Experiences of physical therapists during the COVID-19 pandemic: an interpretive phenomenological analysis.

INTRODUCTION: The COVID-19 pandemic is the most fundamental challenge to the healthcare system in current generations. Physical therapists (PTs), as essential members of the healthcare team, were impacted substantially. Understanding their experiences during this unique and challenging time would help PTs manage the pandemic and future crises in healthcare. It may also reveal professional changes that may persist through the pandemic and beyond. PURPOSE: To describe the experiences of PTs in the New York metropolitan area during the initial wave of the pandemic. METHODS: This was an interpretive phenomenological study. Data were collected during 8 focus groups of 2-3 PTs each in August and September 2020 via videoconference. Audio recordings of the groups were transcribed, and data were coded in 3 rounds. RESULTS: Twenty-two PTs from a range of settings participated. Four themes were identified: (1) Everything was disrupted; (2) It was not safe; (3) It was overwhelming; and (4) There was a professional transformation. In hospitals, participants described chaos, poor communication, and unsafe working environments. In outpatient settings, participants described job instability and challenges adapting to telehealth. As the pandemic progressed inpatient PTs felt safer, gained confidence, and became critical members of interdisciplinary care teams. Outpatient therapists adapted to telehealth and experienced rising caseloads as patients returned to therapy. CONCLUSION: Physical therapists experienced a variety of challenges during the initial phases of the pandemic. As the pandemic progressed, they redefined practice.

Relevance of the Activities-Specific Balance Confidence (ABC) Scale to Urban Community-Dwelling Adults With Diagnosed Vestibular Dysfunction.

OBJECTIVE: To determine how relevant the items on the activities-specific balance confidence (ABC) scale are to patients living in an urban setting and to evaluate additional items relevant to urban populations but not included in the current version of the scale. DESIGN: Cross-sectional clinical survey. SETTING: Urban, tertiary vestibular rehabilitation clinic. PARTICIPANTS: Vestibular rehabilitation clinic outpatients (N=103). INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: Relevance of 16 day-to-day tasks on the ABC scale on a scale of 0 (not performed) to 10 (performed regularly); median relevancy score (MRS) for most relevant items. RESULTS: One hundred three participants (73.7% female, mean age 61.5± years) with vestibular disorders completed the survey. The items with the highest MRS were walking around a house (MRS=10), reaching for a shelved item eye level (MRS=9), taking the stairs (MRS=7), bending over and picking up a slipper (MRS=7), and stepping onto or off an escalator while holding the railing (MRS=7). Lowest MRS items to someone living in an urban environment included walking across a parking lot to the mall (MRS=0) and walking outside the house to a car parked in the driveway (MRS=0). The most common functional activities not addressed by ABC score included navigating the subway/public transit (35.9%) and walking through crowds (32.0%). CONCLUSIONS: This study revealed insights about important activities of daily living for those in an urban setting. Results show that the ABC scale should be modified to better reflect the specific activities of urban dwellers.

Dialogic Health Education to Reduce COVID-19 Disparities and Increase Health Literacy in Community and Correctional Settings: Protocol for a Two-Pronged Health Education Program.

