The Impact of Level of Physical Therapist Assistant Involvement on Patient Outcomes Following Stroke.

OBJECTIVE: This study investigates if higher utilization of physical therapist assistants adversely affects patient outcomes in the acute rehabilitation setting for patients following a cerebrovascular accident (CVA). METHODS: Participants were admitted to 1 of 5 inpatient rehabilitation facilities following a CVA from 2008 to 2010. High physical therapist assistant use was defined as ≥20% of the physical therapist visits being provided by the physical therapist assistant for an episode of care. Multivariable regression techniques examined differences in functional outcome, discharge location, and length of stay between high and low physical therapist assistant use groups. Propensity scoring methods supplemented findings of the regression analyses. RESULTS: Of the 1561 participants, 496 (32%) had high physical therapist assistant involvement. Baseline participant characteristics such as age, sex, baseline motor function, and comorbidities did not differ between high and low physical therapist assistant use groups. After adjusting for patient characteristics, rehabilitation facility, and year, higher physical therapist assistant use did not adversely affect functional outcome or length of stay. Fewer conclusions can be drawn regarding discharge location, although there was no significant difference in discharge location between groups with high and low physical therapist assistant utilization. Propensity scoring methods supported the findings of the regression analyses. CONCLUSIONS: Higher physical therapist assistant involvement in the rehabilitation of patients following CVA did not adversely affect functional outcome, increase length of stay, or reduce the likelihood of discharge to home from an inpatient rehabilitation facility. IMPACT: The results demonstrate the value of the physical therapist assistant in the provision of physical therapy for patients with stroke in the inpatient rehabilitation setting. Higher involvement of the physical therapist assistant may provide cost savings while maintaining patient outcomes for this setting and population.

Claim Costs, Musculoskeletal Health, and Work Exposure in Physical Therapists, Occupational Therapists, Physical Therapist Assistants, and Occupational Therapist Assistants: A Comparison Among Long-Term Care Jobs.

BACKGROUND: Patient/resident-handling tasks are physically demanding and associated with musculoskeletal disorders (MSDs) among nursing personnel. The routine performance of such tasks by physical therapists and occupational therapists during treatment can cause similar problems. OBJECTIVE: This study characterized the magnitude of MSDs and the risk factors for MSDs in physical therapists, occupational therapists, physical therapist assistants, and occupational therapist assistants (collectively called "therapy personnel" for this study) and compared them with those of other nursing home workers, especially nursing staff. DESIGN: This was a cross-sectional study. METHODS: Workers' compensation claim (WCC) data from 1 year of experience in a long-term care company were used to compute claim rates by body region, nature, and cause of injury, and the costs per case and per full-time-equivalent employee. Data regarding musculoskeletal symptoms, use of patient/resident-lifting equipment, and perceived physical and psychological job demands were obtained from a concurrent cross-sectional survey of workers from 24 long-term care facilities. RESULTS: About 80% of the WCCs were related to musculoskeletal incidents in nursing aides and therapy personnel. WCC costs paid per case for therapy personnel were more than twice those for nursing staff for both ergonomic and resident-handling incidents. Prevalence of low back pain in therapy personnel was the same as in nursing aides (48%) but involved more chronic, milder pain. About half of therapy personnel reported "never" or "rarely" using patient/resident-lifting equipment. Therapy personnel, nursing aides, and housekeeping/dietary/maintenance personnel reported the highest physical job demands. LIMITATIONS: Causal inference cannot be determined due to the cross-sectional nature of the survey data. Study findings are relevant only to therapy work in long-term care settings because exposures vary in other health care settings (hospitals, outpatient, and others). CONCLUSIONS: MSD prevalence and claim costs in therapy personnel are high enough to deserve more attention. The low use of patient/resident-lifting equipment in therapy could increase the risk for MSDs. Future studies with comprehensive ergonomic analysis of therapist tasks and recommendations to reduce injuries are warranted.

Increasing Mobility via In-hospital Ambulation Protocol Delivered by Mobility Technicians: A Pilot Randomized Controlled Trial.

