Socioeconomic Influence on Physical Therapist Student Financial Literacy, Self-Efficacy, Stress, and Anxiety.

INTRODUCTION: Doctor of Physical Therapy (DPT) students have considerable educational debt upon graduation with suspected low levels of financial literacy, limited financial self-efficacy, and elevated stress and anxiety. The purpose of this study was to determine the relationships between financial knowledge, financial anxiety, financial stress, and financial self-efficacy with socioeconomic determinants in DPT students. SUBJECTS: Five hundred seventy-eight DPT students, surveyed through a cross-sectional sample of convenience. METHODS: Participants responded to a 40-item demographic questionnaire providing a self-assessment of their current financial literacy, financial self-efficacy, financial anxiety, financial stress, and level of general social support. Pairwise correlations were used to determine the relationship between independent variables and composite scores on self-assessment tools. Multiple regression analyses were conducted to predict financial knowledge, self-efficacy, anxiety, stress, and social support by socioeconomic indicators and educational debt status. RESULTS: While there was a moderate, positive association between presence of debt and financial self-efficacy and financial anxiety for all students (r = .55), there was no statistically significant difference in financial knowledge, self-efficacy, anxiety, stress, or social support for students based on race/ethnicity. There was a negligible to weak correlation between financial knowledge, financial self-efficacy, and level of financial anxiety based on age, race/ethnicity, gender, socioeconomic background, debt load, risk tolerance, and retirement reflection. When subjected to multiple regression analysis, the level of education-related debt could explain a large proportion of the variance in multiple measures, including financial self-efficacy, anxiety, and stress. Economic background explained a large proportion of variance in the general social support students felt. DISCUSSION AND CONCLUSION: We found a strong, positive correlation between the presence of debt and financial stress and anxiety for all DPT student respondents. While there is no difference in financial literacy and self-efficacy based on race and ethnic background, there is a moderate correlation between self-efficacy and financial anxiety for all students. Education on strategies to manage debt load may reduce both factors.

Influences of Financial and Workplace Factors on Physical Therapist Job Satisfaction.

OBJECTIVE: The physical therapist labor market has recently noted higher rates of turnover and job vacancies. An understudied factor contributing to these trends in the profession is job satisfaction. The profession continues to experience relatively low wages compared with other health professions, and graduates of Doctor of Physical Therapy programs face increasingly high student debt. This study used the labor-search model as a conceptual framework to understand associations between job satisfaction, income, and educational debt. The purpose of this study is to observe the financial and workplace factors that are associated with higher levels of physical therapist job satisfaction. METHODS: Data from 4764 physical therapists in 1 state were captured retrospectively through the state's licensure renewal process from 2014 to 2020. A random effects panel analysis, with job satisfaction as the dependent variable, was used to evaluate the relationships between job satisfaction and income, educational debt, and a variety of work-related factors. RESULTS: Job satisfaction was negatively correlated with educational debt, number of hours worked per week, and some practice settings. Conversely, job satisfaction was positively correlated with the expected age of retirement. The percentage of time spent in research and administration was also positively correlated with job satisfaction, though additional research in this area is needed to draw meaningful conclusions on this association. CONCLUSION: The results support the conceptual framework, which suggests that early career physical therapists, motivated by high amounts of educational debt, may choose more financially advantageous practice settings and increased working hours to the detriment of job satisfaction. IMPACT: High levels of job satisfaction among physical therapists are correlated with low levels of educational debt, working 45 hours or less per week, a longer time horizon until retirement, and practice settings other than home health and skilled nursing facilities.

Impacts of educational debt on physical therapist employment trends.

