Evidence for the use of exercise in patients with breast cancer to reduce cancer-related fatigue

Background & Purpose: Cancer-related fatigue is the most commonly reported side effect of cancer treatment and affects 70-100% of patients. According to the 2013 National Comprehensive Cancer Network Guidelines on Cancer-Related Fatigue, institutions should assess the quality of fatigue management in their continuous quality improvement projects. In addition, the Guidelines also state that Medicare contracts should reimburse for fatigue management and disability insurance should include coverage for the continuing effects of fatigue. Exercise has been suggested for breast cancer survivors as an intervention to reduce cancer-related fatigue both during and after cancer treatment. However, it has been reported that only 68% of patients receive information about fatigue during their cancer treatment and the information they receive is not specific enough to initiate an exercise program. The objective of this systematic literature review was to summarize the effects of exercise to reduce cancer-related fatigue in patients with breast cancer and discuss the exercise dosage in terms of mode, frequency, duration and intensity. Number of Subjects: Five studies met the inclusion/exclusion criteria for this review. Materials/Methods: The literature search included key word searches in the databases, Medline and CINHAL, and a hand-search of studies included in a Cochrane review. The search was limited to females only, published in 2008-2013 and English language. Of the 23 studies that met the search criteria, five were chosen based on inclusion of an aerobic component, measurement of fatigue levels and high PEDro scores. Types of studies reviewed included clinical trials comparing an exercise intervention group to a control group and one cross sectional survey of an exercise intervention. Outcomes: Four out of five studies showed an improvement in cancer treatment related fatigue in individuals with breast cancer following the exercise intervention. Three different outcome tools were used to measure fatigue. The length of exercise intervention varied among each study and there was inconsistent duration, type of exercise, or supervision reported. The range included 8 weeks aquatic aerobic and resistance exercise, 12 weeks of aerobic, resistance and stretching, a home based walking program of 6 weeks or 14 weeks, in addition to a yearlong combined home-based aerobic exercise program. Intensity was measured using both RPE and/or heart rate. No study reported negative impacts of exercise implementation. General study limitations included group contamination when the control group began an exercise program on their own or there was decreased adherence to the exercise intervention by the study subjects. Systemic bias may have occurred when the control group received little/no attention and the Hawthorne effect of study participants. Discussion: Physical therapists should be aware not only of the important role of exercise intervention for the management of cancer-related fatigue in individuals with breast cancer but the mode, frequency and duration that is most effective. Additional research is needed in this population to clarify optimal exercise dosage and to compare outcomes of total daily physical activity versus only formal exercise. Despite these limitations, the available evidence supports the value of exercise for individuals with breast cancer-related fatigue and the active role physical therapists can play to initiate exercise programs

Evaluation of a Student-Centered Digital Education Project in Health Science Education

Student-centered learning is essential and evidence shows higher levels of achievement when students are engaged with educational activities that include critical thinking and effective communication in addition to creativity. The aim of this prospective cohort study was to evaluate a student-centered digital education project during a course about physical therapy (PT) management of chronic diseases. The objectives of this student project were to apply content through a well thought-out digital project and critically analyze information considering multiple points of view. Each project was evaluated by faculty using a rubric, and students completed a self- and peer-assessment. All projects were shared at the end of the semester. Students self-selected the topic (and deadline), whether to work individually or in groups and the digital format of their project (infographic, screencast or PechaKucha/Ignite). Data analyzed from three cohorts (n=137) show this student project was well-received with 69% agreeing the time it took to complete the project was appropriate for the percentage of the final grade, 76% reported having a better understanding of the topic and 80% reported a new understanding of presenting information to health professions audience. The studentcentered components of the project were also highly favored with the ability to self-select the digital project format (86%), due date (85%) and topic (87%). Most students choose to work in groups (96%) and the infographic digital format was selected most (88%), followed by screencast (7%) and Pecha Kucha/Ignite (5%). Faculty noted an excitement by students about their completed projects and eagerness to share with others. These results support the use of a student-centered digital educational project allowing students to make connections between course material and PT with an individualized project plan to present information digitally. The millennial generation of students are comfortable with technology and this project introduced new platforms for presenting healthcare information