BACKGROUND: COVID-19 vaccines significantly reduce rates of hospitalization and death for those infected with the SARS-CoV-2 virus. Those facing social oppression, including people of color, experience heightened risk for COVID-19 and comorbidities, but are often mistrustful of governmental agencies and initiatives, contributing to low vaccine uptake and a reluctance to access vital health care services. Dialogue-based health literacy interventions may mitigate mistrust and increase access to health services and information, subsequently increasing rates of vaccination and other behaviors that reduce COVID-19 risk. OBJECTIVE: To improve health literacy and reduce COVID-19 disparities, the Westchester County Department of Health, in partnership with two universities, community- and faith-based organizations, and the Westchester County Department of Correction, co-developed a health education program for community members, correctional officers, and incarcerated jail residents in Westchester, New York. Specific objectives are to increase preventative health behaviors, positive attitudes toward use of public health protocols, full vaccination or intentions to vaccinate, health care information understanding, health provider care access, clear communication with health care providers, and personal health care decision-making. METHODS: Grounded in dialogic learning, the program entails training community-based "trusted messengers" and correctional officers to lead health information sessions in community and correctional settings. During the grant period, the program intends for 80 community-based trusted messengers to receive training from the Department of Health and will be expected to reach a goal of 100 members (N=8000) of their communities. Correctional staff with experience delivering educational programs will be trained to facilitate sessions among 400 correctional facility residents and 600 correctional staff. RESULTS: Pre-post surveys will assess changes in health behaviors, attitudes, and perceptions. The program has been administered in the correctional facility since February 2022, with information sessions expected to cease for correctional staff and residents in June 2022 and November 2022, respectively. An initial cohort of community-based trusted messengers began training in February 2022, and information sessions have been scheduled in various virtual and community settings since March 2022. As of April 2022, the two-pronged health education program has reached 439 correctional officers, 98 jail residents, and 201 community members countywide. Program evaluation findings will be released in future publications after study implementation is complete. CONCLUSIONS: Few studies have evaluated the combined effects of training-of-trainers (ToT) and dialogical learning models on behavior and health literacy. As the first known COVID-19-specific dialogue-based health education program that applies a ToT model in the community-based, correctional, and virtual settings simultaneously, this study fills a gap in current knowledge about health literacy and health behavior in marginalized populations. Thus, this evidence-based framework can remedy COVID-19 disparities while also addressing risks for a host of health-related issues at the community level, potentially serving as a best-practice model for future health programs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/37713.

Walking improvement in chronic incomplete spinal cord injury with exoskeleton robotic training (WISE): a randomized controlled trial.

STUDY DESIGN: Clinical trial. OBJECTIVE: To demonstrate that a 12-week exoskeleton-based robotic gait training regimen can lead to a clinically meaningful improvement in independent gait speed, in community-dwelling participants with chronic incomplete spinal cord injury (iSCI). SETTING: Outpatient rehabilitation or research institute. METHODS: Multi-site (United States), randomized, controlled trial, comparing exoskeleton gait training (12 weeks, 36 sessions) with standard gait training or no gait training (2:2:1 randomization) in chronic iSCI (>1 year post injury, AIS-C, and D), with residual stepping ability. The primary outcome measure was change in robot-independent gait speed (10-meter walk test, 10MWT) post 12-week intervention. Secondary outcomes included: Timed-Up-and-Go (TUG), 6-min walk test (6MWT), Walking Index for Spinal Cord Injury (WISCI-II) (assistance and devices), and treating therapist NASA-Task Load Index. RESULTS: Twenty-five participants completed the assessments and training as assigned (9 Ekso, 10 Active Control, 6 Passive Control). Mean change in gait speed at the primary endpoint was not statistically significant. The proportion of participants with improvement in clinical ambulation category from home to community speed post-intervention was greatest in the Ekso group (>1/2 Ekso, 1/3 Active Control, 0 Passive Control, p < 0.05). Improvements in secondary outcome measures were not significant. CONCLUSIONS: Twelve weeks of exoskeleton robotic training in chronic SCI participants with independent stepping ability at baseline can improve clinical ambulatory status. Improvements in raw gait speed were not statistically significant at the group level, which may guide future trials for participant inclusion criteria. While generally safe and tolerable, larger gains in ambulation might be associated with higher risk for non-serious adverse events.

Discharge Rehabilitation Measures Predict Activity Limitations in Patients With Stroke 6 Months After Inpatient Rehabilitation.

OBJECTIVE: The aim of this study was to identify rehabilitation measures at discharge from acute inpatient stroke rehabilitation that predict activity limitations at 6 mos postdischarge. DESIGN: This is a retrospective analysis of a prospective, longitudinal, observational cohort study. It was conducted in an acute inpatient rehabilitation unit at an urban, academic medical center. Activity limitations in patients ( N = 141) with stroke of mild-moderate severity were assessed with the activity measure for post-acute care at inpatient stroke rehabilitation discharge and 6-mo follow-up. Rehabilitation measures at discharge were investigated as predictors for activity limitations at 6 mos. RESULTS: Measures of balance (Berg Balance Scale), functional limitations in motor-based activities (functional independence measure-motor subscore), and motor impairment (motricity index), in addition to discharge activities measure for post-acute care scores, strongly predicted activity limitations in basic mobility and daily activities at 6 mos (51% and 41% variance explained, respectively). Functional limitations in cognition (functional independence measure-cognitive subscore) and executive function impairment (Trail Making Test-part B), in addition to the discharge activities measure for post-acute care score, modestly predicted limitations in cognitively based daily activities at 6 mos (12% of variance). CONCLUSIONS: Standardized rehabilitation measures at inpatient stroke rehabilitation discharge can predict future activity limitations, which may improve prediction of outcome post-stroke and aid in postdischarge treatment planning.