BACKGROUND: Newly graduated physical therapists have high amounts of educational debt. Educational debt may negatively affect job satisfaction, aspirations for professional development, and choice of workplace setting. Research has not shown this association directly, yet it is conceptually supported by the Labor-Search Model. The purpose of this study was to understand the role that educational debt has on additional factors related to job choice in the Labor-Search Model. METHODS: Retrospective data were captured through the Virginia Longitudinal Data System (VLDS) for 12,594 licensed physical therapists within the Commonwealth of Virginia from 2014 to 2020. A fixed effects panel analysis, with inflation-adjusted educational debt as the variable of interest, was conducted to assess whether patterns of professional certifications, volume of work, workplace setting, and job satisfaction were related to educational debt. RESULTS: Educational debt was positively correlated with higher professional degrees (p = 0.009), the number of hours worked per week (p = 0.049), and expected number of years until retirement (p = 0.013). Job satisfaction was statistically significant (p = 0.042) and negatively correlated with educational debt. CONCLUSIONS: Those with higher educational debt appear to have the habit of working more hours per week and have a longer time horizon until retirement. Newly licensed physical therapists with higher amounts of educational debt are more likely to experience this trend. Income and job satisfaction demonstrated an interaction effect on educational debt, such that those with lower levels of income had a stronger, negative relationship between their debt and job satisfaction, as compared to those with higher income.

Individualized Exercise Prescription for Athletes Using a Construct-Based Model.

Rehabilitation professionals prescribe exercise regularly with the goals of decreasing pain, increasing function, and returning athletes to competition. To maximize the effect of an exercise intervention, the program must be individualized and in context for the athlete considering biopsychosocial aspects of care. Current models of exercise prescription may not be ideal considering that less than 50% of injured athletes return to their pre-injury level. Advice on exercise prescription has been offered in the past, but the paradigms are either not user friendly or user friendly but linear, based on phases of recovery. As such, there is a need for a more flexible exercise prescription paradigm that should improve the individuality of exercise prescription. In this Current Opinion, we offer a user-friendly construct-oriented paradigm designed to facilitate the creation of individualized exercise programs for athletes.

Goodness of Fit of the Clinical Instructor Teaching Effectiveness Survey (CITES) for Health Professions Students.

Student evaluations of teaching have demonstrated limited validity in traditional classrooms, but there is some evidence that they may be more useful in measuring teaching effectiveness in simulation or clinical environments. Current student evaluations of clinical teaching measure a subset of constructs designed for use by a single profession, which may limit institutional evaluation and make interprofessional evaluations challenging. The purpose of this study was to describe the multi-step creation of the CITES and to establish its internal consistency and goodness of fit for measuring students' perceptions of clinical instructor teaching effectiveness. In its second iteration, the CITES is a 25-item questionnaire that was tested among 161 physical therapy and physician assistant students. Most items, with the exception of item 5, demonstrated goodness of fit, with a standardized coefficient of 0.94. Internal consistency was high, with a Cronbach alpha of 0.96-0.97. Though this tool demonstrates internal consistency and goodness of fit, the test information curve indicated that it would be more useful as a screening tool to detect those who are very poor clinical teachers, rather than a tool to evaluate those who are highly effective at teaching.

Segmental spine mobility differences between lumbar flexion- and extension-based movement syndromes in patients with low back pain.

BACKGROUND: The Movement System Impairment (MSI) model is useful for identifying spine-hip mobility and motor control deficits that may contribute to low back pain (LBP). While previous studies have found differences in global spine-hip movement impairments between lumbar MSI subgroups, no studies have compared segmental spine movement impairments between these subgroups. Therefore, the purpose of this study is to analyze segmental lumbar mobility in participants with LBP and a lumbar flexion- or extension-based MSI. METHODS: Forty participants with subacute-chronic LBP were placed into one of three age groups (< 35, 35-54, or > 54 years-old) and then classified into a flexion- or extension-based MSI sub-group. Segmental lumbar range of motion (ROM) was measured in degrees using a skin-surface device. Total lumbar and segmental flexion and extension ROM of L1-L2 to L5-S1 was compared between MSI sub-groups for each age group using separate two-way ANOVAs. RESULTS: Significant main effects were found for the independent variables of MSI subgroup and age. Participants in all three age groups with a flexion-based MSI displayed significantly less lumbar extension (-0.6∘) at L4-5 as compared to participants with an extension-based MSI (-2.1∘), p= 0.03. In addition, lumbar total and segmental ROM was significantly less for older individuals in both subgroups. CONCLUSIONS: Individuals with LBP may demonstrate a pattern of lumbar segmental hypomobility in the opposite direction of their MSI. Future studies may investigate the added value of direction-specific spinal mobilization to a program of MSI-based exercise.

