Front-loading of anatomy content has no effect on long-term anatomy knowledge retention among physical therapy students: a prospective cohort study.

BACKGROUND: Information learned over a longer period of time has been shown to result in better long-term knowledge retention than information learned over a shorter period of time. In order to address multiple curricular goals, the timing and spacing of anatomy content within the Doctor of Physical Therapy (DPT) program at our institution recently changed from a very spaced to a very compressed format. The purpose of the present study was to assess differences in anatomy knowledge retention that might have been impacted by this change. The research hypothesis was that students receiving spaced instruction would have significantly better anatomy knowledge retention than students receiving massed instruction. METHODS: Participants consisted of two cohorts of DPT students that both received 45 contact hours of anatomy lecture and 90 contact hours of anatomy lab. The LONG cohort experienced anatomy through a lecture and lab taught over a 30-week, 2 semester period as separate courses. In contrast, the SHORT cohort took their anatomy lecture and lab concurrently over one 10-week semester. A pre-test was administered on the first day of their anatomy lecture course, and a post-test was administered to each cohort 18 months after completion of their last anatomy exam. RESULTS: After controlling for age-related differences in the two groups, no significant differences in mean pre-test, post-test, or percentage improvement were found between cohorts (p = 0.516; 0.203; and 0.152, respectively). CONCLUSION: These findings refute the hypothesis and show that both spaced and massed instruction in these cohorts resulted in the same level of long-term anatomy knowledge retention.

Pediatric Physical Therapists' Use of the Congenital Muscular Torticollis Clinical Practice Guidelines: A Qualitative Implementation Study.

PURPOSE: This study is a follow-up to the quantitative survey to examine the perceptions of pediatric physical therapists (PTs) on the application of the 2013 Congenital Muscular Torticollis Clinical Practice Guideline (CMT CPG). METHOD: Qualitative semi-structured telephone interviews were completed. Interview questions focused on how the guidelines influenced practice, facilitators and barriers to implementation, and knowledge translation activities. RESULTS: Thirteen pediatric PTs from a variety of practice settings participated. Positive perceptions about the CMT CPG included the use of flow charts, synthesized literature in one place, and validation of examination and intervention approaches. Negative perceptions included its length and that approaches without published evidence were not addressed. Three major themes were identified: knowledge and evidence for practice, education of clinicians, and the CPG structure and components that influenced practice. CONCLUSIONS: The CMT CPG provided a number of benefits. Recommendations for future enhancement and development are provided.

The Integrated Clinical Education Strategic Initiatives Project-Development of Parameters to Guide Harmonization in Clinical Education: A Scoping Review.

BACKGROUND: Clinical education curricular models specifically related to integrated clinical education (ICE) vary across physical therapist education programs. The interconnectedness of ICE to the advancement of a shared vision for clinical education in professional physical therapist education needs investigating. PURPOSE: The purpose of this scoping review was to: (1) define ICE, (2) define baseline expectations and parameters of ICE, and (3) discern and describe current ICE models. DATA SOURCES: Databases accessed included Medline, MedlinePlus with Full, CINAHL, and CINAHL Plus with full text. STUDY SELECTION: A multimodal data collection scoping review was completed. Data collection included survey research, a systematic review of the literature, and a series of focus groups. The McMaster Critical Appraisal Tool assessed methodological study quality. A qualitative, metasynthesis approach was used for data synthesis. Consensus agreement produced results. DATA EXTRACTION: Twenty-two articles were included in the literature review from the health disciplines of medicine, nursing, physical therapy, occupational therapy, and speech-language pathology. Data synthesis produced 8 parameters defining the factors essential to categorizing clinical education experiences as ICE in physical therapist education. The 8 parameters and ICE definition are supported by a description of models of ICE that currently exist within health profession curricula. DATA SYNTHESIS: Data synthesis followed a qualitative, metasynthesis approach. Themes emerged from the surveys, literature review, and focus group data. Patterns were compared, analyzed, and synthesized to generate the themes and ICE parameters. LIMITATIONS: Selection bias from the literature search could have limited the richness of the model descriptions by unintentional exclusion of articles, and might limit the applicability of results beyond the United States. Sampling bias from survey and focus groups, although purposeful, might have limited a broader description of current viewpoints about ICE. However, the data sources, including multiple health profession perspectives coupled with consensus agreement, provide sound evidence in development of profession-based parameters. CONCLUSIONS: The results of this scoping review provide the profession with a standard definition of ICE and parameters that can guide a program in designing a curriculum using ICE experiences as a foundation. A recommended next step is to design education research studies using reliable and valid outcome measures across programs to determine impact and effectiveness of ICE as an educational intervention.