Early Career Physical Therapy Faculty Networking and Scholarly Productivity: A Mixed-Methods Study

While it is well-known that physical therapist (PT) faculty must retain a scholarly agenda, few report being activity engaged and many programs have low scholarly dissemination. There is evidence that knowledge of the make-up of a faculty network leads to improved performance and innovation. The purpose of this explanatory sequential mixed methods study was to explore agency (behaviors and perspectives about career advancement) and the professional network structure and composition of early career PT faculty as they relate to scholarly activity. This dissertation research study included 50 early career faculty who worked in accredited entry-level physical therapy programs. The quantitative phase results showed a more open and less interconnected network is associated with higher scholarly activity when controlling for the duration as a faculty member and whether the individual has an academic doctoral degree. Agency behavior and perspective scores were not associated with higher scholarly activity. The Scholar Score developed during this phase offered a clear and uniform, peer-validated approach to account for the quantity and quality of scholarly activities. The qualitative phase used a grounded theory approach to analyze interviews with a sub-set of 20 study participants. The result was a central phenomenon of connecting with others for scholarly activity. The two constructs in the model are strategies used to develop network connections and how these connections helped faculty participate in scholarly activity. The findings about the network development process helped explain the quantitative results of high and low performers of scholarly activity. Without both study phases important information would have been missed. Key implications from this study include advancing the application of the Scholar Score and demonstrating network analysis for PT faculty. More importantly this study generated new knowledge about an effective network and the process used to create professional relationships to strengthen an early career PT faculty scholarly agenda. Network analysis made the connections visible for the early career faculty who reside at the lower end of the academic hierarchy in terms of tenure, academic rank, and scholarly productivity

Who\u27s in the Inner Circle? Exploring Network Connections Among Health Professions Faculty for Career Advancement

Purpose/Hypothesis The purpose of this study is to explore the meaning of network connections in new or early career health professional faculty. Knowing this information can foster targeted faculty development strategies to build, leverage and maintain connections for advancement with scholarly activity. Faculty shortages currently exist amongst the medical and healthcare professions compounded by an aging U.S. population, increasing the demand for health care services.1 Each year, new faculty are hired, following carefully executed and costly searches. Much time, energy and finances are invested into human resources, not limited to, but including; salary, benefits and start up packages. All of this only matters if the new faculty member is retained and successfully achieves promotion and tenure.2,3 All faculty must retain an active scholarly agenda to successfully advance in the higher education paradigm. Each discipline may have unique challenges; however, all must achieve optimal performance in the three pillars: teaching, service and scholarship.4,5 When mentors and faculty members are knowledgeable about the existing and potential network connections, a more individualized approach is possible.6 Armed with professional network information combined with the goals and resources of the institution, career advancement may be achieved quicker or with less confusion. Methods/Description An explanatory sequential mixed methods study design was employed in this study. First information about the network was collected via a quantitative survey using social network analysis methods. Scholarly activity scores were calculated from the participants curriculum vitae. Next, interviews were completed to further explain the connections and scholarly activity noted during the quantitative phase. The data was collected in series, analyzed separately and presented in a joint display showing the overlap of the network connections, scholarly activity scores and resultant themes. This pilot study took place at urban university system in the United States. We studied the School of Health Sciences and Professional Programs 8 new faculty. In an early preemptive strategy to promote faculty development and retention, the Dean meets twice a semester with this interdisciplinary faculty cohort, at the Dean\u27s New Faculty Luncheon Forum. All provided consent to participate. Identifiable data was handled by an independent researcher at another University. Participant names were replaced with a numerical code, while mentor/collaborator names were replaced by alpha coding. The lists linking names and codes are maintained by the independent researcher. Results We measured network structure by size and interconnectedness among contacts. We measured composition by reviewing the similarity in characteristics to the faculty member (homophily) and diversity of characteristics (e.g. academic rank, gender) of all members (heterogeneity). Network visualization maps were created for each faculty member. During the interview, study participants described the connections including the level of understanding, degree of helpfulness about knowing more about their network and how this influences scholarly activity. This cohort will be continued and closely monitored throughout the pursuits of their promotion and tenure. Conclusions/Relevance to the conference theme This study demonstrates the value increased self-reflection about one’s professional networks have on faculty development toward scholarly activity goals. Strategies for creating effective networks of collaborators should be implemented and utilized as one of the tools used by mentors in the development of new and early career faculty scholarly pursuits. Continuing this strategy each year with all new and early career health professional faculty as a cohort model will be further executed and monitored to continue to better define/refine strategies to positively influence faculty scholarship, career advancement and retention. The medical and health professions faculty shortages are real issues which will only get worse unless deliberate measures are taken to reduce faculty attrition, while enhancing faculty preparedness and scholarship to address the challenges that lie ahead (large numbers of senior faculty approaching retirement). The academic strength of an institution is tied to its faculty success. They represent diversity of expertise in research, education and scholarship. This presentation will introduce the exploration of professional networks as an innovative tool to assist faculty development and counter the faculty shortage issues that exist amongst the medical and health care professions. This one strategy along with a combination of other strategies, some of which were built into this cohort model (an interdisciplinary cohort group, opportunities for collaboration and mentoring, along with administrative support), will all help to increase faculty numbers to better educate students and provide high quality care to an ever growing, diverse aging population

