Measuring Professionalism in Physical Therapy

INTRODUCTION: Professionalism has no clear definition and remains ambiguous throughout all health care disciplines. The American Physical Therapy Association (APTA) included professionalism in Vision 2020 as an important construct to advance the development of the profession. In 2002, the APTA identified seven Core Values of Professionalism that serve as a definition for practice. Presently, there is no valid instrument available for measuring professionalism behaviors of the individual physical therapist. PURPOSE: The purpose of this research was to develop and validate a survey for measuring professionalism behaviors among practicing physical therapists. METHODOLOGY: Grounded theory techniques guided development of a common set of indicators in initial survey development. A systematic review of cross-sectional research literature examining general measures of professionalism in physical therapy, medicine, and pharmacy was conducted. Face validation was obtained via a convenience sample of 10 practicing physical therapists representing multiple practice sites. An expert panel of four physical therapist professionalism content experts and one survey design expert participated in initial survey content validation. A sample of 161 licensed physical therapists from the Commonwealth of Virginia participated in the construct validation for the newly developed survey instrument. Exploratory factor analyses in the form of principal component analysis were used in construct validation. RESULTS: Face validation and four rounds of content validation resulted in a 39-item survey designed as a self-assessment for measuring professionalism in physical therapy. Exploratory factor analysis resulted in the development of a five-factor solution, which accounted for 51.4 percent of the unique variance in the data. The five factors are named: Accountability, Patient- Centered Care, Advancement, Participation, and Values. Accordingly, individual professionalism represents behaviors that progress in development across individual, patient/client, institutional, and societal levels. All seven Core Values of Professionalism are represented in the survey. CONCLUSIONS: The new survey, Professionalism in Physical Therapy, is unique in the physical therapy literature. The survey is of reasonable length and is designed for easy data collection. The instrument demonstrates content and initial construct validity and thus may be used to measure individual practitioner professionalism in physical therapy practice. As physical therapy approaches Vision 2020, physical therapist practitioners are expected to demonstrate more advanced professional behaviors in patient/client interactions, among practitioners within and among practices and representing the needs of the community and the profession at the societal level. These results contribute to the growing body of literature defining and measuring professional behaviors in health care and may be used to direct academic and professional development programming and substantiate professionalization of physical therapy

Molecular Phylogeny of the Leafy Liverwort Lejeunea (Porellales): Evidence for a Neotropical Origin, Uneven Distribution of Sexual Systems and Insufficient Taxonomy

Background: Lejeunea is a largely epiphytic, subcosmopolitan liverwort genus with a complex taxonomic history. Species circumscriptions and their relationships are subject to controversy; biogeographic history and diversification through time are largely unknown. Methodology and Results: We employed sequences of two chloroplast regions (trnL-trnF, rbcL) and the nuclear ribosomal ITS region of 332 accessions to explore the phylogeny of the Harpalejeunea-Lejeunea-Microlejeunea complex. Lejeunea forms a well-supported clade that splits into two main lineages corresponding to L. subg. Lejeunea and L. subg. Crossotolejeunea. Neotropical accessions dominate early diverging lineages of both main clades of Lejeunea. This pattern suggests an origin in the Neotropics followed by several colonizations from the Neotropics into the Paleotropics and vice versa. Most Afro- Madagascan clades are related to Asian clades. Several temperate Lejeunea radiations were detected. Eighty two of the 91 investigated Lejeunea species could be identified to species level. Of these 82 species, 54 were represented by multiple accessions (25 para- or polyphyletic, 29 monophyletic). Twenty nine of the 36 investigated species of L. subg. Lejeunea were monoicous and 7 dioicous. Within L. subg. Crossotolejeunea, 15 of the 46 investigated species were monoicous and 31 dioicous. Some dioicous as well as some monoicous species have disjunct ranges. Conclusions/Significance: We present the first global phylogeny of Lejeunea and the first example of a Neotropical origin of a Pantropical liverwort genus. Furthermore, we provide evidence for the Neotropics as a cradle of Lejeunea lineages and detect post-colonization radiations in Asia, Australasia, Afro-Madagascar and Europe. Dioicy/monoicy shifts are likely nonrandomly distributed. The presented phylogeny points to the need of integrative taxonomical studies to clarify many Lejeunea binomials. Most importantly, it provides a framework for future studies on the diversification of this lineage in space and time, especially in the context of sexual systems in Lejeuneaceae.Open-Access-Publikationsfonds 201