Factors Contributing to Physical Therapist Attrition: A Qualitative Study.

BACKGROUND: Physical therapists (PTs) report job satisfaction when delivering autonomous, high-quality care, but they also experience work-related stress, burnout, and emotional exhaustion. Retaining experienced and skilled clinicians is important. However, a subset of PTs are choosing to voluntarily leave clinical practice (i.e., experience attrition). PT attrition may negatively impact patient care, increase organizational costs, and negatively impact the profession. PURPOSE: This study examined the nature of the experiences of PTs voluntarily leaving clinical practice in order to understand factors contributing to PT attrition. METHOD: A pragmatic qualitative approach with individual, semi-structured interviews conducted with PTs who left clinical practice was used. Interviews were transcribed verbatim and analyzed using deductive thematic analyses. DISCUSSION: Nineteen US-based PTs who left clinical practice were interviewed. Participants were predominately female (n=15), Doctors of Physical Therapy (n=10), with a median of 6 years working in clinical practice as a PT. Analyses revealed five key themes contributing to leaving clinical practice subdivided into Herzberg's Theory: 1) lack of career advancement opportunities; 2) rising productivity requirements reducing the quality of patient care; 3) financial concerns due to imbalance between cost of PT education and compensation; 4) physical demands either contributing to attrition or seen as a benefit of the profession; and 5) emotional burden contributing to attrition or emotional connection seen as professional value. CONCLUSIONS: Understanding the factors contributing to PT attrition is important to guide future strategies to address these factors. Further research may identify opportunities to address these concerns in entry-level education, workplace environments, and professional continuing education.

Understanding Injury and Injury Prevention in Para Sport Athletes.

CONTEXT: Training loads, injury, and injury prevention in the Para sports population has not been well established. OBJECTIVE: The purpose of this study was to survey elite-level swimming, cycling, and athletic Para sport athletes in the United States who were competing in the 2016 US Paralympic trials to better understand common injuries among athletes in each sport and to determine whether injury prevention programs were being utilized. DESIGN: Cross-sectional, survey study. SETTING: The 2016 US Paralympic trials for swimming, cycling, and athletics. PARTICIPANTS: Athletes who competed in swimming, cycling, and/or athletics at the 2016 US Paralympic trials (N = 144; 83 males and 61 females). MAIN OUTCOME MEASURES: Participants completed electronic survey using Qualtrics XM (Qualtrics, Provo, UT) with questions pertaining to average number of hours trained per week, number of cross-training hours performed each week, descriptive information regarding sport-related injuries, pain, whether athletes received treatment for injuries, and descriptive information regarding whether the athletes had participated in an injury prevention program. RESULTS: Over 64% of respondents reported training greater than or equal to 11 hours per week, and 45% of athletes reported spending greater than or equal to 6 hours per week cross-training. Forty-two percent of athletes reported currently having pain with 34% reporting missing a competition because of injury. Only 24% of respondents reported having participated in an injury prevention program. CONCLUSIONS: Many Para sport athletes train at similar durations as able-bodied counterparts and have pain that interferes with their ability to train and compete, however, only a small percentage consistently perform injury prevention programs.

Preventive Effects of Eccentric Training on Acute Hamstring Muscle Injury in Professional Baseball.

BACKGROUND: Hamstring injuries are the second most common injury causing missed days in professional baseball field players. Recent studies have shown the preventive benefit of eccentric conditioning on the hamstring muscle group in injury prevention. Specifically, Nordic-type exercises have been shown to decrease the incidence of acute hamstring injuries in professional athletes. PURPOSE: This was a prospective study performed in coordination with a single Major League Baseball (MLB) organization (major and minor league teams) that targeted the effects of Nordic exercises on the incidence of acute hamstring injuries in the professional-level baseball player. STUDY DESIGN: Prospective cohort study; Level of evidence, 2. METHODS: The daily workouts of 283 professional baseball players throughout all levels of a single MLB organization were prospectively recorded. The intervention group participated in the Nordic exercise program and was compared with a randomly selected control group of professional athletes within the organization not participating in the exercise program. The incidence of hamstring injuries in both groups was compared, and the total number of days missed due to injury was compared with the 2 previous seasons. RESULTS: There were 10 hamstring injuries that occurred during the 2012 season among the 283 professional athletes that required removal from play. There were no injuries that occurred in the intervention group (n = 65, 0.00%; P = .0381). The number needed to treat (NNT) to prevent 1 hamstring injury was 11.3. The average repetitions per week of the injured group were assessed at multiple time points (2, 4, 6, and total weeks) prior to injury. There were significantly fewer repetitions per week performed in the injured group at all time points compared with overall average repetitions per week in the noninjured group (P = .0459, .0127, .0164, and .0299, respectively). After beginning the Nordic exercise program, there were 136 total days missed due to a hamstring injury during the 2012 season. This number was less than the 2011 season (273 days missed) and the 2010 season (309 days missed). CONCLUSION: Study results indicate the initiation of Nordic hamstring exercises may decrease the incidence of acute hamstring injuries and potentially decrease the total number of days missed due to injury in professional baseball players. CLINICAL RELEVANCE: The financial and competitive interest in professional baseball players is of large importance to the player, team, and fans. Prevention of injuries is as important to all parties involved as the treatment and rehabilitation following an injury. This prospective study shows the initiation of a simple, free exercise can reduce the incidence of hamstring injury in the professional-level baseball player.