Step Up to the Plate! Using Multimedia Content and Game Winning Strategies for Implementation

The working memory, also known as cognitive load, has a limited capacity and course learning materials should avoid overload. There are content development strategies using visual and auditory channels to maximize learner efficiency and minimize distractions for long-term memory development (Clark, Nguyen & Sweller, 2006). For example, diagrams with embedded labels next to the graphic they describe can lower the working memory demand. Multimedia e-learning materials abound and should be designed with sound educational theory (Clark & Mayer, 2011). Guiding this interactive session are two people with a shared interest for using technology to help students learn. One is a faculty member with a passion for assisting students understand complex processes utilizing innovative teaching strategies at both the undergraduate and graduate levels. The other presenter is an instructional designer with extensive experience creating adult learning in both corporate training and higher education. They will use an entertaining case study approach, based upon their practical experiences, showing how to enhance existing or new course content. Participants will summarize the importance and impact that design can make on a learner’s ability to process large quantities of information more effectively. Exemplars will illustrate best practices that add value to the learner’s experiences

Use of a Team Building Activity to Teach Clinical Decision-Making Concepts to Physical Therapy Students

PURPOSE : The purpose of this research was to find out if a team building exercise carried out by student groups will facilitate learning how to make clinical decision involving concepts from the International Classification of Function (ICF). SIGNIFICANCE: Scant literature exists regarding the concept of integrating student and expert team case-based learning with the ICF to develop clinical decision-making skills. SUBJECTS: Subjects were 213 first-year physical therapy students in the DPT program at UNMC in the first semester of the curriculum of years 2013-2016. METHODS AND MATERIALS: A patient case was developed which included clinical decision-making steps using concepts from the ICF. The authors were surveyed in order to rank the decision-making steps in order of priority and identify ICF concepts involved. The ranking was performed again after review of first round results and feedback. Students were expected to view an online ICF presentation produced by the APTA. Each student attended small group concurrent sessions each facilitated by a faculty member to accomplish the following as individuals: complete a pre-test of ICF knowledge, rank 15 case decision items in order of priority, and identify each item\u27s ICF category (health condition, impairment, activity limitation, or participation restriction). Students, using group discussion, then re-ranked the decision items and categorized ICF components. They compared their individual rankings and ICF categorizations with those of the expert panel, and calculated the absolute values of the ranking differences and the number of correct categorizations of the items in the ICF scheme. They also compared their group rankings and categorizations with those of the expert panel. Individual students then completed a post-test and later a 12-question electronic survey find out their opinions about the usefulness of the exercise. RESULTS: For the 200 students participating, the mean of differences between sums of individual ranks and those of the expert panel was 41.7 (range 12-83), with a median of 42. The mean of ICF category matches for all students was 6.8 (range 2- 12 out of 15) with a median of 7. The mean of the sums of group rank differences was 28.2 (range 8-46), with a median of 26, and the mean of the group ICF matches was 9.1 out of 15 (range 6-12), median 9. For 16 of 19 groups the sum of group rank differences was lower than the mean of the individual rank differences. In addition, 18 of 19 groups had higher ICF category matching rates than those of individuals. Pre-test score for ICF knowledge for all students was 5.2/8 (mean), and post-test mean was 5.87/8, a significant difference. In the post event survey, 89 of 129 respondents believed that group discussion was either successful or very successful in learning how the ICF assists decision-making, and 106 of 129 believed that the activity was either successful or very successful in learning to prioritize clinical decisions. CONCLUSIONS: The first-year physical therapy students in the UNMC PT program discovered that team decision-making usually results in improved congruence with the decisions of an expert panel. Comparison of pre- and post-test scores show that knowledge of use of the ICF was enhanced. Students generally believed that the activity was useful to their understanding of how the ICF may be used for clinical decision-making