Immediate Improvement in Subjective Visual Vertical and Disequilibrium Predicts Resolution of Benign Paroxysmal Positional Vertigo Following Single Canalith Repositioning Maneuver.

Objective: To evaluate whether immediate post-canalith repositioning maneuver (CRM) vestibular changes are predictive of benign paroxysmal positional vertigo (BPPV) resolution. Study Design: Retrospective cohort study. Setting: Tertiary referral center. Patients: Adults (n = 27) with posterior canal BPPV. Interventions: Single CRM with Frenzel goggles. Main Outcome Measures: The Visual Analog Scale (VAS) for disequilibrium, the subjective visual vertical (SVV), the subjective visual horizontal (SVH), and the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB) were administered pre- and immediately following single CRM. Dix-Hallpike was performed 1-3 weeks after CRM to assess for BPPV resolution. Pre- and post-treatment vestibular assessments were compared between groups to determine if post-CRM vestibular changes could predict BPPV resolution. Results: The change in VAS score following CRM treatment was statistically different between patients who responded to CRM treatment (n = 15) and those who did not (n = 12), (-0.07 points versus -2.40 points, respectively; P = 0.03). Likewise, a significantly greater improvement in SVV score was observed for CRM responders compared with CRM nonresponders (0.92° versus -0.06°, respectively; P = 0.02). Change in SVH and mCTSIB scores did not differ significantly between groups. Additionally, patient age was found to predict outcome of CRM treatment, with older patients more likely to experience persistent BPPV (P ≤ 0.01). Conclusions: Immediate improvement in VAS and SVV scores following CRM may be useful in predicting resolution of BPPV and may assist in directing the timing and need for future interventions. Younger age may have a favorable predictive value for improvement following single CRM.

Young individuals with stroke in rehabilitation: a cohort study.

Stroke in younger populations is a public health crisis and the prevalence is rising. Little is known about the progress of younger individuals with stroke in rehabilitation. Characterization of the course and speed of recovery is needed so that rehabilitation professionals can set goals and make decisions. This was a cohort study with data extracted from electronic medical records. Participants were 408 individuals diagnosed with stroke who participated in inpatient rehabilitation in an urban, academic medical center in the USA. The main predictor was age which was categorized as (18-44, 45-64, 65-74 and 75+). Outcomes included baseline-adjusted discharge functional independence measure (FIM) scores and FIM efficiency. In linear regression models for FIM scores, the reference category was the youngest age group. The oldest group was discharged with significantly lower FIM total (B = -8.84), mobility (B = -4.13), self-care (B = -4.07) and cognitive (B = -1.57) scores than the youngest group after controlling for covariates. The 45-64 group also finished with significantly lower FIM total (B = -6.17), mobility (B = -2.61) and self-care (B = -3.01) scores than youngest group. FIM efficiencies were similar for all ages in each of the FIM scales. Younger individuals with stroke make slightly greater functional gains compared to older individuals with stroke, but other factors, such as admission scores, are more important and the rates of recovery may be similar.

Changes in the Activity Measure for Post-Acute Care Domains in Persons With Stroke During the First Year After Discharge From Inpatient Rehabilitation.