Vestibular Rehabilitation Is Associated With Visuovestibular Improvement in Pediatric Concussion.

BACKGROUND AND PURPOSE: Vision and vestibular-related deficits are common after concussion and are associated with prolonged recovery times, substantially impacting the quality of life for children. The utility of targeted vestibular rehabilitation for these deficits in children after concussion is unknown. The purpose of this study was to determine whether active vestibular rehabilitation is associated with an improvement in visuovestibular signs and symptoms in children with concussion. METHODS: A retrospective cohort study of children diagnosed with concussion and referred to vestibular rehabilitation between 2012 and 2014 was conducted. Patient-reported symptoms and visuovestibular performance measures were assessed in the medical practice and physical therapy settings. RESULTS: One hundred nine children were included in the study with a mean age of 11.8 (3.4) years. Among this group, 59 (54%) were male and 48 (44%) had a sports-related concussion. Children presented to a pediatric sports medicine office and physical therapy a median of 24 (interquartile range [IQR], 14-42) and 55 (IQR, 39-94) days after injury, respectively. Concussion symptoms decreased from a median of 9 (IQR, 5-13) symptoms at initial evaluation to a median of 0 (IQR, 0-2) symptoms at final assessment. Performance on all visuovestibular tasks improved significantly over the course of therapy except for near point of convergence. For the 45 children who completed the Balance Error Scoring System at both initial and final therapy visits, there was a significant improvement in mean level of performance (P < 0.0001). Characteristics between those who completed a full versus partial course of physical therapy were similar. DISCUSSION AND CONCLUSIONS: Vestibular rehabilitation in children with concussion is associated with improvement in symptoms as well as visuovestibular performance. This active intervention may benefit children with persistent symptoms after concussion. Future prospective studies are needed to determine the efficacy and optimal postinjury timing of vestibular rehabilitation.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A208).

Implementing treatment frequency and duration guidelines in a hospital-based pediatric outpatient setting: administrative case report.

BACKGROUND AND PURPOSE: Determining treatment frequency and duration of physical therapist services is an important component of outpatient pediatric physical therapist practice, yet there is little research available to inform these decisions. Treatment frequency guidelines (TFG) can assist decision making in guiding pediatric physical therapy. The purpose of this project was to examine the feasibility and application of implementing TFG in hospital-based pediatric outpatient physical therapy. PROJECT DESCRIPTION: Previously developed TFG were modified for use in our pediatric outpatient physical therapy department to include duration and were referred to as treatment frequency and duration guidelines (TFDG). In order to successfully implement the TFDG, there were 2 phases to the project. In phase 1, the staff were provided the guidelines and procedures in a staff meeting and via email using a PowerPoint presentation. Phase 2 was initiated due to the poor response of the staff in implementing the guidelines in their practice after phase 1. The format was changed to include formal re-education via small-group and one-on-one education sessions (phase 2). Chart reviews were completed to assess therapists' adherence to using TFDG. OUTCOMES: Therapists' adherence to use of TFDG increased following re-education: phase 1 (n=225 charts, 31% adherence) and phase 2 (n=197 charts, 90% adherence). DISCUSSION: Treatment frequency and duration guidelines may assist in guiding frequency and duration decisions in pediatric physical therapy. Education via in-person meetings may improve adherence among staff.

A tool for clinical reasoning and reflection using the international classification of functioning, disability and health (ICF) framework and patient management model.

