Clinical Reasoning Readiness and Confidence of DPT Students with PT Interventions Using Telehealth

Telehealth service-delivery content has an emerging footprint on entry-level physical therapy programs. This study evaluated clinical reasoning readiness and confidence in third-year DPT students during clinical experiences with and without telehealth. Students’ clinical reasoning readiness and confidence were determined using the Physical Therapist Self-Efficacy (PTSE) score, self-confidence rating treating patients, and final APTA Clinical Performance Instrument (CPI) clinical reasoning and summative ratings. DPT students providing PT interventions using telehealth reported lower clinical reasoning self-efficacy (PTSE) when compared to traditional service-delivery. Confidence treating using telehealth was greater at the initial visit compared to subsequent visits, suggesting a lack of student readiness for providing subsequent telehealth visits. Final CPI ratings did not differ between DPT students with and without telehealth

Doctor of Physical Therapy students’ clinical reasoning readiness and confidence treating with telehealth: a United States survey

Purpose: Telehealth has an emerging footprint on entry-level physical therapy programs. Students’ readiness for clinical reasoning with virtual versus traditional face-to-face treatment remains unknown. The purpose of this study was to evaluate Doctor of Physical Therapy (DPT) students’ preparedness for clinical experiences with and without telehealth. Methods: A descriptive and exploratory cross-sectional survey was employed, with a voluntary convenience sample of 211 second- and third-year university DPT students during Fall 2020 clinical experiences. Descriptive and inferential statistics evaluated differences in DPT students’ (1) Physical Therapist Self-Efficacy (PTSE) scale scores, (2) confidence with treating initial and subsequent same-patient visits, and (3) final Clinical Performance Instrument (CPI) clinical reasoning and summative scores during clinical experiences with and without telehealth. Results: Telehealth availability was 40.3%, with 16.6% of DPT students reporting participation. Most students reported being comfortable (39.3%) or neutral (32.2%) using telehealth. DPT students’ confidence level using telehealth to treat was 74% on initial and 97% on subsequent same-patient visits. Mean PTSE scores were significantly lower during clinical experiences with telehealth (13.1) compared to traditional experiences (15.1) (PP Conclusion: While entry-level DPT programs continue to establish best practice for telehealth education, current trends in academic curriculum seem to prepare students’ clinical reasoning readiness for clinical experiences. The PTSE could be used to identify outlier students requiring additional mentoring during traditional and telehealth clinical experiences

Ethnicity Does Not Impact Physical Therapy Students’ Clinical Readiness and Performance, a United States Exploratory Study

Purpose: To explore the impact of ethnicity on clinical readiness and performance among Doctor of Physical Therapy (DPT) students, as determined by 1) Physical Therapist Self-Efficacy (PTSE) score, 2) self-confidence treating patients, and 3) final American Physical Therapy Association (APTA) Clinical Performance Instrument (CPI) clinical reasoning and summative ratings during clinical experiences. Methods: This study is a survey-based, descriptive, and exploratory cross-sectional research design involving sample of 211 DPT students evaluated for differences across ethnic students’ groups 1) PTSE score during student clinical experiences, 2) confidence with treating initial and subsequent same-patient visits, and 3) final CPI clinical reasoning and summative scores during clinical experiences. Results: Kruskal-Wallis test showed no difference across ethnic groups (American Indian or Alaskan Native, Asian/Pacific Islander, Black or African American, Hispanic, White or Caucasian, prefer not to answer, and multiple ethnicity) in 1) clinical reasoning self-efficacy (PTSE), n=211, p=.438; 2) confidence treating at initial visit n=211, p=.088 and subsequent patient visits n=211, p=.584; and 3) clinical performance on the CPI for clinical reasoning n=211, p=.273 and summative n=211, p=.189 scores. Conclusions and Recommendations: All ethnic groups demonstrated strong clinical readiness and performance during each clinical experience level. Ethnic groups did not differ on clinical reasoning self-efficacy or confidence treating patients. Although the gap appears to be closing, there continues to be underrepresentation of ethnic groups in DPT programs. We recommend investigating factors impacting underrepresentation of ethnic groups in DPT academic programs to explore initiatives to close the diversity gap and best match societal representation

The Immediate Effects of Foam Rolling and Stretching on Iliotibial Band Stiffness:A Randomized Controlled Trial

