Long-Term Effects and Impressions of Minimal Footwear in Older Adults.

INTRODUCTION: Foot pathologies can lead to difficulty walking and falls in older adults. Intrinsic foot muscles contribute to the structural support and alignment of the foot and provide somatosensory input from the ground. Minimally cushioned footwear may naturally strengthen intrinsic foot muscles and enhance sensory input to the foot; however, these effects are largely unknown in older adults. Further, there is little evidence regarding the prescription of minimal footwear and the perceptions of this footwear by older adults. METHODS: Twenty-four adults age ≥65 volunteered to use minimal footwear for prescribed times during daily activities for 16 weeks. The cross-sectional area (CSA) of 5 intrinsic foot muscles was measured using ultrasound imaging at baseline, 8 weeks, and 16 weeks. Semi-structured interviews were recorded regarding participants' impressions of the footwear, the progressive wear schedule, the footwear's effects on orthopedic-related pain, balance, and foot awareness/sensation. RESULTS: Across the cohort, there was no significant difference in CSA of the 5 muscles after 16 weeks of minimal footwear use. Thirteen participants had clinically meaningful increased CSA of the abductor hallucis muscle (Abh). These positive responders had no significant differences in age, grip strength, foot structure, or fall risk scores compared to participants with little to no CSA change. Interview results indicated a generally positive experience with minimal footwear for 68.1% of the cohort. A large percentage of the cohort reported no difficulty with the progressive wear schedule (77.2%), no aggravation of preexisting conditions and no new pain (77.2%), improved balance (63.6%), and improved foot awareness/sensation (72.7%) with minimal footwear use. The progressive wear schedule was perceived as inconvenient by some in the first few weeks (22.8%), but resulted in mild to no adverse effects when followed as prescribed. CONCLUSION: Sixteen weeks of progressive minimal footwear use in older adults did not lead to changes in intrinsic foot muscle CSA; however, half of the cohort had clinically meaningful increased CSA in the Abh muscle. It is unclear what individual qualities were associated with this positive response. Older adults reported generally positive experiences with minimal footwear with self-reported improvements in balance and foot awareness/sensation. The wear schedule may have been too conservative or not long enough to produce foot muscle hypertrophy, but subjective reports suggest beneficial neuromuscular adaptations and sensory changes occurred. Future research may need a greater length of time and larger samples to further determine the effects of long-term minimal footwear use in older adults.

The persistence of gender and racial disparities in vascular lower extremity amputation: an examination of HCUP-NIS data (2002-2011).

The purpose of this study was to examine trends in racial and gender disparities in the severity of lower extremity amputation among individuals with peripheral artery disease (PAD) over the period of a decade (2002-2011). This is a longitudinal secondary analysis of data from the Healthcare Utilization Project Nationwide Inpatient Survey (HCUP-NIS) for the years 2002-2011. Level of amputation was determined from ICD-9-CM procedure and coded as either transfemoral (TF) or transtibial (TT). The main predictors were gender and race; covariates including age, race, income, insurance status and presence of vascular disease were incorporated as control variables in regression analysis. A total 121,587 cases of non-traumatic dysvascular amputations were identified. Female gender (odds ratio (OR) 1.35; 95% confidence interval (CI) 1.32, 1.39) and black race (OR 1.17; 95% CI 1.12, 1.23) are both significantly associated with increased odds for receiving TF amputation with no change in these odds over the decade of study. Other covariates with significant associations with TF amputation level include increased age (OR 1.03; 95% CI 0.99, 1.09), low income (OR 1.21; 95% CI 1.15, 1.27), Medicaid insurance (OR 1.36; 95% CI 1.29, 1.44), Medicare insurance (OR 1.27; 95% CI 1.21, 1.32), and cerebrovascular disease (OR 2.12; 95% CI 2.03, 2.23). In conclusion, although overall rates of amputation have decreased, disparities in level of amputation related to female gender and black race have not significantly changed over time. Higher-level amputation has significant consequences from a quality-of-life, medical and economic perspective.

No short-term savings in health care expenditures for physically active adults.