BACKGROUND: Ambulating medical inpatients may improve outcomes, but this practice is often overlooked by nurses who have competing clinical duties. OBJECTIVE: This study aimed to assess the feasibility and effectiveness of dedicated mobility technician-assisted ambulation in older inpatients. DESIGN: This study was a single-blind randomized controlled trial. SETTING: Patients aged ≥60 years and admitted as medical inpatients to a tertiary care center were recruited. INTERVENTION: Patients were randomized into two groups to participate in the ambulation protocol administered by a dedicated mobility technician. Usual care patients were not seen by the mobility technician but were not otherwise restricted in their opportunity to ambulate. MEASUREMENTS: Primary outcomes were length of stay and discharge disposition. Secondary outcomes included change in mobility measured by six-clicks score, daily steps measured by Fitbit, and 30-day readmission. RESULTS: Control (n = 52) and intervention (n = 50) groups were not significantly different at baseline. Of patients randomized to the intervention group, 74% participated at least once. Although the intervention did not affect the primary outcomes, the intervention group took nearly 50% more steps than the control group (P = .04). In the per protocol analysis, the six-clicks score significantly increased (P = .04). Patients achieving ≥400 steps were more likely to go home (71% vs 46%, P = .01). CONCLUSIONS: Attempted ambulation three times daily overseen by a dedicated mobility technician was feasible and increased the number of steps taken. A threshold of 400 steps was predictive of home discharge. Further studies are needed to establish the appropriate step goal and the effect of assisted ambulation on hospital outcomes.

An audit of the utilization of physiotherapy assistants in the musculoskeletal outpatients setting within a primary care physiotherapy service.

BACKGROUND: Physiotherapy assistants account for approximately 20% of the physiotherapy workforce across a community health service in North Staffordshire. Although their job descriptions state that the post is primarily clinical, their role depends heavily on the qualified physiotherapists and how they utilize their clinical skills. METHODS: An audit of the physiotherapy assistants' tasks was carried out to reveal whether the physiotherapy assistants' time spent on clinical tasks complied with their job descriptions. Using the audit improvement cycle, pathway mapping of specific anatomical areas was performed to identify which parts of treatment can be carried out by physiotherapy assistants, clarify the physiotherapy assistants' clinical role and standardize treatments. A competences and training needs analysis was completed and physiotherapy assistants were trained before the pathways were implemented. Finally, the physiotherapy assistants' practice was re-audited and job satisfaction questionnaires were redistributed after the pathways were implemented. RESULTS: The results showed that, following the implementation of the pathways, the amount of working time that physiotherapy assistants spent treating patients increased from 9% to 16%. Their job satisfaction changed from 11% prior to the implementation of the pathways to 100% post-implementation. CONCLUSIONS: Using defined pathways in the treatment of musculoskeletal conditions of the peripheral joints provides the framework to standardize delegation of clinical tasks from qualified physiotherapists to physiotherapy assistants. However, the utilization of such pathways needs to be examined further, to clarify the clinical and cost effectiveness of delegating clinical work to physiotherapy assistants, and also the perceptions of qualified physiotherapists.

Cross-Sectional Examination of Patient and Therapist Factors Affecting Participation in Physical Therapy in Acute Care Hospital Settings.

Background: Research has demonstrated benefits of early and continued physical therapy for patients in acute care hospitals. Despite known benefits, scheduled sessions do not always result in treatment. Reported percentages for nontreatment are 15% to 25%. Understanding when and why nontreatment occurs is fundamental to future interventions to reduce it and provide patients with needed services. Objective: The study objective was to describe nontreatment and the extent to which attributes of the patient, physical therapist, and environment affect its occurrence at a suburban community hospital. Design: This was a cross-sectional study. Methods: Medical records for 1,252 patients who were scheduled for 6,246 physical therapy sessions were reviewed. Therapist demographics were collected via a questionnaire. Results: Therapist sexes were equally represented, and most therapists were nonwhite and worked full time at the hospital. The nontreatment percentage for individual therapists ranged from 5.4% to 23.2%. This percentage was 1.3% for the first scheduled session but nearly 20% for the remaining sessions. In more than 30% of nontreatment events, the specific therapist attempting treatment was not identified. Patients were much less likely to experience nontreatment if they were scheduled for therapy on a Tuesday or if they were in the hospital for a musculoskeletal condition. Sunday had a particularly high percentage of nontreatment. Limitations: The participants were recruited from a single hospital. The specific therapist associated with nontreatment events was not always known. Conclusions: Hospital and rehabilitation department policies and culture for weekend therapy staffing should be evaluated in light of the high percentage of nontreatment on Sunday. The impact of patient diagnosis on nontreatment must be evaluated further and may reflect hospital culture. Future research efforts should be designed to obtain data on the assigned therapist for all instances of nontreatment.