OBJECTIVE: To describe functional changes after inpatient stroke rehabilitation using the Activity Measure for Post-Acute Care (AM-PAC), an assessment measure sensitive to change and with a low risk of ceiling effect. DESIGN: Retrospective, longitudinal cohort study. SETTING: Inpatient rehabilitation unit of an urban academic medical center. PARTICIPANTS: Among 433 patients with stroke admitted from 2012-2016, a total of 269 (62%) were included in our database and 89 of 269 patients (33.1%) discharged from inpatient stroke rehabilitation had complete data. Patients with and without complete data were very similar. The group had a mean age of 68.0±14.2 years, National Institutes of Health Stroke Score of 8.0±8.0, and rehabilitation length of stay of 14.7±7.4 days, with 84% having an ischemic stroke and 22.5% having a recurrent stroke. INTERVENTION: None. MAIN OUTCOME MEASURES: Changes in function across the first year after discharge (DC) were measured in a variety of ways. Continuous mean scores for the basic mobility (BM), daily activity (DA), and applied cognitive domains of the AM-PAC were calculated at and compared between inpatient DC and 6 (6M) and 12 months (12M) post DC. Categorical changes among individuals were classified as "improved," "unchanged," or "declined" between the 3 time points based on the minimal detectable change, (estimated) minimal clinically important difference, and a change ≥1 AM-PAC functional stage (FS). RESULTS: For the continuous analyses, the Friedman test was significant for all domains (P≤.002), with Wilcoxon signed-rank test significant for all domains from DC to 6M (all P<.001) but with no change in BM and DA between 6M and 12M (P>.60) and a decline in applied cognition (P=.002). Despite group improvements from DC to 6M, for categorical changes at an individual level 10%-20% declined and 50%-70% were unchanged. Despite insignificant group differences from 6M-12M, 15%-25% improved and 20%-30% declined in the BM and DA domains. CONCLUSIONS: Despite group gains from DC to 6M and an apparent "plateau" after 6M post stroke, there was substantial heterogeneity at an individual level. Our results underscore the need to consider individual-level outcomes when evaluating progress or outcomes in stroke rehabilitation.

The effectiveness of biofeedback for improving pain, disability and work ability in adults with neck pain: A systematic review and meta-analysis.

BACKGROUND: Biofeedback is used to optimise muscle activation patterns in people with neck pain. OBJECTIVES: To evaluate the safety and efficacy of electromyographic and pressure biofeedback on pain, disability and work ability in adults with neck pain. DESIGN: Systematic review and meta-analysis. METHODS: We searched key databases and trial registries to September 2020, using terms synonymous with 'neck pain' and 'biofeedback'. We included randomised controlled trials (RCTs) evaluating biofeedback (against any comparison) for adults with neck pain. Outcomes included pain, disability, work ability and adverse events. Two authors independently selected the studies, extracted data, and evaluated risk of bias. GRADE was applied to each meta-analysis. Data were pooled using random-effects models to determine the standardised mean change (SMC). RESULTS: We included 15 RCTs (n = 990). Moderate-quality evidence suggests biofeedback has a moderate effect on reducing short-term disability (SMC = -0.42, 95%CI: 0.59 to -0.26, nine trials, n = 627), and a small effect on reducing intermediate-term disability (SMC = -0.30, 95%CI: 0.53 to -0.06, five trials, n = 458). Biofeedback had no effect on pain or work ability in the short- and intermediate-term (low-to moderate-quality evidence). One study reported headaches in 6.7% of participants, but headache frequency was not reported by group. LIMITATIONS: There were a variety of control interventions across studies. Few studies compared biofeedback with no treatment or placebo. CONCLUSION: Biofeedback appears to have a small-to-moderate effect on reducing neck pain disability in the short- and intermediate-term, but no effect on pain or work ability. More trials reporting adverse events and comparing biofeedback to placebo are needed.

Standardized Outcome Measures in Stroke Rehabilitation and Falls After Discharge: A Cohort Study.

INTRODUCTION: Individuals with stroke discharged from inpatient rehabilitation units (IRUs) are at increased risk for falls. In IRUs, standardized outcome measures (SOMs) have been used to predict falls, but the results have been mixed. OBJECTIVE: To examine the relationship between SOMs and the risk of falls in individuals with stroke within 6 months of discharge from an IRU. DESIGN: Prospective cohort study with 6-month follow-up. SETTING: IRU that was part of a large, urban academic medical center. PARTICIPANTS: Individuals with stroke who underwent rehabilitation. MAIN OUTCOME MEASURES: Self-reported falls within 6 months of discharge. RESULTS: The study included 105 participants who were discharged to their homes after inpatient rehabilitation and who responded to a 6-month follow-up (57% response rate) phone call. Twenty-nine participants (28%) reported falling. Significant odds ratios (ORs), adjusted for age, sex, and stroke severity, were found for the following measures: Berg Balance Scale (OR 0.95, 95% confidence interval [CI] 0.92-0.99), Activity Measure for Post-Acute Care basic mobility (OR 0.89, 95% CI 0.81-0.97), Motricity Index (OR 0.96, 95% CI 0.94-0.98), Functional Independence Measure mobility subscale (OR 0.89, 95% CI 0.80-0.98), and Trunk Control Test (OR 0.97, 95% CI 0.95-0.99). Areas under the curve ranged from .64 to .71. In samples of 82 to 90 patients who could complete the tests, gait speed, the Functional Reach Test, the 6-minute Walk Test, and Timed Up and Go did not result in significant ORs. CONCLUSIONS: At discharge, SOMs were associated with the odds of falls within 6 months. The multifactorial nature of falls will continue to make prediction challenging but SOMs can be helpful. Lower extremity strength deserves more attention as a risk factor.