OBJECTIVE: The purpose of this study was to investigate the association of physical activity and health care expenditures in a nationally representative sample of non-disabled adults. METHODS: This was a secondary analysis of data from 8843 adults. Physical activity measures were derived from participants in the 2006 and 2007 National Health Interview Survey. Demographic and expenditure variables came from the Medical Expenditure Panel Survey data files for panels 12 (2007-2008) and 13 (2008-2009). Multivariable regression models were used to determine the association between levels of physical activity participation and total health care expenditures, drug expenditures, and out-of-pocket health care expenditures. RESULTS: Unadjusted data revealed lower health care expenditures among those whose activity level met the CDC guidelines with greater savings apparent among those who exercised above recommended guidelines. However, in the models that adjusted for age, sex, race, income and health status these differences disappeared. CONCLUSION: In the short-term, the amount of physical activity undertaken by an adult may have little effect on the expenditures for health services, drugs and the money expended directly out-of-pocket. However, given the benefits of physical activity in terms of chronic disease prevention there are very likely long-term expenditure savings to be had.

National Benchmarks to Understand How Doctor of Physical Therapy Learners From Minoritized Race and Ethnicity Groups Perceive Their Physical Therapist Education Program.

OBJECTIVE: The demographic homogeneity of the physical therapist workforce and its educational pathway may undermine the profession's potential to improve the health of society. Building academic environments that support the development of all learners is fundamental to building a workforce to meet societal health care needs. The Benchmarking in Physical Therapy Education study uses the Physical Therapy Graduation Questionnaire to comprehensively assess learner perceptions of the physical therapist academic environment. The present report examined whether racial and ethnic minoritized (REM) physical therapist learners perceive their doctor of physical therapy education differently from their non-REM peers. METHODS: Five thousand and eighty graduating doctor of physical therapy learners in 89 institutions provided demographic data and perceptions of a range of learning environment domains. Analyses included REM versus non-REM comparisons as well as comparisons among individual race and ethnicity groups. RESULTS: Compared with their non-minoritized peers, REM respondents expressed less satisfaction with their education and lower confidence in their preparedness for entry-level practice. REM respondents observed more faculty professionalism disconnects and demonstrated less agreement that their program had fostered their overall psychological well-being. REM respondents experienced higher rates of mistreatment than their peers and reported higher rates of exhaustion and disengagement, the 2 axes of academic burnout. Black/African American and Hispanic/Latino/a/x (Hispanic, Latino, Latina, and/or Latinx) respondents incurred significantly more educational debt than Asian and White respondents. REM respondents reported greater empathy and greater interest in working in underserved communities. CONCLUSION: REM respondents perceived the physical therapist learning environment more negatively than their non-minoritized peers but expressed strong interest in serving people from underserved communities. These national benchmarks offer academic institutions the opportunity to self-assess their own environment and to work to improve the quality of the educational experience for all learners. IMPACT: In a nationwide benchmarking study, learners from minoritized race and ethnicity backgrounds reported more negative experiences and outcomes during physical therapist education than their non-minoritized peers. These same learners demonstrated high empathy and interest in serving people from underserved (under-resourced) communities. Learning environments that permit all individuals to thrive may be an essential avenue to improve the health of a rapidly diversifying society.

Building a Foundation for Health Informatics Content in Physical Therapy Education Through Concept Analysis and Concept Mapping.

INTRODUCTION: Health informatics curricular content, while beneficial to the spectrum of education in physical therapy, is currently only required in physical therapist education programs, and even there, it is only crudely defined. The purpose of our study was to use the techniques of concept analysis and concept mapping to provide an outline of informatics content that can be the foundation for curriculum development and the construction of informatics competencies for physical therapy. REVIEW OF LITERATURE: There is no established consensus on the definition of health informatics. Medical and nursing informatics literature that clarifies and agrees on the attributes of health informatics is insufficient for curriculum development. Concept analysis is an approach commonly used in nursing and other health professions to analyze and deconstruct a term, in this case, health informatics, in order to provide clarity on its meaning. SUBJECTS: A total of 73 definitions of health informatics were extracted from articles that met search criteria. METHODS: We used an 8-step methodology from the literature for concept analysis, which included 1) selecting a concept; 2) determining the aims of the analysis; 3) identifying uses of the concept; 4) determining the defining attributes of the concept; 5) identifying a model case; 6) identifying related and illegitimate cases; 7) identifying antecedents and consequences; and 8) defining empirical referents. In addition, concept mapping was used to develop a visual representation of the thematic attributes and the elements that make them up. RESULTS: We provide a visual map of the concept we now term "informatics in human health and health care" and clarify its attributes of data, disciplinary lens, multidisciplinary science, technology, and application. We also provide clarification through the presentation of a model case and a contrary case. DISCUSSION AND CONCLUSION: Concept analysis and mapping of informatics in human health and health care provided clarity on content that should be addressed across the continuum of physical therapy education. The next steps from this work will be to develop competencies for all levels of physical therapy education.

