Competency-Based Education and Practice in Physical Therapy: It's Time to Act!

Competency-based education (CBE) is a concept, a philosophy, and an approach to educational design where learner progression occurs when competency is demonstrated. It assumes a set of standard defined performance outcomes for any level of professional practice-students, residents, or practicing physical therapists. Those outcomes are based on the health needs of society and guide the curricular design, implementation, and evaluation of health professions education programs. Lack of a CBE framework-with no required demonstration of competence throughout one's career-has the potential to lead to variation in physical therapists' skills and to unwarranted variation in practice, potentially hindering delivery of the highest quality of patient care. CBE requires a framework that includes a commonly understood language; standardized, defined performance outcomes at various stages of learner development; and a process to assess whether competence has been demonstrated. The purpose of this perspective article is to (1) highlight the need for a shared language, (2) provide an overview of CBE and the impetus for the change, (3) propose a shift toward CBE in physical therapy, and (4) discuss the need for the profession to adopt a mindset requiring purposeful practice across one's career to safely and most efficiently practice in a given area. Utilizing a CBE philosophy throughout one's career should ensure high-quality and safe patient care to all-patient care that can adapt to the changing scope of physical therapist practice as well as the health care needs of society. The physical therapy profession is at a point at which we must step up the transition to a competency-based system of physical therapist education.

Reliability of Doppler and stethoscope methods of determining systolic blood pressures: considerations for calculating an ankle-brachial index.

PURPOSE: The purposes of this study were to: (1) identify the interrater and intrarater reliability of systolic blood pressures using a stethoscope and Doppler to determine an ankle-brachial index (ABI), and (2) to determine the correlation between the 2 methods. BACKGROUND: Peripheral arterial disease (PAD) affects approximately 8 to 12 million people in the United States, and nearly half of those with this disease are asymptomatic. Early detection and prompt treatment of PAD will improve health outcomes. It is important that clinicians perform tests that determine the presence of PAD. METHOD: Two individual raters trained in ABI procedure measured the systolic blood pressures of 20 individuals' upper and lower extremities. Standard ABI measurement protocols were observed. Raters individually recorded the systolic blood pressures of each extremity using a stethoscope and a Doppler, for a total of 640 independent measures. RESULTS: Interrater reliability of Doppler measurements to determine SBP at the ankle was very strong (intraclass correlation coefficient [ICC], 0.93-0.99) compared to moderate to strong reliability using a stethoscope (ICC, 0.64-0.87). Agreement between the 2 devices to determine SBP was moderate to very weak (ICC, 0.13-0.61). Comparisons of the use of Doppler and stethoscope to determine ABI showed weak to very weak intrarater correlation (ICC, 0.17-0.35). Linear regression analysis of the 2 methods to determine ABI showed positive but weak to very weak correlations (r2 = .013, P = .184). CONCLUSIONS: A Doppler ultrasound is recommended over a stethoscope for accuracy in systolic pressure readings for ABI measurements.

Peripheral arterial disease and the ankle-brachial index: what home healthcare clinicians need to know.

Registered nurses and physical therapists working in home healthcare are ideally situated to identify individuals with undiagnosed peripheral arterial disease (PAD). This article focuses on identifying PAD in the lower extremities. The purpose of this continuing education article is to assist the reader in recognizing the role of the home healthcare clinician in identifying and managing PAD. At completion of this module, participants will be able to identify key factors related to PAD, including use of the ankle-brachial index (ABI), and to identify individuals with the disease.

The effect of a walking program on perceived benefits and barriers to exercise in postmenopausal African American women.

PURPOSE: Rates of exercise participation among African Americans is low. Identifying and overcoming perceived benefits/ barriers unique to African American women (AAW) may increase their exercise participation. The purpose of this study was to describe perceived benefits/barriers to exercise in AAW before and after participation in a walking program. METHOD: Thirty-five postmenopausal AAW participated in a 7-week structured walking program with 2 walking goals. Perceived benefits and barriers to exercise were assessed using the Exercise Benefits/Barriers Scale at the beginning and end of the program. Participants engaged in a postintervention interview to further assess benefits/barriers to exercise participation. RESULTS: Perceived benefits/barriers to exercise did not change significantly with participation in a walking program. Lack of time due to work and family responsibilities affected achievement of the brisk walking goal. CONCLUSIONS: Postmenopausal AAW in this study strongly believed in the benefits of exercising and had increased levels of participation in a walking program when lack of time was not a barrier. Overcoming this barrier is the true challenge to health care professionals.

Integrating health promotion, patient education, and adult education principles with the older adult: a perspective for rehabilitation professionals.

With demographic changes and an increase in the number and proportion of older adults, there is now a greater demand for health promotion and patient education by rehabilitation professionals who are experts in their respective fields and who are knowledgeable about normal and pathologic aging. Older adults are more at risk for chronic illnesses and are interested in learning more about their own health. Many interrelationships between health promotion, patient education, and adult education exist in the context of rehabilitation for older adults. Changes in the U.S. health care system have decreased resources for long-term rehabilitation so that interventions must have the maximal impact possible. Health promotion and patient education are within the scope of practice of rehabilitation professionals, but the effectiveness of these efforts are diminished unless concepts and approaches for teaching and interacting with older adults are used. This commentary discusses the rationale for integrating these three aspects of patient care.