Impact of Faculty and Programmatic Resources on the Proportion of Academic Doctoral Degrees in Professional Physical Therapist Education Programs.

OBJECTIVE: The Commission on Accreditation in Physical Therapy Education has introduced a requirement that 50% of core faculty members in a physical therapist education program should have an academic doctoral degree, which many programs are not currently meeting. Competition between programs for prestige and resources may explain the discrepancy of academic achievement among faculty despite accreditation standards. The purpose of this study was to identify faculty and program characteristics that are predictive of programs having a higher percentage of faculty with academic doctoral degrees. METHODS: Yearly accreditation data from 231 programs for a 10-year period were used in a fixed-effects panel analysis. RESULTS: For a 1 percentage point increase in the number of core faculty members, a program could expect a decline in academic doctoral degrees by 14% with all other variables held constant. For a 1% increase in either reported total cost or expenses per student, a program could expect a 7% decline in academic doctoral degrees with all other variables held constant. Programs that have been accredited for a longer period of time could expect to have proportionately more faculty members with academic doctoral degrees. CONCLUSIONS: Programs may be increasing their core faculty size to allow faculty with academic doctoral degrees to focus on scholarly productivity. The percentage of faculty with academic doctoral degrees declines as programs increase tuition and expenditures, but this may be due to programs' tendency to stratify individuals (including part-time core faculty) into teaching- and research-focused efforts to maximize their research prowess and status. IMPACT: This study illuminates existing relationships between physical therapist faculty staffing, time spent in research versus teaching, and program finances. The results of this study should be used to inform higher education policy initiatives aimed to lower competitive pressures and the costs of professional education.

Faculty and programmatic influences on the percentage of graduates of color from professional physical therapy programs in the United States.

The physical therapy profession in the United States suffers from a shortage of providers of color. This is unlikely to change with newly graduating students, as 2.6% of 2017 graduates were African American and 5.7% were Hispanic or Latino. Faculty mentorship has a more profound influence on the retention of underrepresented minority students as compared with students from privileged backgrounds, according to undergraduate literature. The influences of faculty characteristics on physical therapy graduates of color are unknown. The purpose of this study was to determine faculty and programmatic characteristics that could influence the percentage of physical therapy graduates of color. This study implemented the theory of academic capitalism to inform the results of a retrospective panel analysis, which used accreditation data from 2008 to 2017. Data from 231 programs was used to create fixed effects and random effects models to estimate the effects that faculty and program characteristics had on the percentage of graduates of color that a program produced. There was a statistically significant positive relationship between faculty of color and graduates of color (p < 0.001), but faculty must be sufficiently diverse before a program can expect a meaningful change in their percentage of graduates of color. Academic capitalist principles suggest that competition between programs for resources could negatively influence the proportion of graduates of color. Cause and effect associations between variables cannot be established. The authors concluded that professional physical therapy programs appeared to have increases in the percentages of graduates of color when they had more core faculty members of color.

Optimization of nutrition support practices early after hematopoietic cell transplantation.

Nutrition support is often required during hematopoietic cell transplant (HCT) given the gastrointestinal toxicity that frequently precludes adequate protein-calorie intake. This article reviews the latest evidence for enteral versus parenteral nutrition in the adult and pediatric HCT population and addresses key considerations as well as barriers to implement this in practice. Registered Dietitian Nutritionists are key members of the interdisciplinary team to proactively manage enteral nutrition support to provide timely, adequate protein and calories to help prevent malnutrition, loss of lean body mass, and functional decline as well as provide evidence-based diet recommendations. This article also reviews emerging research supporting the role of luminal nutrients to maintain microbiotal diversity.