Mind the Gap: An Analysis of Physical Therapist Earnings in the United States by Male/Female Sex.

OBJECTIVE: Earnings discrepancies between male and female health and medical professionals are well documented. The purpose of this study was to examine the distribution of physical therapist earnings using a quartile regression approach to determine the nature of the gender-based differences in earnings between male and female physical therapists in the United States, with "gender" as defined by the dataset as being male or female. METHODS: This observational study used data from the 2014 to 2018 American Community Survey 5-year public use microdata file. The file contained 12,123 physical therapist cases weighted to an estimate of the physical therapist active workforce of 238,221 (95% CI = 232,587 to 243,855). To analyze the influence of gender on earnings, a multivariable quantile regression approach was used in which physical therapist earnings were the dependent variable and the variables representing the geographic distribution, social characteristics, and employment characteristics were the independent variables. RESULTS: In 2018 dollars, the average annual earnings of a physical therapist were $73,444.98 (95% CI = $72,498.19 to $74,391.11), with a median value of $71,735.09. Differences in male and female earnings were evident in both the unadjusted bivariable and in the adjusted values produced by the quartile regression. The ratios of female-to-male earnings at each quartile were 0.89, 0.90, and 0.89. When age of the earner is accounted for, male physical therapists earned more than female therapists in both the 30-to-54-year age group and the ≥55-year age group. In the youngest age group of earners under 30 years of age, the differences were substantially smaller. CONCLUSIONS: Gender differences in income persist across the distribution of earnings, resulting in female physical therapists earning approximately 10% less than their male counterparts. The differences are most distinct as physical therapists advance in their careers. IMPACT: The etiology of the earnings gap is unknown, but gender equity has not been achieved yet for physical therapy.

Responding to stakeholder needs to engage rehabilitation professionals in the delivery of evidence-based health programming for adults with osteoarthritis.

Although there are many evidence-based programs that promote healthy lifestyles and symptom modification for people with osteoarthritis, their delivery in rehabilitation clinical settings in the United States is limited. These programs can be a primary component of treatment or a discharge option to facilitate long-term mobility and pain management. The purpose of this perspective article is to describe a delivery model that brings one arthritis-appropriate, evidence-based intervention, the Arthritis Foundation's Walk With Ease program, to older adults seeking physical therapy related to their osteoarthritis. We embedded program delivery into a Doctor of Physical Therapy curriculum using a student health coaching approach and partnering with physical therapy clinics and other community agencies for participant referrals. This model of delivery is cost-effective, sustainable, and provides outcomes that meet goals of the national agenda for osteoarthritis. The model provides benefits for students in health professions education programs, community organizations and rehabilitation clinics, and adults living with osteoarthritis.

Sex disparities in level of amputation.

OBJECTIVE: To determine whether there is a sex-related disparity in the management of lower-extremity ischemia by evaluating the relationship between sex and level of nontraumatic amputation. DESIGN: This is a retrospective secondary analysis of community hospital data from the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample for 2007. Level of amputation was determined from International Classification of Diseases-9th Revision-Clinical Modifications procedure and coded as either transfemoral or transtibial. The main predictor was sex; covariates including age, race, income, insurance status, and presence of vascular disease were incorporated as control variables in regression analysis. SETTING: Nonfederal, short-term U.S. community hospitals. PARTICIPANTS: Persons discharged from hospitals with a nontraumatic transtibial or transfemoral amputation (N=11,114). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Level of limb loss. RESULTS: A significant association was found between female sex and transfemoral amputation in both the bivariable (χ²=187.0; P<.000) and multivariable analysis (odds ratio [OR]=1.4; 95% confidence interval [CI]=1.3-1.5). Other covariates significant for influencing level of amputation during multivariable analysis include age, with highest age greater than 78 years at highest risk (OR=3.0; 95% CI, 2.6-3.5); 0-25% quartile of income or annual income less than $36,000 (OR=1.3; 95% CI, 1.1-1.5); Medicare insurance (OR=1.4; 95% CI, 1.1-1.6); Medicaid insurance (OR=1.3; 95% CI, 1.3-1.6); and cerebrovascular disease (OR=2.0; 95% CI, 1.7-2.4). CONCLUSIONS: Female sex is significantly associated with transfemoral amputation compared with male sex. Transfemoral amputation has significant consequences, and further evaluation of preventative care and screening for women with vascular disease should be considered.

