Health-Related Fitness for Children and Adults with Cerebral Palsy

Position Statement of ACSM Sports Medicine Basics 2016: Health-related physical fitness for persons with Cerebral Palsy should be developed in the same model as fitness for all of us: start early, be easily available and continue throughout the life span

Doctoral Physical Therapy Students\u27 Increased Confidence Following Exploration of Active Video Gaming Systems in a Problem-based Learning Curriculum in the United States: A Pre-and Post-intervention Study

Purpose: Active video gaming (AVG) is used in physical therapy (PT) to treat individuals with a variety of diagnoses across the lifespan. The literature supports improvements in balance, cardiovascular endurance, and motor control; however, evidence is lacking regarding the implementation of AVG in PT education. This study investigated doctoral physical therapy (DPT) students\u27 confidence following active exploration of AVG systems as a PT intervention in the United States. Methods: This pretest-posttest study included 60 DPT students in 2017 (Cohort 1) and 55 students in 2018 (Cohort 2) enrolled in a problem-based learning curriculum. AVG systems were embedded into patient cases and 2 interactive laboratory classes across 2 consecutive semesters (April-December 2017 and April-December 2018). Participants completed a 31-question survey before the intervention and 8 months later. Students\u27 confidence was rated for general use, game selection, plan of care, set-up, documentation, setting, and demographics. Descriptive statistics and the Wilcoxon signed-rank test were used to compare differences in confidence pre- and post-intervention. Results: Both cohorts showed increased confidence at the post-test (cohort 1: pre-test, median [IQR]=57.1 [44.3-63.5]), post-test, median [IQR]=79.1 [73.1-85.4]; cohort 2: pre-test, median [IQR]=61.4 [48.0-70.7], post-test, median [IQR]=89.3 [80.0-93.2]). Cohort 2 was significantly more confident at baseline than cohort 1 (

Initial Steps for Integrating Academic Electronic Health Records into Clinical Curricula of Physical and Occupational Therapy in the United States: A Survey-based Observational Study

Training programs must be designed to prepare physical and occupational therapy students for using Electronic Health Records (EHR) and interprofessional collaboration. This report aims to describe physical and occupational therapy students\u27 perceptions of integrating Academic EHR in their Problem-Based Learning (PBL) curricula in the College of Health Professions, Sacred Heart University, Fairfield, Connecticut, the United States. A paper-based case approach to PBL was adapted by creating patient cases in an Academic EHR (AEHR). Students were asked to complete chart reviews and review provider notes to enhance their learning. An online survey was conducted to determine their perceptions of using AEHR from May 2014-August 2015. Eighty-five students completed the survey, 88.1% felt that using AEHR was needed, 82.4% felt that the additional notes enhanced their understanding of the interdisciplinary team; however, 83.5% reported the AEHR system increased their time to extract meaningful information. Incorporating an AEHR into curricula is essential to ensure students are adequately prepared for future patient interactions

Validity and Usability of a Professional Association’s Web-Based Knowledge Translation Portal: American Physical Therapy Association’s PTNow.org

Background: PTNow.org is an evidence-based, on-line portal created by a professional membership association to promote use of evidence in practice and to help decrease unwarranted variation in practice. The site contains synthesis documents designed to promote efficient clinical reasoning. These documents were written and peer-reviewed by teams of content experts and master clinicians. The purpose of this paper is to report on the content and construct validity as well as usability of the site. Methods: Physical therapist participants used clinical summaries (available in 3 formats--as a full summary with hyperlinks, quick takes with hyperlinks, and a portable two-page version) on the PTNow.org site to answer knowledge acquisition and clinical reasoning questions related to four patient scenarios. They also responded to questions about ease of use related to website navigation and about format and completeness of information using a 1-5 Likert scale. Responses were coded to reflect how participants used the site and then were summarized descriptively. Preferences for clinical summary format were analyzed using an analysis of variance (ANOVA) and a Dunnett T3 post hoc analysis. Results: Seventeen participants completed the study. Clinical relevance and completeness ratings by experienced clinicians, which were used as the measure of content validity, ranged from 3.1 to 4.6 on a 5 point scale. Construct validity based on the information on the PTNow.org site was supported for knowledge acquisition questions 66 % of the time and for clinical reasoning questions 40 % of the time. Usability ratings for the full clinical summary were 4.6 (1.2); for the quick takes, 3.5 (.98); and for the portable clinical summary, 4.0 (.45). Participants preferred the full clinical summary over the other two formats (F = 5.908, P = 0.007). One hundred percent of the participants stated that they would recommend the PTNow site to their colleagues. Conclusion: Prelimary evidence supported both content validity and construct validity of knowledge acquisition, and partially supported construct validity of clinical reasoning for the clinical summaries on the PTNow.org site. Usability was supported, with users preferring the full clinical summary over the other two formats. Iterative design is ongoing