BackgroundIliotibial Band Syndrome (ITBS) is a common clinical condition likely caused by abnormal compressive forces to the iliotibial band (ITB). Stretching interventions are common in ITBS treatment and may predominantly affect tensor fascia latae (TFL). Another ITBS treatment is foam rolling, which may more directly affect the ITB. Shear wave ultrasound elastography (SWUE) measures real-time soft tissue stiffness, allowing tissue changes to be measured and compared.PurposeTo examine effects of foam rolling and iliotibial complex stretching on ITB stiffness at 0 degrees and 10 degrees of hip adduction and hip adduction passive range of motion (PROM).Study DesignRandomized controlled trial.MethodsData from 11 males (age = 30.5 +/- 9.0 years, Body Mass Index (BMI) = 27.8 +/- 4.0) and 19 females (age = 23.5 +/- 4.9, BMI = 23.2 +/- 2.1) were analyzed for this study. Subjects were randomly assigned to one of three groups: control, stretching, and foam rolling. Shear wave ultrasound elastography measurements included ITB Young's modulus at the mid-thigh, the distal femur and the TFL muscle belly. ITB-to-femur depth was measured at mid-thigh level. Hip adduction PROM was measured from digital images taken during the movement.ResultsNo significant interactions or main effects were found for group or time differences in ITB Young's modulus at the three measured locations. The ITB stiffness at the mid-thigh and distal femur increased with 10 degrees adduction, but TFL stiffness did not increase. A main effect for adduction PROM was observed, where PROM increased 0.8 degrees post-treatment (p = 0.02).ConclusionA single episode of stretching and foam rolling does not affect short-term ITB stiffness. The lack of ITB stiffness changes may be from an inadequate intervention stimulus or indicate that the interventions have no impact on ITB stiffness.</p

Glenohumeral joint capsular tissue tension loading correlates moderately with shear wave elastography: a cadaveric investigation

Purpose The purpose of this study was to investigate changes in the mechanical properties of capsular tissue using shear wave elastography (SWE) and a durometer under various tensile loads, and to explore the reliability and correlation of SWE and durometer measurements to evaluate whether SWE technology could be used to assess tissue changes during capsule tensile loading. Methods The inferior glenohumeral joint capsule was harvested from 10 fresh human cadaveric specimens. Tensile loading was applied to the capsular tissue using 1-, 3-, 5-, and 8-kg weights. Blinded investigators measured tissue stiffness and hardness during loading using SWE and a durometer, respectively. Intraobserver reliability was established for SWE and durometer measurements using intraclass correlation coefficients (ICCs). The Pearson product-moment correlation was used to assess the associations between SWE and durometer measurements. Results The ICC3,5 for durometer measurements was 0.90 (95% confidence interval [CI], 0.79 to 0.96; P<0.001) and 0.95 (95% CI, 0.88 to 0.98; P<0.001) for SWE measurements. The Pearson correlation coefficient values for 1-, 3-, and 5-kg weights were 0.56 (P=0.095), 0.36 (P=0.313), and -0.56 (P=0.089), respectively. When the 1- and 3-kg weights were combined, the ICC3,5 was 0.72 (P<0.001), and it was 0.62 (P<0.001) when the 1-, 3-, and 5-kg weights were combined. The 8-kg measurements were severely limited due to SWE measurement saturation of the tissue samples. Conclusion This study suggests that SWE is reliable for measuring capsular tissue stiffness changes in vitro at lower loads (1 and 3 kg) and provides a baseline for the non-invasive evaluation of effects of joint loading and mobilization on capsular tissues in vivo

Training volume and previous injury as associated factors for running-related injuries by race distance: A cross-sectional study

Objective: This study aims to determine the relationship between weekly pre-competition running volume and the presence of running-related injuries (RRIs) by race distance. Methods: An online questionnaire was sent to 25,000 participants, 14 days following the running event. The questionnaire included the presence and topography of RRIs, previous injury in the last 12 months, running experience, training, and sociodemographic characteristics. Univariate and multivariable binomial regression was used to analyse the crude and adjusted relationship of RRI and training volumes. Results: 4380 surveys were analysed (10km, n=1316; 21km, n= 2168; 42km, n=896). The median age was 36 years. Previous injury was reported by 51.8% of the respondents. Median training volume in the previous month was 15 km/week (IQR 6-24), 30 km/week (IQR 15-40) and 45 km/week (IQR 30-60), for the 10km, 21km, and 42km distances, respectively. During the race, 14.1% reported a RRI, with 43.1% located at the knee. The multivariable analysis showed previous injury and distance as the main associated factors, whereas weekly training volume, age, and previous participation were protective. Conclusion: Race is an inciting event for developing a RRI. Running race distance is an important factor itself and should be incorporated with other modifiable risk factors in current injury models