Developing core education principles for rehabilitation professionals in response to the opioid crisis: an example from physical therapy education.

PURPOSE: We describe how educators in one state developed a set of core principles for the education of Doctor of Physical Therapy students in response to the opioid crisis, and we present these principles as a model for educators globally. METHODS: In Massachusetts, a working group from the physical therapy program directors developed a model for opioid education based on a review of the literature, of curricula and of the accreditation standards. RESULTS: The "Core Principles for the Education of Physical Therapy Professionals in the Context of the U.S. Opioid Emergency" provide a model that recognizes the profession's role in care and prevention; a role that engages the profession with patients who have painful conditions and are at risk for substance and/or opioid misuse, patients who have painful conditions and opioid use disorder, and patients who have opioid use disorder as a primary diagnosis. The principles ensure that graduates have the skills and knowledge to provide care that minimizes the social stigma and biases that individuals with opioid use disorder may face. DISCUSSION: The Core Principles provide a roadmap for educational programs. Health professions educators can assume a role of leadership in the opioid crisis and ensure that students and clinical instructors are prepared for care provision and advocacy.IMPLICATIONS FOR REHABILITATIONIn light of the opioid crisis, students in the rehabilitation professions should have education targeted specifically to opioid use and opioid use disorder that incorporates pharmacology, pain science, behavioral and socio-political perspectives.The Core Education Principles document posits that physical therapy education around opioid use should focus on three patient populations, people who have painful conditions and are at risk for substance and/or opioid misuse, people who have painful conditions and opioid use disorder, and people who have opioid use disorder as a primary diagnosis.Within each of the patient populations there are curricular implications in terms of teaching about screening and prevention, movement system interventions, and interprofessional care activities.

The physical therapist informatician as an enabler of capacity in a data-driven environment: an administrative case report.

Background and purpose: Many professions including nursing and medicine have developed subspecialties in the field of clinical informatics to assist in the management of patient outcomes. This report describes the development of a physical therapist-informatician (PT-I) that occurred concurrently with the introduction of an electronic health record (EHR). Case description: A physical therapist supervisor participated in professional development to become a full-time PT-I within the Department of Physical Medicine and Rehabilitation (DPMR) of an academic medical center. Cycles of needs assessment and gap analysis produced a nimble process that evolved to meet a shifting environment and to incorporate lessons learned. Outcomes: The development of a full-time PT-I enabled the DPMR to become the stewards of mobility data across the enterprise. The benefits that accrued, as a result, included enhanced success of EHR adoption, decreased revenue loss, and actionable, meaningful data use. Discussion: Having a PT-I facilitate the adoption of informatics into DPMR culture enabled participation in enterprise-level EHR optimization. Standardized data from the EHR was used to improve the performance of clinicians throughout the hospital. The field of physical therapy could benefit from a targeted use of informatics to articulate the EHR workflow and data needs.

Demographic determinants of participation in strength training activities among U.S. adults.

This study used a health services approach to examine the demographic correlates of participation in strength training activities among U.S. adults. The purpose of this study was to develop a profile of adults who participate in strength training activities and analyze the demographic factors that predict strength training participation. The study was a secondary data analysis employing a nonexperimental correlational design. Subjects for the study were derived from the data source, the 2003 National Health Interview Survey, a multistage probability survey that produced a U.S. representative sample of 29,783 adults capable of participating in strength training. The prevalence of strength training participation among adults was calculated, and a logistic regression equation was used to develop a multivariate model of factors that influence participation. Twenty-one percent of adults participated in strength training activities on at least 2 days of the week. In the regression, participation was associated with age, sex, ethnicity, marital status, level of education, and census region. The likelihood of participating in regular strength training activities was lower among older adults and women but higher with increasing levels of education and with participation in other aerobic type exercise. Strength training professionals should employ public health methodologies to promote continuation of this type of activity among those who were shown to participate regularly and to improve participation among those subgroups with lower levels of activity.

Application of a contextual instructional framework in a continuing professional development training program for physiotherapists in Rwanda.