Financial Literacy Among Health Professions Graduate Students.

AIMS: The impact of student debt management on mental health, career choices, and advanced training in allied health professions is unknown. The purpose of this project was to pilot a survey that identifies students' financial literacy and self-efficacy. METHODS: A cross-sectional survey containing 43 items related to financial habits, savings knowledge, credit and borrowing strategies, and investment knowledge was administered to assess financial literacy, self-efficacy, and career plans in a group of health professions graduate students. RESULTS: 134 of 268 surveys were completed by a variety of health professions. Financial habits and credit and borrowing categories scored the highest at 50% correct. Students scored the lowest on investment knowledge with an average of 25% correct responses. The overall mean self-efficacy score was 15.5±3.8. Three independent variables had a significant correlation of determination with overall financial literacy, which included marital status, older age, and individuals who identified as white non-Hispanic. Similarly, identification as white non-Hispanic had a significant correlation of determination with financial self-efficacy, but there were no significant differences based on age or marital status. CONCLUSIONS: Allied health students demonstrated low financial literacy and self-efficacy. Health care educators should consider delivering educational content to address these deficits.

Characteristics of Professional Physical Therapist Faculty and Doctor of Physical Therapy Programs, 2008-2017: Influences on Graduation Rates and First-Time National Physical Therapy Examination Pass Rates.

OBJECTIVE: Graduation rates and first-time National Physical Therapy Examination (NPTE) pass rates among Doctor of Physical Therapy (DPT) programs have ranged from 30% to 100% and 0% to 100% between 2008 and 2017, respectively. Prior studies on predictors of graduation rates and NPTE pass rates from DPT programs have used cross-sectional data and have not studied faculty data. This study sought to understand how trends in DPT faculty and program characteristics correlated with graduation rates and first-time NPTE pass rates. METHODS: This study was a retrospective panel analysis of yearly data from 231 programs between 2008 and 2017. Random effects models estimated the correlations between faculty and program characteristics regarding graduation rates and first-time NPTE pass rates. RESULTS: Graduation rates peaked when programs devoted 25% of faculty time, on average, to scholarship. The number of peer-reviewed publications was positively correlated with graduation rates; however, the trend was logarithmic, indicating a diminishing rise in graduation rates as the number of publications exceeded 1 per faculty full-time equivalent. Tenure-track status, faculty of color, and part-time faculty were all negatively correlated with first-time NPTE pass rates. However, these 3 trends are likely not meaningful, because the predicted rates of decline in pass rates were minimal. CONCLUSIONS: Faculty engagement in scholarly activities can positively influence graduation rates, but only up to a certain level of faculty time devoted to scholarship. IMPACT: This is the first study to provide data on the influence of faculty on DPT student outcomes and will help education programs develop strategies to improve those outcomes.

Factors That Predict Institutional Adoption of Professional Physical Therapist Education Programs.

BACKGROUND: Between 1995 and 2015, the number of accredited physical therapist education programs in the United States rose from 127 to 224. Colleges and universities have been known to develop new programs in an effort to generate revenues through student tuition. OBJECTIVE: In the present study, sources of institutional revenue and expenditures were used as predictors for the adoption of physical therapist education programs. DESIGN: Yearly data from the Integrated Postsecondary Education Data System for 1731 higher education institutions were combined with dates from the Commission on Accreditation in Physical Therapy Education for physical therapist education program accreditation from 1995 to 2015. METHODS: A retrospective event history analysis of yearly institutional data was used to calculate the hazard of an institution adopting a physical therapist education program on the basis of institutional revenues and expenditures. RESULTS: Private institutions were 62% less likely to adopt a physical therapist education program when they experienced a 1% increase in total revenue per full-time-equivalent student. Conversely, a given private institution was 2.71 times more likely to adopt a physical therapist education program for every 1% increase in total expenditures per full-time-equivalent student. Both public and private institutions experienced an increased chance of adopting an entry-level (professional) physical therapist education program when instructional expenditures rose. They were also more than twice as likely to adopt physical therapist education programs when they experienced a 1% increase in the number of students. LIMITATIONS: Causation between professional physical therapist education program adoption and the variables studied cannot be determined through observational analysis alone. CONCLUSIONS: The more revenue a private institution generated, the less likely it was to add a program in the search for further revenues. As expenses rose, the chance of adoption trended upward beyond increases in institutional revenues for both public and private not-for-profit institutions.

