Screening for Osteoporosis Risk Among Community-Dwelling Older Adults: A Scoping Review.

BACKGROUND AND PURPOSE: Due to potential health-related consequences of osteoporosis (OP), health care providers who do not order imaging, such as physical therapists, should be aware of OP screening tools that identify individuals who need medical and rehabilitation care. However, current knowledge and guidance on screening tools is limited. Therefore, we explored OP screening tools that are appropriate and feasible for physical therapy practice, and evaluated tools' effectiveness by examining their clinimetric properties. METHODS: A systematic search of the following databases was performed: PubMed, PEDro, PsycINFO, CINAHL, and Web of Science. Articles were included if the study population was 50 years and older, had a diagnosis of OP, if the screening tool was within the scope of physical therapy practice, and was compared to either a known diagnosis of OP or bone densitometry scan results. Included articles underwent multiple reviews for inclusion and exclusion, with each review round having a different randomly selected pair of reviewers. Data were extracted from included articles for participant demographics, outcome measures, cut-off values, and clinimetric properties. Results were categorized with positive and negative likelihood ratios (+LR/-LR) based on the magnitude of change in the probability of having or not having OP. RESULTS: +LRs ranged from 0.15 to 20.21, with the Fracture Risk Assessment Tool (FRAX) and Study of Osteoporotic Fractures (SOF) having a large shift in posttest probability. -LRs ranged from 0.03 to 1.00, with the FRAX, Male Osteoporosis Risk Estimation Scores, Osteoporosis Self-Assessment Tool (OST), and Simple Calculated Osteoporosis Risk Estimation having a large shift in posttest probability. CONCLUSION: Tools with moderate-large shift for both +LR and -LR recommended for use are: (1) OST; (2) FRAX; and (3) SOF. The variability in cut-off scores and clinimetric properties based on gender, age, and race/ethnicities made it impossible to provide one specific recommendation for an OP screening tool. Future research should focus on OP risk prediction among males and racial and ethnic groups.

Examining physical activity participation barriers among adults 50 years and older: a scoping review.

Background: Addressing physical activity (PA) barriers is essential for increasing PA levels in middle-aged and older adults. However, there are no recommendations on selecting PA barrier assessment tools. Objectives: Thus, we aimed to identify and provide clinimetric properties on PA barrier assessment tools that healthcare providers, exercise experts, and public health officials can use to examine potential barriers faced by community-dwelling adults 50 years and older. Methods: We performed a systematic search of the following databases: PubMed, PsycINFO, CINAHL, and Web of Science. Articles were included if they presented clinimetric data on a PA participation barrier assessment tool for community-dwelling participants with a mean age of 50 years and older. The 561 identified articles underwent multiple rounds of blinded reviews. Included articles underwent data extraction for participant characteristics, scoring, constructs, reference tests, and clinimetric properties. Results: The 35 included articles reported on 33 different PA participation barrier assessment tools. Eighteen articles reported on participants with cardiovascular, musculoskeletal, or neurological diagnoses, diabetes, hemodialysis, history of cancer, or mobility limitations. Tools with two or more supporting publications included the Exercise Benefits/Barrier Scale (EBBS), Episode-Specific Interpretations of Exercise Inventory (ESIE), and Inventory of Physical Activity and Barriers (IPAB). Due to differences in methodologies, across-tool comparison was not possible. Conclusion: The EBBS, ESIE, and IPAB are promising tools for community-dwelling adults 50 years and older. However, additional research is warranted to identify the best PA barrier assessment tool among adults 50 years and older.

Examining physical activity participation barriers among adults 50 years and older: a scoping review protocol.

Background: Despite the benefits of physical activity (PA), 61% of adults 50 years and older do not meet the recommended levels of PA. One method of increasing PA participation is assessing and addressing PA participation barriers. Currently, no guidance on methodologies for assessing PA participation barriers exist. Objective: The primary objective of this scoping review is to map the methodologies used to examine potential PA participation barriers faced by community-dwelling adults 50 years and older. A secondary objective is to evaluate the clinimetric properties of these methodologies. Methods: This scoping review protocol is registered with Open Science Framework (https://osf.io/wd2hx). A systematic search of the following databases will be performed: PubMed, PsycINFO, CINAHL, Web of Science, and PEDro. Included studies will 1) present either a) data on development or clinimetric properties of PA participation barrier tool (s); or b) relative risk or odds ratios of PA participation barrier(s); 2) compare PA participation barriers or PA participation barrier tool(s) to either subjective or objective measures of PA; and 3) comprise of community-dwelling participants with a mean age of 50 years and older. A two-phase blinded independent screening process will be conducted to select the included publications. Data will be extracted using a standardized form and cross-checked by the first author. A narrative summary will accompany the results presented in tables and figures. Conclusion: This scoping review will provide a comprehensive understanding of current literature and gaps related to PA participation barrier methodologies used with adults 50 years and older.