BACKGROUND: Continuing professional development is an important component of capacity building in low resource countries. The purpose of this case study is to describe the use of a contextual instructional framework to guide the processes and instructional design choices for a series of continuing professional development courses for physiotherapists in Rwanda. METHODS: Four phases of the project are described: (1) program proposal, needs assessment and planning, (2) organization of the program and instructional design, (3) instructional delivery and (4) evaluation. Contextual facilitating factors and needs informed choices in each phase. OUTCOMES: The model resulted in delivery of continuing professional development to the majority of physiotherapists in Rwanda (n = 168, 0.48 rural/0.52 urban) with participants reporting improvement in skills and perceived benefit for their patients. Environmental and healthcare system factors resulted in offering the courses in rural and urban areas. Content was developed and delivered in partnership with Rwandan coinstructors. Based on the domestic needs identified in early courses, the program included advocacy and leadership activities, in addition to practical and clinical instruction. CONCLUSIONS: The contextual factors (environment, healthcare service organization, need for rehabilitation and status and history of the physiotherapy profession) were essential for project and instructional choices. Facilitating factors included the established professional degree and association, continuing professional development requirements, a core group of active professionals and an existing foundation from other projects. The processes and contextual considerations may be useful in countries with established professional-level education but without established postentry-level training. Implications for Rehabilitation Organizations planning continuing professional development programs may benefit from considering the context surrounding training when planning, designing and developing instruction. The surrounding context including the environment, the organization of healthcare services, the population defined need for rehabilitation, and the domestic status and history of the physiotherapy profession, is important for physiotherapy projects in countries with lower resources. Facilitating factors in low resource countries such as an established professional degree and association, continuing professional development requirements, a core group of active professionals and an existing foundation from other projects impact the success of projects. Methods that may be useful for relevance, dissemination and consistency include involvement of in-country leaders and instructors and attendance in multiple courses with consistent themes. Rehabilitation professionals in low resource countries may benefit from continuing professional development courses that emphasize practical skills, and clinical reasoning, accompanied by clinical mentoring and directed coaching that encourages knowledge transfer to the clinical setting. Active learning approaches and multiple progressive courses provide opportunities to develop peer support through professional communities of practice.

Leadership Development of Rehabilitation Professionals in a Low-Resource Country: A Transformational Leadership, Project-Based Model.

BACKGROUND AND RATIONALE: This paper presents an overview of the activities and outcomes of the Leadership Institute (LI), a short-term leadership development professional development course offered to physiotherapists in a low-resource country. Previous studies have provided examples of the benefits of such programs in medicine and nursing, but this has yet to be documented in the rehabilitation literature. The prototype of leadership development presented may provide guidance for similar trainings in other low-resource countries and offer the rehabilitation community an opportunity to build on the model to construct a research agenda around rehabilitation leadership development. PEDAGOGY: The course used a constructivist approach to integrate participants' experiences, background, beliefs, and prior knowledge into the content. Transformational leadership development theory was emphasized with the generation of active learning projects, a key component of the training. OUTCOMES: Positive changes after the course included an increase in the number of community outreach activities completed by participants and increased involvement with their professional organization. Thirteen leadership projects were proposed and presented. DISCUSSION: The LI provided present and future leaders throughout Rwanda with exposure to transformative leadership concepts and offered them the opportunity to work together on projects that enhanced their profession and met the needs of underserved communities. CONSTRAINTS AND CHALLENGES: Challenges included limited funding for physiotherapy positions allocated to hospitals in Rwanda, particularly in the rural areas. Participants experienced difficulties in carrying out leadership projects without additional funding to support them. LESSONS LEARNED: While the emphasis on group projects to foster local advocacy and community education is highly recommended, the projects would benefit from a strong long-term mentorship program and further budgeting considerations. CONCLUSION: The LI can serve as a model to develop leadership skills and spur professional growth in low-resource settings. Leadership development is necessary to address worldwide inequities in health care. The LI model presents a method to cultivate transformational leadership and work toward improvements in health care and delivery of service.

Reported characteristics of participants in physical therapy-related clinical trials.

