these task elements on performance improvement. Students were asked to select the elements perceived valuable, to rank them from highest to lowest learning value, and to motivate their choices. Interviews were transcribed verbatim and analyzed, using a phenomenographical approach and following template analysis guidelines. A quantitative approach was used to describe the ranking results. RESULTS: Quantitative analyses showed that the perceived impact on learning varied widely. Performing the clinical task in the PT role, was assigned to the first place (1), followed by receiving expert feedback (2), and observing peer performance (3). Receiving peer feedback was not perceived the most powerful task element.Qualitative analyses resulted in three emerging themes: pre-performance, true-performance, and post-performance triggers for improvement. Each theme contained three categories: learning activities, outcomes, and conditions for learning.Intended learning activities were reported, such as transferring prior learning to a new application context and unintended learning activities, such as modelling a peer's performance. Outcomes related to increased self-confidence, insight in performance standards and awareness of improvement areas. Conditions for learning referred to the quality of peer feedback. CONCLUSIONS: PA may be a powerful tool to improve clinical performance, although peer feedback is not perceived the most powerful element. Peer assessors in undergraduate PT education use idiosyncratic strategies to assess their peers' performance.

Improving the standard of care for people with ankylosing spondylitis and a new approach to developing specialist ESP-Led AS clinics.

OBJECTIVES: In the UK, there is a wide variation in the quality of care that people with ankylosing spondylitis (AS) receive. People with AS require early diagnosis and referral to a specialist team to commence treatment and optimize outcome. METHODS: At East Kent Hospitals University Foundation Trust, a specialist clinic led by an extended scope practitioner (ESP) physiotherapist has been set up for the assessment and monitoring of patients with AS. This report describes the service provided by the AS clinic. RESULTS: Over eight years, the number of patients seen has risen from 62 to 352, and annual consultations from 186 to 986, with an average of 2.8 visits per patient per year. Ninety-seven patients have started treatment with a Tumour Necrosis Factor (TNF) blocker. The service has expanded by the addition of a support worker and biologic clinics. CONCLUSION: For the Trust, the specialist service provides an improved quality of care and cost-effective use of staff resources. Evaluation has demonstrated that patients welcome the new service.

Use of quality indicators in physical therapist practice: an observational study.

BACKGROUND: The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 contain provisions specific to health care quality that apply to physical therapists. Published evidence examining gaps in the quality of physical therapy services is limited. OBJECTIVE: The primary purpose of this study was to determine the use of quality indicators in physical therapist practice. DESIGN: This was an observational study. METHODS: All members of the Orthopaedic and Private Practice sections of the American Physical Therapy Association were invited to participate by completing an electronic survey. The survey included 22 brief patient descriptions, each followed by questions regarding the use of examinations and interventions based on the 2009 list of Medicare-approved quality measures. Separate multivariate logistic regression models were used to determine the odds ratios related to the performance of each examination and intervention on more than 90% of patients, given perceptions of its importance to care, the burden of performing it, and the level of evidence supporting its use. RESULTS: Participants (n=2,544) reported a relatively low frequency of performing examinations and interventions supporting primary and secondary prevention (3.6%-51.3%) and use of standardized measures (5.5%-35.8%). Perceptions of high importance and low burden were associated with greater odds of performing an examination or intervention. Importance and burden were more influential factors than the perceived availability of evidence to support use of identified techniques. LIMITATIONS: The survey was not assessed for test-retest reliability. A low response rate was a source of potential bias. CONCLUSION: The study findings suggest that physical therapists may not see themselves as providers of primary or secondary prevention services. Patient management strategies associated with these types of services also may be perceived as relatively unimportant or burdensome.

The Assessment of Physiotherapy Practice (APP) is a valid measure of professional competence of physiotherapy students: a cross-sectional study with Rasch analysis.

QUESTION: Is the Assessment of Physiotherapy Practice (APP) a valid instrument for the assessment of entry-level competence in physiotherapy students? DESIGN: Cross-sectional study with Rasch analysis of initial (n=326) and validation samples (n=318). Students were assessed on completion of 4, 5, or 6-week clinical placements across one university semester. PARTICIPANTS: 298 clinical educators and 456 physiotherapy students at nine universities in Australia and New Zealand provided 644 completed APP instruments. RESULTS: APP data in both samples showed overall fit to a Rasch model of expected item functioning for interval scale measurement. Item 6 (Written communication) exhibited misfit in both samples, but was retained as an important element of competence. The hierarchy of item difficulty was the same in both samples with items related to professional behaviour and communication the easiest to achieve and items related to clinical reasoning the most difficult. Item difficulty was well targeted to person ability. No Differential Item Functioning was identified, indicating that the scale performed in a comparable way regardless of the student's age, gender or amount of prior clinical experience, and the educator's age, gender, or experience as an educator, or the type of facility, university, or clinical area. The instrument demonstrated unidimensionality confirming the appropriateness of summing the scale scores on each item to provide an overall score of clinical competence and was able to discriminate four levels of professional competence (Person Separation Index=0.96). Person ability and raw APP scores had a linear relationship (r(2)=0.99). CONCLUSION: Rasch analysis supports the interpretation that a student's APP score is an indication of their underlying level of professional competence in workplace practice.