The use of safe patient handling and mobility equipment in rehabilitation.

BACKGROUND: Increasingly, occupational and physical therapists are using safe patient handling and mobility (SPHM) equipment, such as mechanical lifts, in rehabilitation. However, there is little guidance in the literature on how SPHM equipment can be used to assist patients to reach rehabilitation goals. The purpose of this projectwas to document and categorize common and innovative ways rehabilitation therapists use SPHM equipment in their clinical practice. OBJECTIVE: This article investigates common and innovative uses of SPHM equipment in rehabilitation practice. METHODS: Occupational, physical and kinesio therapist employed at the Veterans Health Administration wrote narratives and took photos describing rehabilitation therapy activities where they used SPHM equipment in their clinical practice. The authors used a systematic process to review and categorize the narratives and subsequent photos by using the World Health Organization's International Classification of Functioning, Disability and Health (ICF). RESULTS: Thirty narratives (13 innovative and 17 common) were coded into four categories on the ICF section of mobility. The most common category was "changing and maintaining basic body position"(21) followed by "walking and moving" (5). The category "carrying, moving and handling objects" garnered two narratives and there were no narratives for "using transportation." CONCLUSIONS: Project findings may serve as a guide for therapists who would like to enhance their use of SPHM equipment in rehabilitation. Additional research is needed to expand the use of SPHM in rehabilitation practice and evaluate the impact on patient rehabilitation outcomes and therapist safety outcomes.

Wrist and hand pain in orthopaedic physical therapists: A mixed-methods study.

BACKGROUND: Orthopaedic physical therapists (PTs) who perform manual therapy are at high risk for wrist and hand pain. Studies that examine the magnitude, scope and causes of wrist and hand pain are needed so that prevention programs can be developed. OBJECTIVES: The objective of this study was to determine the magnitude, scope, and impact of wrist and hand pain in orthopaedic PTs and to identify potential strategies for prevention. DESIGN: This was a sequential, mixed methods study including quantitative and qualitative components. METHODS: The quantitative phase consisted of an online survey sent to members of the Academy of Orthopaedic Physical Therapy. The qualitative phase consisted of focus groups with Orthopaedic PTs who had wrist and hand pain. RESULTS: The survey included 962 PTs and the focus groups included 10 PTs. The one-year prevalence of wrist and hand pain was 75%. Increasing age, decreasing experience, female gender, performing more manual therapy and working more than 40 h per week were associated with an increased risk of moderate to severe wrist and hand pain. Soft-tissue mobilization was the most frequently cited causative factor. The most commonly mentioned strategy for prevention was altering body mechanics and technique. Focus group participants highlighted the importance of managing expectations for manual therapy by patients. CONCLUSIONS: Formal injury prevention programs for PT students and PTs are urgently needed. These programs should focus on improving body mechanics and technique, attention to workload, careful selection of manual techniques, and managing expectations for manual therapy.

Musculoskeletal pain associated with recreational yoga participation: A prospective cohort study with 1-year follow-up.

BACKGROUND: Yoga is a popular complementary therapy for musculoskeletal pain. There are few studies however, that have examined the risks of recreational participation for causing musculoskeletal pain. OBJECTIVES: To examine the relationship between musculoskeletal pain and recreational yoga participation. METHODS: This was a prospective cohort study with one-year follow-up. Data were collected via electronic questionnaires, one year apart. Outcomes included incidence and impact of pain caused by yoga and prevalence of pain caused, exacerbated, unaffected, and improved by yoga. Predictors included age, experience, hours of participation, and intensity of participation. RESULTS: The final sample included 354 participants from two suburban yoga studios. The incidence rate of pain caused by yoga was 10.7%. More than one-third of incident cases resulted in lost yoga participation time and/or symptoms lasting more than 3 months. None of the risk factors at baseline increased the risk for subsequent incident cases of pain caused by yoga. CONCLUSIONS: Yoga can cause musculoskeletal pain. Participants may benefit from disclosure of practice to their healthcare professionals and by informing teachers of injuries they may have prior to participation. Yoga teachers should also discuss the risks for injury with their students.