BACKGROUND: The inclusion of sociodemographic and anthropometric variables in published clinical trials enables physical therapists to determine the applicability of trial results to patients in their clinics. OBJECTIVE: The aim of this study was to examine the reporting of participant sociodemographic and anthropometric characteristics in published physical therapy-related clinical trials. DESIGN: This was a retrospective review of clinical trials from 2 samples drawn from literature applicable to physical therapy. METHODS: Two reviewers independently extracted data from a random sample of 152 clinical trials from the Physiotherapy Evidence Database (PEDro) and a purposive sample of 85 clinical trials published in the journal Physical Therapy (PTJ). A database containing the occurrence of sociodemographic (age, sex, race/ethnicity, level of education, marital status) and anthropometric variables (height, weight, body mass index) in each article was created to generate descriptive statistics about both samples. RESULTS: Among the sociodemographic variables, at least 90% of articles reported the sex and age of trial participants. Additional sociodemographic characteristics that were reported in 20% to 26% of articles were participant level of education and participant race/ethnicity. The reporting of anthropometric data differed between the 2 samples, with body mass index being most commonly reported in the PEDro sample (48.0%) and weight being most commonly reported in the PTJ sample (38.8%). LIMITATIONS: Articles reviewed were limited by year of publication (from 2008 to 2012 for PTJ articles and 2010 for clinical trials from PEDro) and to English-language-only literature. CONCLUSIONS: The physical therapy literature would benefit from enhanced reporting requirements for both sociodemographic and anthropometric data about participants.

Out-of-Pocket Spending for Ambulatory Physical Therapy Services From 2008 to 2012: National Panel Survey.

BACKGROUND: Out-of-pocket (OOP) expenditures are incurred as insurers and employers shift some of the burden of health care costs onto consumers. As cost-sharing increases, OOP expenditures could be a barrier to physical therapy care. OBJECTIVE: The purposes of this study were: (1) to identify factors associated with any OOP physical therapy spending and (2) to identify factors associated with higher spending among individuals incurring OOP costs. DESIGN: The study was a retrospective analysis using the 4 most recently available panels of data from the Medical Expenditure Panel Survey (MEPS) encompassing 2008-2012. METHODS: A data file containing episodes of physical therapy care for 2,189 people was created. Logistic regression was used to identify factors related to having an OOP expenditure. A multivariable generalized linear model was used to identify factors related to mean OOP expenditures. RESULTS: On average, an episode of care encompassed 9.9 visits, with mean total expenditures of $1,708 (median: $792). Fifty-four percent of episodes of care had an OOP expenditure. For individuals with OOP expenditures, the mean OOP expenditure for an episode of care was $351 (median: $144). Being female or non-Hispanic and having a higher income were associated with higher odds of incurring an OOP expenditure, whereas being in worse general health, >65 years of age, or nonwhite and having public funding were associated with lower odds of incurring an OOP expenditure. Amounts of OOP spending were higher in urban areas and in all census geographic regions relative to the Northeast region. LIMITATIONS: Estimates are based on household-reported survey data, limited to ambulatory care, and do not include institutionalized individuals. CONCLUSIONS: At 54%, the proportion of individuals with OOP expenditures for physical therapy is lower than for general medical care. Several predictors were found of having OOP expenditures and of the magnitude of those expenditures.

Factors associated with care seeking from physicians, physical therapists, or chiropractors by persons with spinal pain: a population-based study.

STUDY DESIGN: Secondary analysis of longitudinal population-based survey data. OBJECTIVES: To investigate factors associated with care seeking for physician-referred physical therapy (MD/PT), as compared to physician-only (MD) or chiropractic-only (DC) care for spinal pain. BACKGROUND: Although a large proportion of ambulatory physical therapy visits are related to spinal pain, physical therapists are not the most commonly seen provider. The majority of visits are to physicians, followed by chiropractors. We attempted to understand more about this disparity by examining social and demographic factors that differentiate between persons who see these providers. METHODS: Episodes of care were constructed from participants in 2 panels from the Medical Expenditure Panel Survey who had spinal pain. The provider of care was identified for each episode, and logistic regression was used to determine factors associated with MD/PT use compared to MD use, and MD/PT use compared to DC use. RESULTS: The majority of patients (61%) received MD care for spinal pain, followed by those who received DC (28%) and MD/PT (11%) care. Female sex, higher levels of education, and higher income were significantly associated with MD/PT care over MD care. Increased age, female sex, lower self-health rating, and presence of at least 1 disability day were all significantly associated with MD/PT care over DC care. CONCLUSION: Sociodemographic and clinical factors are associated with those who get MD/PT care as compared to MD or DC care. We found evidence of an access disparity for physical therapy and identified population characteristics that both increase and reduce the likelihood of physical therapy service use.

The gender gap in peer-reviewed publications by physical therapy faculty members: a productivity puzzle.