Current use and barriers and facilitators for implementation of standardised measures in physical therapy in the Netherlands.

BACKGROUND: In many countries, the need for physical therapists to use standardised measures has been recognised and is recommended in clinical practice guidelines. Research has shown a lack of clinimetric knowledge and clinical application of measurement instruments in daily practice may hamper implementation of these guidelines. OBJECTIVES: The aims of our study were a) to investigate the current use of measurement instruments by Dutch physical therapists; b) to investigate the facilitators and barriers in using measurement instruments. METHODS: To get a complete and valid overview of relevant barriers and facilitators, different methods of data collection were used. We conducted a literature search, semi-structured interviews with 20 physical therapists and an online survey. RESULTS: Facilitators are the fact that most therapists indicated a positive attitude and were convinced of the advantages of the use of measurement instruments. The most important barriers to the use of measurement instruments included physical therapists' competence and problems in changing behaviour, practice organisation (no room; no time) and the unavailability and feasibility of measurement instruments. Furthermore, physical therapists indicated the need to have a core set of measurement instruments with a short user's instruction on application, scoring and interpretation. CONCLUSIONS: The main barriers are on the level of the physical therapist (lack of knowledge; not focusing on the use of outcome measures) and organisation (lack of time; availability; lack of management support).There seems to be a disparity between what physical therapists say and what they do. The majority of participating physical therapists indicated a positive attitude and were convinced of the advantages of the use of measurement instruments. However, the main problem for physical therapists is when to use which instrument for what patient (lack of knowledge). Furthermore, physical therapists indicated a need to compile a core set of measurement instruments with instructions concerning application, scoring and interpretation. Based on the identified factors, a number of strategies will be developed and evaluated in future studies.

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.

European Union of Medical Specialists (UEMS) section of Physical & Rehabilitation Medicine: a position paper on physical and rehabilitation medicine in acute settings.

Physical and rehabilitation medicine (PRM) specialists have an important role in the clinical care of patients during the acute phase of a disabling health condition. This phase is defined as once definitive care or resuscitation has taken place and a patient's need to stay in hospital as an inpatient is primarily for PRM services for rehabilitation. This paper describes 4 options for the delivery of services for people, who continue to require to be inpatients and who will benefit from PRM interventions. These are described, along with their clear benefits during the acute phase of a health condition. The first 2 models are the most effective in making best use of the acute facilities and PRM services. The benefits of dedicated PRM beds appear to outweigh those of the other options and may be cheaper, although no cost-effectiveness studies comparing the first 2 options have yet been undertaken. Prospective trials are required to show this benefit, and a number of examples need to be set up to pilot this in order to provide realistic cost-effectiveness data.

Psychometric properties of a peer-assessment program to assess continuing competence in physical therapy.

BACKGROUND: The College of Physiotherapists of Ontario implemented an Onsite Assessment to evaluate the continuing competence of physical therapists. OBJECTIVE: This study was undertaken to examine the reliability of the various tools used in the Onsite Assessment and to consider the relationship between the final decision and demographic factors. DESIGN: This was a psychometric study. METHODS: Trained peer assessors (n=63) visited randomly selected physical therapists (n=106) in their workplace. Fifty-three physical therapists were examined by 2 assessors simultaneously. The assessment included a review of practice issues, record keeping, billing practices, the physical therapist's professional portfolio, and a chart-stimulated recall process. The Quality Management Committee made the final decision regarding the physical therapist's performance using the assessor's summary report. Generalizability theory was used to examine the interrater reliability of the tools. Correlation coefficients and regression analyses were used to examine the relationships between demographic factors and performance. RESULTS: The majority of the physical therapists (88%) completed the program successfully, 11% required remediation, and 1% required further assessment. The interrater reliability of the components was above .70 for 2 raters' evaluations, with the exception of billing practices. There was no relationship between the final decision and age or years since graduation (r<.05). Limitations Limitations include a small sample and a lack of data on system-related factors that might influence performance. CONCLUSIONS: The vast majority of the physical therapists met the College of Physiotherapists of Ontario's professional standards. Reliability analysis indicated that the number of charts reviewed could be reduced. Strategies to improve the reliability of the various components must take into account feasibility issues related to financial and human resources. Further research to examine factors associated with failure to adhere to professional standards should be considered. These results can provide valuable information to regulatory agencies or managers considering similar continuing competence assessment programs.