Readiness for Clinical Practice Promoting Safe Student Performance in Physical Therapy Education.

BACKGROUND: Physical therapy educators have a responsibility to graduate entry-level PTs who can provide safe high-quality care. The main purpose of this retrospective study was to determine if students who were not safe on campus have different midterm Clinical Performance Instrument (CPI) safety scores on clinical education experiences (CEEs) than students who were safe on campus. METHODS: Forty-six DPT students were categorized into two safety groups: (1) students who were not safe on campus and had successful safety remediation (n=17) and (2) students who were safe on campus (n=29). Student self-assessment (SSA) and clinical instructor (CI) midterm CPI safety scores were analyzed from 10-week CEEs (Practicum 2, 3, and 4). RESULTS: CPI data show that neither SSA nor CI midterm CPI safety scores were significantly different between safety groups for Practicum 2, 3, and 4 (p>0.05). Students who were not safe on campus had significantly higher Practicum 2 SSA midterm CPI safety scores in the majority outpatient setting (median 12.0) compared to the majority inpatient setting (median 8.5) (p=0.015). CONCLUSION: Early identification and formal remediation of safety concerns on campus can lead to suc¬cessful safety performance during CEEs.

Professionalism in Physician Assistant, Physical Therapist, Occupational Therapist, Clinical Psychology, and Biomedical Sciences Students.

UNLABELLED: Interprofessional collaboration for healthcare requires a better understanding of the commonalities and differences in student perceptions of professionalism. METHODS: 217 students in five programs (PA 71, PT 46, OT 29, CP 12, and BMS 59) completed a 22-item survey (response rate 79.5%). A Likert scale grading from 1 (hardly ever) to 5 (always) was used to assess professional attitudes and behaviors. RESULTS: A mixed-model MANOVA, supplemented with post-hoc analyses, showed significant group by time interactions for 5 items. Sensitivity to differences and diversity of other people increased for BMS students, but decreased for PT students. Timeliness increased for BMS students, but did not change for PA students. Seeking out new learning experiences increased for BMS students, but did not change for PA or PT students. Taking a group leadership role increased for BMS students, decreased for PT students, while PA and OT students showed no change. Volunteering time to serve others decreased for OT and PA students, while BMS and BM students showed no change. CONCLUSION: It is plausible that these findings emerge from differences in program curricula and specific training objectives. The findings provide initial insight to educators on ways that attitudes and behaviors pertaining to professionalism sometimes vary among students in different health science programs.

Self-assessment of professionalism in physical therapy education.

OBJECTIVE: With the physical therapy (PT) professions' advancement to the clinical doctorate degree and the promotion of autonomous practice, exemplary professional conduct is an expectation of the PT profession. PT education programs are being challenged to develop methods to teach and assess professional behavior. PARTICIPANTS: Forty-three PT students (11 male and 32 female, ages 20-28 years) completed the APTA Professionalism in Physical Therapy: Core Values Self-Assessment (PPTCVSA) after their first 3 week clinical experience and again after their final clinical experience. METHODS: A mixed design ANOVA compared participants' total scores and individual Core Value scores on the Professionalism in Physical Therapy: Core Values Self-Assessment (PPTCVSA) after 3 and 33 weeks of clinical education. The effects of gender, age, and undergraduate area of study on growth in professionalism scores were also investigated. RESULTS: Total PPTCVSA scores and individual Core Value scores on professionalism (accountability, altruism, compassion/caring, excellence, integrity, professional duty, and social responsibility) were higher after 33 weeks compared to scores after 3 weeks of clinical education. Female student's total professionalism scores were higher than male student's scores on both the first and second self-assessments. In addition, female students scored themselves higher than their male peers on accountability, excellence, integrity, and professional duty. CONCLUSIONS: Improved scores on the PPTCVSA indicate that physical therapy education is playing an important role in the development of professional behavior, knowledge, and application in practice.

The clinical reasoning process for the intervention of chronic plantar fasciitis.