Impact of funding allocation on physical therapist research productivity and DPT student graduates: an analysis using panel data.

Financial support for institutional research is relatively stagnant, and thus institutions are likely to seek tuition revenue to offset the costs of research and teaching. It is likely that this has led to increases in tuition driven activities, and thus has limited research activities of academic physical therapy (PT) programs in particular. However, the relationships between sources of program revenue, the number of graduates from PT programs, and the scholarly production of PT faculty have not been studied. The purpose of this paper is to study the effects of types of funding-including research grants and tuition-on the number of physical therapy graduates from each program and the research productivity of physical therapy faculty. Data from 2008 to 2016 were utilized to perform a fixed-effects panel analysis. Panel models created predictions for the number of graduates and the number of peer-reviewed publications for programs from grant funding, annual tuition, and number of funded faculty members. In any given program, a 1% increase in annual tuition is associated with 24% more graduates per year, but a single percentage point increase in the mix of NIH grant funding over other funding types is associated with 8% fewer graduates, all else equal. For every 1% increase in annual tuition, a program can expect to have 41% fewer publications per year. Those institutions with higher numbers of graduates tended to have higher numbers of publications. Higher annual program tuition appears to be associated with both higher numbers of physical therapy graduates and lower levels of publications. Different funding sources have variable effects on degree production and scholarly productivity. Data are self-reported by programs on the Annual Accreditation Report, and cause and effect cannot be established through observational design.

THE EFFECT OF AXIOSCAPULAR AND ROTATOR CUFF EXERCISE TRAINING SEQUENCE IN PATIENTS WITH SUBACROMIAL IMPINGEMENT SYNDROME: A RANDOMIZED CROSSOVER TRIAL.

BACKGROUND: While physical therapy is an effective element in the rehabilitation of rotator cuff (RC) disease, the most effective sequence of exercise training interventions has not been defined. HYPOTHESIS/PURPOSE: The purpose of this study is to determine if there is a difference in pain or function in patients who are given RC strengthening prior to or after initiating scapular stabilization exercises. STUDY DESIGN: Level I randomized crossover trial. METHODS: This was a prospective study of 26 men and 14 women with a mean age 51 who were diagnosed with subacromial impingement syndrome (SAIS). They were randomly assigned to one of two groups for a comprehensive and standardized rehabilitation program over six visits at an orthopedic outpatient clinic. One group was prescribed a 4-week program of scapular stabilization exercises while the other group began with RC strengthening exercises. The crossover design had each group add the previously excluded four exercises to their second month of rehabilitation. RESULTS: The results showed significant improvements in pain (p < 0.001), function (p < 0.001), and patient satisfaction (p < 0.001) at all follow-up times for both groups. There was not a statistically significant difference in pain or function at any follow-up period for initiating one group of exercise before the other (p > 0.05). There was a statistically significant interaction between the patient's global rating of change at the 4 week follow-up as compared to 8 weeks (p = 0.04) or 16 (p < 0.001). CONCLUSION: Patients with SAIS demonstrate improvement in pain and function with a standardized program of physical therapy regardless of group exercise sequencing. LEVEL OF EVIDENCE: 1b.