Doctor of Physical Therapy students’ clinical reasoning readiness and confidence treating with telehealth: a United States survey

Purpose: Telehealth has an emerging footprint on entry-level physical therapy programs. Students’ readiness for clinical reasoning with virtual versus traditional face-to-face treatment remains unknown. The purpose of this study was to evaluate Doctor of Physical Therapy (DPT) students’ preparedness for clinical experiences with and without telehealth. Methods: A descriptive and exploratory cross-sectional survey was employed, with a voluntary convenience sample of 211 second- and third-year university DPT students during Fall 2020 clinical experiences. Descriptive and inferential statistics evaluated differences in DPT students’ (1) Physical Therapist Self-Efficacy (PTSE) scale scores, (2) confidence with treating initial and subsequent same-patient visits, and (3) final Clinical Performance Instrument (CPI) clinical reasoning and summative scores during clinical experiences with and without telehealth. Results: Telehealth availability was 40.3%, with 16.6% of DPT students reporting participation. Most students reported being comfortable (39.3%) or neutral (32.2%) using telehealth. DPT students’ confidence level using telehealth to treat was 74% on initial and 97% on subsequent same-patient visits. Mean PTSE scores were significantly lower during clinical experiences with telehealth (13.1) compared to traditional experiences (15.1) (P <.001) and for integrated (second-year) (14.1) compared to terminal (third-year) clinical experiences (15.5) (P <.001). For traditional experiences, weak positive associations were demonstrated between PTSE and CPI scores. There were no significant differences for CPI scores between telehealth and traditional experiences. Conclusion: While entry-level DPT programs continue to establish best practice for telehealth education, current trends in academic curriculum seem to prepare students’ clinical reasoning readiness for clinical experiences. The PTSE could be used to identify outlier students requiring additional mentoring during traditional and telehealth clinical experiences

The Effect of Volitional Preemptive Abdominal Contraction on Biomechanical Measures During A Front Versus Back Loaded Barbell Squat

# Background Weightlifting is growing in popularity among recreational and competitive athletes. The barbell back squat (BackS) is commonly included in these training programs, while the barbell front squat (FrontS) is commonly performed as a component of other lifts such as the power clean or clean and jerk, it is less commonly practiced in isolation. # Hypothesis/Purpose The purpose of this study was to examine the effects of VPAC performance on trunk muscle and LE biomechanical responses during loaded BackS versus FrontS in healthy subjects. # Study Design Controlled Laboratory Study # Methods Healthy male subjects with the ability to perform a sub-maximal loaded barbell squat lift were recruited. Subjects completed informed consent, demographic/medical history questionnaires and an instructional video. Subjects practiced VPAC and received feedback. Surface electromyography (sEMG) electrodes and kinematic markers were applied. Muscles included were the internal oblique (IO), external oblique (EO), rectus abdominis, iliocostalis lumborum (ICL), superficial multifidi, rectus femoris, vastus lateralis, biceps femoris, and gluteus maximus. Maximal voluntary isometric contractions established reference sEMG values. A squat one-rep-max (1RM) was predicted by researchers using a three to five repetition maximum (3RM, 5RM) load protocol. Subjects performed BackS trials at 75% 1RM while FrontS trials were performed at 75% BackS weight, both with and without VPAC. Subjects performed three repetitions of each condition with feet positioned on two adjacent force plates. Significant interactions and main effects were tested using a 2(VPAC strategy) x 2(squat variation) and 2(VPAC strategy) x 2(direction) within-subject repeated measures ANOVAs. Tukey's Post-Hoc tests identified the location of significant differences. # Results Trunk muscle activity was significantly higher during FrontS versus BackS regardless of VPAC condition. (IO: p=0.018, EO: p\<0.001, ICL: p\<0.001) VPAC increased performance time for both squat variations (p=.0011), which may be associated with decreased detrimental force potential on the lumbar spine and knees. VPAC led to improved ability to maintain a neutral lumbar spine during both squat variations. This finding is associated with decreased detrimental force potential on the lumbar spine. # Conclusions Findings could help guide practitioners and coaches to choose squat variations and incorporate VPAC strategies during their treatments and/or training programs. # Level of Evidence Level 3 ©The Author(s