Ethical leadership in physical therapy: a developing construct that demands consideration.

PURPOSE: This paper aims to introduce the Theory of Ethical Leadership as a possible means of actualizing the mission and vision statements of the American Physical Therapy Association as well as individual professional objectives. Specific examples of how this can be applied directly to the profession of physical therapy will be presented. DESIGN/METHODOLOGY/APPROACH: Leadership influences can profoundly affect a profession, an organization and an individual. This has led to exploring which leadership style would be most effective in moving their organization forward. Through a review of the literature, this viewpoint paper compares leadership theories present in the health-care literature, as well as why they may fall short of actualizing the mission and vision statements of the American Physical Therapy Association as well as individual professional objectives. FINDINGS: Most research has separated ethics from leadership, but all agree that to be successful, the leader needs to exhibit a strong moral compass and demonstrate positive ethical behavior. At the intersection of ethics and leadership is the emerging theory of ethical leadership. Ethical leadership is based on the premise that employees look outside of themselves for ethical guidance and that leaders have an opportunity to provide this moral awareness by making an ethical message sufficiently salient to be recognized in the organizational context as well as allowing the leader to stand out against an ethically neutral ground. ORIGINALITY/VALUE: This paper is an original work and has not been published previously, either in whole or in part. Additionally, this paper is not under consideration for publication by any other journal.

Relationship Between Grit Scale Score and Academic Performance in a Doctor of Physical Therapy Program: A Case Study.

Admission into Doctor of Physical Therapy (DPT) programs includes assessment of academic and non-academic metrics. Due to a lack of reliability of non-academic data, programs may base the admission decision solely on academic metrics. The Grit Scale score (GSs) has well-documented reliability associated with perseverance and passion in the context of long-term goals. The purpose of this study was to determine if a relationship exists between the GSs and final cumulative DPT grade point average (GPA) and between the GSs and final DPT class rank, and thus determine if the GSs is a useful non-academic metric in the admission process. METHODS: This nonexperimental correlational cohort study examined data from 168 DPT students during the years of 2012-2016 from one eastern university. The 12-item Grit Scale was administered during the on-site DPT application interview as part of the overall application process. Final cumulative DPT GPA and final DPT class rank were obtained from the students' university records. RESULTS: There was a moderate, positive, linear correlation between the students' GSs and class rank percentile (r=0.532, p<0.01) and a moderate, positive, linear correlation between the students' GSs and their final cumulative DPT GPA (r=0.553, p<0.01). CONCLUSION: With this evidence, DPT admissions committees may choose to consider the GSs as a non-academic admission metric to aid the admission's process. Additional research is needed to discern the effectiveness of the GSs as a predictor of performance in the professional program and in other entry-level health care academic programs.

Use of Surface Electromyography to Measure Muscle Fatigue in Patients in an Acute Care Hospital.

BACKGROUND: Functional outcomes with early rehabilitation in the acute care setting have improved; however, an improved understanding of muscle fatigue using surface electromyography (sEMG) is warranted to better guide patient-centered exercise prescription. OBJECTIVES: The objectives of this study were to assess the safety and feasibility of collecting sEMG at the acute care bedside and to determine differences in muscle fatigue during isometric and dynamic submaximal contractions among patients in the hospital, healthy younger participants, and healthy older participants. DESIGN: The study used an observational cohort design. METHODS: There were 37 participants. Median frequency (Fmed) of the myoelectric signal of the quadriceps femoris muscles and time to task failure (TTTF) were measured using sEMG during an isometric and dynamic fatiguing contraction. Primary analysis compared TTTF between groups for both types of contractions. Secondary analysis compared Fmed at initiation and termination of fatiguing contraction. RESULTS: High-quality sEMG measures were safe and feasible to collect at the acute care bedside with no adverse events. There was a statistically significant difference in TTTF between groups after isometric and dynamic contractions; hospitalized patients fatigued faster than healthy younger and healthy older participants after both contractions. With the exception of the vastus lateralis during a dynamic contraction in healthy younger and hospitalized patients, there was a statistically significant difference between Fmed at initiation and termination of contraction, indicating that subjects' muscles did truly fatigue. LIMITATIONS: A limitation of the study was the small sample size of patients who were hospitalized without matched controls. CONCLUSIONS: sEMG is a lab quantitative technique that was found to be safe and feasible to assess muscle fatigue in the acute care environment. The protocol yielded similar results to previously published literature for healthy younger and healthy older people. Further research is needed to better understand how to integrate sEMG findings into patient-centered exercise prescriptions.

Serum biomarkers as signals for risk and severity of work-related musculoskeletal injury.

Work-related musculoskeletal disorders (MSDs) have accounted for a significant proportion of work injuries and workers' compensation claims in industrialized nations since the late 1980s. Despite epidemiological evidence for the role of repetition and force in the onset and progression of work-related MSDs, complete understanding of these important occupational health problems requires further elucidation of the underlying pathogenesis. Results from several clinical and experimental studies indicate that pathological and/or adaptive tissue changes occur as a consequence of performing repetitive and/or forceful tasks. Here, we review evidence of these tissue changes as revealed by the testing of serum biomarkers. Biomarkers of inflammation (inflammatory cytokines and C-reactive protein), cell stress or injury (malondialdehyde and creatine kinase), and collagen synthesis and degradation (collagen I carboxy-terminal propeptide and type-I collagen cross-linked C-telopeptide, respectively) and their association with MSDs will be reviewed.

Inflammatory biomarkers increase with severity of upper-extremity overuse disorders.

MSDs (musculoskeletal disorders) from overuse are common occupational health problems that cause pain, functional loss and loss of work time. The aim of the present study was to determine whether a relationship exists between the severity of early-onset overuse-related MSDs of the upper extremity and serum levels of IL-1beta (interleukin-1beta), TNF-alpha (tumour necrosis factor-alpha), IL-6 (interleukin-6) and CRP (C-reactive protein). Twenty-two subjects with upper-extremity MSDs due to overuse for no longer that 12 weeks were stratified according to the severity of upper-extremity signs and symptoms as determined by a UBMA (upper-body musculoskeletal assessment). Nine asymptomatic subjects also participated. Serum cytokines were analysed using ELISA, and CRP was analysed using a laser nephelometry technique. CRP was strongly correlated, and TNF-alpha, IL-1beta and IL-6 were moderately correlated, with UBMA scores. Only CRP and TNFalpha were significantly associated with UBMA scores in an ordinal logistic regression analysis in which age and BMI (body mass index) were covariates. These results are of clinical importance as they suggest that early-onset overuse-related MSDs may have an inflammatory component. The possibility of using a combination of serum biomarkers to follow the progression of overuse-related MSDs or their response to therapeutic intervention may be of interest to clinical practitioners and should be the focus of future research.