Descriptive Values for Dancers on Baseline Concussion Tools.

CONTEXT: Capturing baseline data before a concussion can be a valuable tool in individualized care. However, not all athletes, including dancers, have access to baseline testing. When baseline examinations were not performed, clinicians consult normative values. Dancers are unique athletes; therefore, describing values specific to dancers may assist those working with these athletes in making more informed decisions. OBJECTIVE: To describe values for key concussion measures of dancers. Our secondary aim was to examine whether differences existed between sexes and professional status. Finally, we explored factors that may affect dancers' scores. DESIGN: Cross-sectional study. SETTING: Professional dance companies and a collegiate dance conservatory. PATIENTS OR OTHER PARTICIPANTS: A total of 238 dancers (university = 153, professional = 85; women = 171; men = 67; age = 21.1 ± 4.8 years). MAIN OUTCOME MEASURE(S): We calculated the total symptom severity from the Sport Concussion Assessment Tool-3rd edition; the Standardized Assessment of Concussion score; the modified Balance Error Scoring System score; and the King-Devick score for each participant. Group differences were analyzed with Mann-Whitney or t tests, depending on the data distribution. We used bivariate correlations to explore the effects of other potential influencing factors. RESULTS: Participants demonstrated the following baseline outcomes: symptom severity = 16.6 ± 12.8; Standardized Assessment of Concussion = 27.5 ± 1.8; modified Balance Error Scoring System = 3.2 ± 3.1 errors; and King-Devick = 41.5 ± 8.2 seconds. A Mann-Whitney test revealed differences in King-Devick scores between female (40.8 ± 8.0 seconds) and male (43.4 ± 8.4 seconds) dancers ( P = .04). An independent-samples t test also demonstrated a difference in modified Balance Error Scoring System scores between female (2.95 ± 3.1 errors) and male (3.8 ± 3.1 errors) dancers ( P = .02). Age, hours of sleep, height, and history of concussion, depression, or injury did not display moderate or strong associations with any of the outcome measures. CONCLUSIONS: Dancers' symptom severity scores appeared to be higher than the values reported for other athletes. Additional studies are needed to establish normative values and develop a model for predicting baseline scores.

Perioperative registered nurses knowledge, attitudes, behaviors, and barriers regarding pressure ulcer prevention in perioperative patients.

BACKGROUND: Hospital acquired pressure ulcers have a detrimental effect on patient quality of life, morbidity, mortality, and cost to the healthcare industry. Little is known about pressure ulcer prevention in perioperative services. OBJECTIVES: The objectives of this study were to describe perioperative registered nurses (RNs) knowledge, attitudes, behaviors, and barriers about pressure ulcer prevention and to determine if knowledge and the availability of a pressure ulcer staging tool are predictors of pressure ulcer prevention behavior. METHODS: A cross-sectional descriptive pilot study was conducted. Sixty-two perioperative RNs from 10 acute care hospitals participated. RESULTS: Perioperative nurses believed carrying out pressure ulcer prevention strategies is essential to nursing practice but only two-thirds reported conducting pressure ulcer risk assessment on all patients and daily assessment on at risk patients. Results indicated a knowledge deficit regarding assessment and prevention of pressure ulcers as performance on the PUKT (72%) fell below the recommended score of 90%. Results of binary logistic regression indicated that knowledge as measured by the PUKT and availability of a pressure ulcer staging tool were statistically significant (p=0.03) predictors of pressure ulcer prevention behavior. The initial model without the predictor variables, indicated an overall success rate of correct predictions of 64% which increase to 73% when the predictor variables were added to the initial model. CONCLUSIONS: Although perioperative nurses believe that pressure ulcer prevention is important, a knowledge deficit exists and there is a need for pressure ulcer prevention education.

Orthopaedic Physical Therapy: Update to the Description of Specialty Practice.