BACKGROUND: Studies of peer-reviewed article publication by faculty in higher education show men publish more than women. Part of the difference in publishing appears to be attributable directly to gender. Gender differences in publishing productivity have not been explored in physical therapy. OBJECTIVE: The purpose of this study was to explore effects of gender on peer-reviewed publication productivity in physical therapy. DESIGN: This was a cross-sectional study using survey methods. METHODS: A survey was administered to a random sample of 881 physical therapy faculty members; 459 responses were used for analysis. RESULTS: Men were more likely than women to be married, have children, hold a PhD degree, be tenured or on a tenure track, and hold the position of department chair. There was a significant difference in peer-reviewed publication rates between male and female respondents. Negative binomial regression models revealed that female gender was a negative predictor of peer-reviewed publication, accounting for between 0.51 and 0.58 fewer articles per year for women than for men over the course of a career. Reasons for the gender differences are not clear. LIMITATIONS: Factors such as grant funding, laboratory resources, nature of collaborative relationships, values for different elements of the teaching/research/service triad, and ability to negotiate the academic culture were not captured by our model. CONCLUSIONS: The gender gap in peer-reviewed publishing productivity may have implications for individuals and the profession of physical therapy and should be subject to further exploration.

Determinants of utilization and expenditures for episodes of ambulatory physical therapy among adults.

BACKGROUND: Comprehensive information on determinants and patterns of use and spending for ambulatory physical therapy services is needed to inform health planning and policy decisions. Most research in the literature on this topic is limited to specific payers, age groups, and conditions. OBJECTIVE: The purpose of this study was to examine factors associated with the resource intensity of physical therapy episodes for adults in the United States as measured by number of visits and expenses per visit. DESIGN: This study was a secondary analysis of longitudinal survey data from the Medical Expenditure Panel Survey (MEPS) panels 9, 10, and 11. METHODS: An analytic file was created based on data from the longitudinal data files for 3 MEPS panels and the annual office-based and hospital outpatient event files. A total of 1,377 episodes of physical therapy care were identified. Variation in both the total number of visits per episode and expenses per visit was examined by fitting regression models to evaluate the effects of selected independent variables classified into 4 categories: episode-level variables, demographic characteristics, geographic variables, and health status indicators. RESULTS: Average total expenses per episode (in 2007 dollars) were $1,184 (median=$651), with an average number of visits per episode of 9.6 (median=6.0) and average expenses per visit of $130 (median=$95). Significant variation by geographic characteristics, sex, and one comorbid condition (high blood pressure) was found in the number of visits model. In the expenditures model, expenses per visit were associated with age/insurance coverage, setting (hospital outpatient versus office based), primary condition category, and mental health status. Limitations Limitations include limited sample sizes of physical therapy users and lack of detailed clinical information. CONCLUSIONS: Variability in the resource intensity of physical therapy episodes is influenced to some degree by nonclinical variables.

Do as I do: exercise habits of physical therapists, physical therapist assistants, and student physical therapists.

BACKGROUND: Physical therapy practitioners are among the many health care professionals who can counsel their patients to address the public health care concern of physical inactivity. Health care providers who are physically active themselves are more likely to counsel patients on the benefits of activity. OBJECTIVE: The purposes of this study were: (1) to examine the leisure-time physical activity habits of physical therapists, physical therapist assistants, and student physical therapists in the United States using Centers for Disease Control and Prevention and American College of Sports Medicine (CDC-ACSM) recommendations and (2) to compare these habits with those of the general population and other health care professionals. DESIGN: A cross-sectional survey design was used. METHODS: There were 2 data sources. A random sample of American Physical Therapy Association members completed an online survey that included questions about physical activity habits worded in same manner as the leisure-time activities section of the 2005 National Health Interview Survey (NHIS). The final study sample comprised 1,238 participants: 923 physical therapists, 210 student physical therapists, and 105 physical therapist assistants. The 2005 NHIS public use data files were the source for the same information about the general US population and for a subset of health care professionals. Rates of participation in vigorous and moderate physical activity were analyzed. RESULTS: Physical therapists, physical therapist assistants, and student physical therapists exercised at higher rates than adults and health-diagnosing professionals in the 2005 NHIS. Limitations The study may be limited by sampling and response bias. CONCLUSIONS: This study identified that physical therapists, physical therapist assistants, and student physical therapists are meeting CDC-ACSM physical activity guidelines at higher rates than the US adult population and health-diagnosing professionals. These rates exceed the physical activity targets set for adults in Healthy People 2010.