BACKGROUND AND PURPOSE: Professional development is a cornerstone of physical therapist practice. As the profession moves toward the ideals of Vision 2020, more emphasis is being placed on the process of clinical decision making. Although reflection and mentorship are widely regarded as important instruments to facilitate the progression of clinical reasoning skills, little guidance exists in the postprofessional arena to assist clinicians with these essential needs. As more organizations develop formal mentoring programs, a need arises for a tool that will engage mentors, protégés, and clinicians of all abilities in thoughtful reflection and discussion that will help develop clinical reasoning skills. CASE DESCRIPTION: The process of developing reflective clinical decision-making skills in physical therapist practitioners is described, and how this process was used at one institution is illustrated. A tool for clinical reasoning and reflection is proposed that incorporates the existing conceptual frameworks of the Guide to Physical Therapist Practice and the International Classification of Functioning, Disability and Health (ICF). OUTCOMES: This case report discusses how the tool was implemented by staff with varying levels of expertise, their outcomes in regard to the development of their clinical reasoning skills, and how the tool facilitated mentoring sessions around patient cases to improve care. DISCUSSION: This case report describes a practical application of a postprofessional educational process designed to develop reflective and patient-centered clinical reasoning skills. Although this process has shown some preliminary success, more research is warranted. By cultivating reflective thinking and critical inquiry, the physical therapy profession can help develop autonomous practitioners of physical therapy and promote the ideals of Vision 2020.

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.

Perspectives of therapist's role in care coordination between medical and early intervention services.

This study explored perspectives of therapist's role in care coordination between early intervention (EI) and medical services, and identified strategies for improving service delivery. Fifty adults participated in one of six focus groups. Participants included parents, pediatricians, and therapists working in hospital and EI programs. Structured guiding questions were used to obtain participants' perceptions. Transcript analysis included open code identification, axial code grouping, and constant comparative methods. The researchers established inter-rater reliability (kappa = 0.85) in the coding scheme before data analysis. The themes identified included information exchange, communication among parents and therapists, approaches toward child and family care, supporting social and emotional needs, perceptions of therapists' roles, and understanding service delivery systems to improve care coordination. Participants recommended training for therapy service providers and pediatricians in the areas of child development, team building, and service systems. Family-centered strategies emphasizing systems of care are recommended to improve therapists' role in care coordination.

Factors that influence the clinical decision making of physical therapists in choosing a balance assessment approach.

BACKGROUND: Many methods for examining patients with balance deficits are supported by the literature. How or why therapists choose specific balance assessment methods during examination of patients remains unclear. OBJECTIVES: The aims of this study were: (1) to explore decision making during examination of patients with balance deficits, (2) to understand the selection and use of assessment methods from the clinician's perspective, and (3) to explore why specific methods were selected. DESIGN: A qualitative design using a grounded theory approach permitted exploration of clinical decision making. METHODS: Eleven therapists were purposefully selected (6 from outpatient offices, 5 from inpatient rehabilitation settings) to participate in repeated interviews. Credibility of the findings was established through low-inference data, member check, and triangulation among participants and multiple data sources. RESULTS: A highly individualized approach to patient examination based on therapists' practical knowledge emerged from the data, with limited influence of the literature. Movement observation was the primary assessment and diagnostic tool. When selecting assessment approaches for specific patients, the perceived value of information gathered mattered more than testing time. A 3-stage model of assessment decision making portrayed both the process and reasons influencing therapists' choices. CONCLUSIONS: In the context of the complex and busy nature of clinical practice, therapists gathered data that they considered meaningful during patient examination. The findings provide insight into factors influencing assessment decisions and suggest mechanisms to foster translation of research into clinical practice.

An interdisciplinary pediatric rehabilitation project in Vietnam: the Temple team experience.

Four faculty members (two nurses, one physical therapist, one occupational therapist) from the College of Allied Health Professions, Temple University in Philadelphia, PA, were invited to Vietnam in March 2001 to present an interdisciplinary workshop on cerebral palsy to the rehabilitation staff at a large hospital for children in Hanoi. The purpose was to present lectures on pediatric rehabilitation, to demonstrate techniques, to conduct clinical assessment rounds, and to increase the staff's knowledge about outcome evaluation. After adjusting to the cultural differences, the team worked with Vietnamese professionals in their respective fields. The goals of the workshop were met except that it was not possible to evaluate outcomes by customary methods. However, trainees indicated verbally that they understood the new materials and techniques. The workshop was part of an ongoing project in rehabilitation in Vietnam that is sponsored by Health Volunteers Overseas, a voluntary agency in Washington, DC.