Evidence-Based Practice Confidence and Behavior Throughout the Curriculum of Four Physical Therapy Education Programs: A Longitudinal Study

Background Evidence-based practice (EBP) is a foundational process taught in health professional education, yet it is unclear when EBP confidence and skills are obtained. Increases in EBP confidence and behaviors from the start of physical therapy programs to post graduation have been reported in studies that evaluated a single program or used non-valid questionnaires. This study aimed to describe changes in EBP confidence and behavior using validated questionnaires of students from four physical therapy education programs throughout their curriculum and one year post graduation. Methods One hundred and eighty-one students from a potential pool of 269 (67.3%) consented to participate. Students completed the Evidence-Based Practice Confidence (EPIC) Scale and the Evidence-Based Practice Implementation Scale (EBPIS) at 6 timepoints: start of the program, prior to first clinical experience, after first clinical experience, at the end of classroom instruction, graduation, and one year post. Medians (Mdn) and 25th and 75th percentiles (P25, P75) were calculated for 42 (23.2%) students with complete data across all timepoints. Change between timepoints was assessed using Friedman’s test and Wilcoxon signed rank test with a Bonferroni correction for post hoc analysis. Results There were significant changes in EPIC scores (p \u3c 0.001) from enrollment (Mdn 50.0, P25, P75 35.5, 65.9) to prior to first clinical experience (Mdn 65.5, P25, P75 57.3, 72.5) and after the first clinical experience (Mdn 67.3, P25, P75, 58.9, 73.2) to the end of classroom instruction (Mdn 78.6, P25, P75, 72.0, 84.1). Significant increases on the EBPIS (p \u3c 0.01) were only seen from after the first year of training (Mdn 15, P25, P75, 10.0, 22.5) to end of the first clinical experience (Mdn 21.5, P25, P75 12.0, 32.0). Conclusions EBP confidence increased significantly after classroom instruction but remained the same after clinical experiences and at one year post graduation. EBP behavior significantly increased only after the first clinical experience and remained the same through graduation. Confidence and behavior scores were higher than were previously reported in practicing professionals. Ongoing assessment of EBP confidence and behavior may help instructors build appropriate curricula to achieve their outlined EBP objectives

Essential Content for Teaching Implementation Practice in Healthcare: A Mixed-Methods Study of Teams Offering Capacity-Building Initiatives

Background Applying the knowledge gained through implementation science can support the uptake of research evidence into practice; however, those doing and supporting implementation (implementation practitioners) may face barriers to applying implementation science in their work. One strategy to enhance individuals’ and teams’ ability to apply implementation science in practice is through training and professional development opportunities (capacity-building initiatives). Although there is an increasing demand for and offerings of implementation practice capacity-building initiatives, there is no universal agreement on what content should be included. In this study we aimed to explore what capacity-building developers and deliverers identify as essential training content for teaching implementation practice. Methods We conducted a convergent mixed-methods study with participants who had developed and/or delivered a capacity-building initiative focused on teaching implementation practice. Participants completed an online questionnaire to provide details on their capacity-building initiatives; took part in an interview or focus group to explore their questionnaire responses in depth; and offered course materials for review. We analyzed a subset of data that focused on the capacity-building initiatives’ content and curriculum. We used descriptive statistics for quantitative data and conventional content analysis for qualitative data, with the data sets merged during the analytic phase. We presented frequency counts for each category to highlight commonalities and differences across capacity-building initiatives. Results Thirty-three individuals representing 20 capacity-building initiatives participated. Study participants identified several core content areas included in their capacity-building initiatives: (1) taking a process approach to implementation; (2) identifying and applying implementation theories, models, frameworks, and approaches; (3) learning implementation steps and skills; (4) developing relational skills. In addition, study participants described offering applied and pragmatic content (e.g., tools and resources), and tailoring and evolving the capacity-building initiative content to address emerging trends in implementation science. Study participants highlighted some challenges learners face when acquiring and applying implementation practice knowledge and skills. Conclusions This study synthesized what experienced capacity-building initiative developers and deliverers identify as essential content for teaching implementation practice. These findings can inform the development, refinement, and delivery of capacity-building initiatives, as well as future research directions, to enhance the translation of implementation science into practice