STUDY DESIGN: Descriptive, cross-sectional observational study. BACKGROUND: In the physical therapist profession, the outcomes of specialty practice analyses are used to determine content areas for specialty board examinations and for American Physical Therapy Association (APTA)-accredited residency curricula. To maintain currency for specialty practices, the American Board of Physical Therapy Specialties (ABPTS) requires any approved specialty area to revalidate its Description of Specialty Practice (DSP) a minimum of every 10 years. OBJECTIVES: The purpose of this article was to describe the most recent practice analysis process and to report revisions to the DSP for orthopaedic physical therapists. METHODS: A survey instrument was developed by a group of subject matter experts, following guidelines established by the ABPTS. The survey was sent electronically to a random sample of 800 orthopaedic certified specialists (OCSs). The survey contained 5 sections: (1) knowledge areas (eg, human anatomy and physiology); (2) professional roles, responsibilities, and values (eg, consultation); (3) patient/client management model (eg, examination); (4) percentage of body regions treated; and (5) demographic information. RESULTS: A total of 224 completed surveys and 43 partially completed surveys were submitted, for a response rate of 33.4%. Based on a priori decision rules regarding survey data, consensus of the group of subject matter experts, and ABPTS suggestions, the DSP for orthopaedic physical therapy was revised. CONCLUSION: The revised DSP will be used to reconstruct the blueprint for future OCS examinations, APTA-accredited orthopaedic residency program curricula, as well as professional development activities related to recertification in orthopaedic physical therapy.

Musculoskeletal Discomfort, Physical Demand, and Caregiving Activities in Informal Caregivers.

OBJECTIVES: To characterize the burden of care and musculoskeletal discomfort associated with caring for adults with chronic physical disability among informal caregivers and to describe the most physically demanding caregiving activities and contributing factors, as perceived by informal caregivers of adults with physical disabilities. METHODS: A mixed methods approach was used for the study. Forty-six informal caregivers of adults with physical disability participated. RESULTS: Most caregivers were classified as "high burden" caregivers. They reported high levels of physical strain and musculoskeletal discomfort. Caregivers identified several activities related to mobility and self-care as the most physically demanding. Factors affecting physical demand included caregiver and care-recipient characteristics, activity requirements, and the physical environment. CONCLUSION: Interventions that target high-demand caregiving activities, including all three aspects of caregiving activity performance, are necessary to support adults with disabilities in the home and their caregivers.

Effects of a safe patient handling and mobility program on patient self-care outcomes.

OBJECTIVE. The aim of this study was to determine the effect of a safe patient handling and mobility (SPHM) program on patient self-care outcomes. METHOD. We used a retrospective cohort design. Data were obtained from the electronic medical records of 1,292 patients receiving inpatient rehabilitation services. Self-care scores from the FIM™ for patients who participated in rehabilitation before implementation of an SPHM program were compared with the scores of patients who participated after implementation of the program. RESULTS. Patients who received inpatient rehabilitation services with an SPHM program were as likely to achieve at least modified independence in self-care as those who received inpatient rehabilitation services without an SPHM program. CONCLUSION. SPHM programs may not affect self-care performance in adults receiving inpatient rehabilitation services. However, more work must be done to define specific and effective methods for integrating patient handling technologies into occupational therapy practice.

Effect of a safe patient handling program on rehabilitation outcomes.

OBJECTIVE: To evaluate the effect of a safe patient handling (SPH) program on rehabilitation mobility outcomes. DESIGN: Retrospective cohort study. SETTING: A rehabilitation unit in a hospital system. PARTICIPANTS: Consecutive patients (N=1291) over a 1-year period without an SPH program in place (n=507) and consecutive patients over a 1-year period with an SPH program in place (n=784). INTERVENTIONS: The SPH program consisted of administrative policies and patient handling technologies. The policies limited manual patient handling. Equipment included ceiling- and floor-based dependent lifts, sit-to-stand assists, ambulation aides, friction-reducing devices, motorized hospital beds and shower chairs, and multihandled gait belts. MAIN OUTCOME MEASURES: The mobility subscale of the FIM. RESULTS: Patients rehabilitated in the group with SPH achieved similar outcomes to patients rehabilitated in the group without SPH. A significant difference between groups was noted for patients with initial mobility FIM scores of 15.1 and higher after controlling for initial mobility FIM score, age, length of stay, and diagnosis. Those patients performed better with SPH. CONCLUSIONS: SPH programs do not appear to inhibit recovery. Fears among therapists that the use of equipment may lead to dependence may be unfounded.