BACKGROUND AND PURPOSE: Of the many foot and ankle conditions affecting older adults, plantar fasciitis (PF) can be especially debilitating when present for many months or years. Chronic PF is an inflammatory condition of the foot that can be detrimental to an individual's functional abilities. Chronic PF significantly impacts older adults since pain associated with PF can cause gait disturbances, difficulty with activities of daily living, and balance impairments and increase the risk of falling. This case report describes the physical therapy examination and subsequent interventions using iontophoresis with dexamethasone and traditional physical therapy in an older adult with chronic PF. CASE DESCRIPTION: The patient was a 61-year-old woman with a 10-year history of chronic PF in the left foot. Physical therapy interventions focused on pain control, flexibility, bilateral and single leg stance tasks, and a progressive home exercise program. The main intervention for pain control was iontophoresis with 4 mg/mL of dexamethasone. OUTCOMES: After 8 sessions of physical therapy that included 7 interventions using iontophoresis with dexamethasone, the patient demonstrated consistent improvement despite the chronicity of her condition. She reported an overall decrease in pain from 6-7 of 10 to 3 of 10 and no longer required night splints. She demonstrated increased ankle active range of motion in all planes. Her weight-bearing tolerance improved as evidenced by the ability to comfortably walk for up to 2 hours, chase after her grandson, and negotiate the grocery store without increased left foot symptoms. CONCLUSION: Iontophoresis with dexamethasone combined with individualized traditional physical therapy may have contributed to decreased plantar foot pain, increased ankle active range of motion, and improved functional mobility in this older adult with chronic PF.

Physical therapy as conservative management for cervical pain and headaches in an adolescent with neurofibromatosis type 1: a case study.

BACKGROUND AND PURPOSE: : Neurofibromatosis is a group of genetic disorders that affect the development and growth of nerve cell tissues. These disorders include tumors of myelin-producing supportive cells that grow on nerves and can cause changes in bone formation, skin integrity, and nerve transmission. Common musculoskeletal impairments associated with neurofibromatosis type 1 (NF 1) include cervical pain, muscle weakness, muscle stiffness, headaches, and postural deviations. CASE DESCRIPTION: : This case study describes successful physical therapy management and outcomes for cervical pain and headaches in a 17-year-old girl with a 16-year history of NF 1. Difficulties in driving, studying, lifting, and participating in recreational activities were all associated with the patient's pain, decreased cervical range of motion, decreased scapular strength, and postural deviations. INTERVENTIONS: : Physical therapy interventions included posture training, dynamic shoulder/scapular strengthening, cervical stabilization, stretching, ultrasound, interferential current, and a progressive home exercise program. OUTCOMES: : By the end of 13 weeks (20 sessions) of physical therapy, the patient was completely pain free, demonstrated increased cervical range of motion, and had improvements in scapular strength. She returned to full and unrestricted recreational activities, driving, studying, and household chores. Furthermore, scores on the Neck Disability Index improved from 44 of 50 (complete disability) to 2 of 50 (no disability). DISCUSSION: : Physical therapy may be a viable option for conservative management of musculoskeletal dysfunction and functional limitations resulting from NF 1.

Does knee osteoarthritis alter the neuromuscular responses to a perturbation during single lower limb stance?

PURPOSE: Evidence substantiating an association between knee osteoarthritis (OA) and altered joint protection responses is relevant to the management of knee OA. The purpose of this study was to detect neuromuscular response times of the vastus lateralis and biceps femoris muscles following a perturbation during single lower limb stance. We hypothesized that muscle response times are: (1) delayed in older adults with knee OA when compared to young and older adults (without diagnosed knee OA) and (2) dependent on the magnitude of load released. SUBJECTS: Ten young adults, 10 older adults, and 7 older adults with symptomatic knee OA participated. METHODS: While in single lower limb stance, the subjects flexed the knee into a range of 33 to 37 degrees while a posterior load of either 6 or 9 kg was applied at the proximal tibia. The load was released after the subjects held the required position for 1 full second. Muscle response times were measured by electromyography. Separate 3 (group) by 2 (load) mixed factorial analysis of variance procedures were performed for electromyography data from the vastus lateralis and biceps femoris. RESULTS: There was no difference in vastus lateralis response times between older adults with knee OA and older adults or between older adults with knee OA and young adults. Older adults did have longer vastus lateralis response times than young adults. There was no difference in biceps femoris response times between older adults with knee OA and older adults; however, both groups had longer biceps femoris response times than young adults. Furthermore, there were no differences in either vastus lateralis or biceps femoris response times between 6 kg and 9 kg loads. CONCLUSION: Although knee OA did not alter muscle responses in our study, the type of functional weightbearing perturbation described could be safely used in the physical therapy clinic to help improve balance and stability while decreasing discomfort in older adults with symptomatic knee OA.