Exploring the links between unhealthy eating behaviour and heavy alcohol use in the social, emotional and cultural lives of young adults (aged 18–25)::A qualitative research study

Alcohol use peaks in early adulthood and can contribute both directly and indirectly to unhealthy weight gain. This is the first qualitative study to explore the links between unhealthy eating behaviour and heavy alcohol use in the social, emotional and cultural lives of young adults. We conducted 45 in-depth interviews with 18–25-year-olds in North-East England to inform development of a dual-focused intervention to reduce health risk due to excess weight gain and alcohol use. Data were analysed thematically, following the principles of constant comparison, resulting in three intersecting themes: (1) how food and alcohol consumption currently link together for this population group; (2) influences upon linked eating and drinking behaviours and (3) young adults’ feelings and concerns about linked eating and drinking behaviours. Socio-cultural, physical and emotional links between food and alcohol consumption were an unquestioned norm among young adults. Eating patterns linked to alcohol use were not tied only to hunger, but also to sociability, traditions and identity. Young adults conceptualised and calculated risks to weight, appearance and social status, rather than to long-term health. This study is the first to evidence the deeply interconnected nature of food and alcohol consumption for many young adults. Findings have important implications for intervention development, UK public health policy and practice, and point to a need for similar research in other countries

The Effects of Manual Therapy on Aging and Older Adults With Neurological Disease

Background: As the population ages, the incidence of neurological diseases associated with aging will increase. Impairments related to neurological disease include spasticity, pain, joint contracture, weakness, and loss of mobility. Manual therapy, skilled hand movements performed by physical therapists, has been found to decrease pain and increase tissue extensibility. The purpose of this article was to review the literature on the effects of manual therapy to manage or improve the impairments and functional limitations related to neurological diseases in the older adults. Results: Literature on the effects of manual therapy on spasticity, range of motion/joint contracture, pain, strength, gross mobility, fine motor skills, and dysphagia were included in this review. Manual therapy treatments included stretching, passive movements, joint mobilizations, massage, proprioceptive neuromuscular facilitation, neurodevelopmental technique, and gait training. Conclusion: There was limited evidence on the effects of manual therapy to treat and prevent joint contracture. Stretching, combined with Botox (botulinum toxin A), was found more effective at improving range of motion than stretching alone. Joint mobilizations showed immediate improvements in range of motion and balance, but higher-quality studies investigating the long-term impact of joint mobilization on patient function need to be conducted. The amount of therapy (dosage) plays a role in recovery of function. Continued research is needed to determine the best practice for the use of manual therapy for individuals with neurological disease

Development of the Clinical Teaching Effectiveness Questionnaire in the United States

The purpose of this study was to develop a single valid measure for assessing clinical teaching effectiveness within the field of physical therapy. Pilot testing with CIs from both universities were purposively sampled to complete the questionnaire. The CI databases yielded 1,001 potential respondents, recruited via e-mail. The questionnaire and two follow-up reminders were sent. Respondents consented by clicking a link which redirected them to the SurveyMonkey® questionnaire. Two hundred five CIs completed the questionnaire, a 20.5% response rate. The 205 respondents were mostly female (68.4%) with an average age of 40.54 years (SD=10.22). CI experience was distributed as follows: 1-5 years (19.1%), 6-10 years (47.4%), and 11+ years (33.5%)

Measurement Characteristics and Clinical Utility of the Capabilities of Upper Extremities Among Individuals With Spinal Cord Injury

Improving upper extremity (UE) function is a high priority for individuals with spinal cord injury (SCI).1 Currently, there is a lack of standardized measures to capture UE function specific to individuals with SCI.2 The Capabilities of Upper Extremities (CUE) is an SCI-specific, patient-reported outcome measure examining UE functions in individuals with tetraplegia. It is a 32-item questionnaire assessing self-perceived difficulty in performing specific tasks including reaching and lifting, pushing and pulling, and wrist, hand, and finger actions