Emotional Exhaustion, Depersonalization, and Feelings of Decreased Personal Accomplishment Oh My: What Message Are We Sending To Our Students?

PURPOSE: The purpose of this presentation is to address the issue of burnout amongst PTs through the lens that addressing this issue in our profession may very well be the first step in building resilience in the academic and clinical environments. METHODS AND/OR DESCRIPTION: Physical therapy student well-being is a priority for academic institutions. Yet, are we, as academic and clinical faculty, who are responsible for promoting student well-being, “well” ourselves? Could burnout of our academic and clinical faculty impact our student’s wellness? Burnout is a syndrome described as emotional exhaustion, depersonalization, and feelings of decreased personal accomplishment. All effects that can influence our own health, work environment, and relationship with others. During this session, we will review the literature regarding the prevalence of burnout amongst PTs and cite factors that may contribute to burnout. We will describe its effects on the health of the provider, atmosphere of the work environment, student instruction and well-being, and ultimately the quality of care received by our patients. Finally, drawing from current research, we will investigate solutions to mitigate burnout in academic and clinical faculty to promote wellness and resilience. RESULTS/OUTCOMES: There is evidence PTs are experiencing a moderate level of burnout at an incidence that, in some cases, is higher than other healthcare professionals. Both job related stresses as well as intrinsic individual factors have been cited as contributing to burnout. This includes factors such as lack of communication and connectedness, diminished personal achievement, time constraints, lack of support from supervisors and colleagues, role conflict and ambiguity, and failure to utilize a task-related coping style. Results show that the effects of burnout can include decreased psychological, physical, and cognitive function, somatic and physical arousal, decreased immunity, morale, and productivity, absenteeism, job turnover, and alcohol and drug abuse. Further, those experiencing burnout develop a negative self-concept, have a poor attitude towards their job including a loss of concern for their patients, co-workers, and themselves. Solutions to alleviate burnout and promote well-being in physical therapists include the use of social network analysis, teamwork, communication, leadership, professional identity programs, targeted work unit interventions, use of rewards and incentives, flexibility and work life integration, and self-care. CONCLUSIONS/RELEVANCE TO CONFERENCE THEME: As academic and clinical faculty, we are in a position to have a major impact on our students. If we want to promote resilience and well-being in our students, it is important that we ourselves are not experiencing burnout and are role-modeling strategies that promote resilience. The effects of burnout are significant and will not only take their toll on our own health but also can influence our relationships with our students. It is important that when building resilience in the academic and clinical environments, we address the needs of both the faculty and the students

Transforming Physical Therapy Education Through the Use of Social Network Analysis

PURPOSE Social Network Analysis (SNA) is a quantitative method to study the patterning and effect of relationships and how individual connections form into social structures that influence outcomes of the group. The purpose of this study is to explain the underpinnings of SNA and its application to PT education for student success and faculty development. This study is innovative and will be beneficial to the profession because there is currently no published literature exploring how PT education is influenced by social structures. METHODS/DESCRIPTION The aims of this study are to describe SNA and outline its potential to transform PT education. A literature search to identify studies that provide a theoretical framework and uses of SNA was performed using the following databases: CINAHL, Academic Search Complete, MEDLINE, Scopus and ProQuest. Studies in education, organizational management, and sociology were reviewed. RESULTS/OUTCOMES Only recently has SNA been identified as relevant in medical education despite wide use in the business and military sectors. Social Network Analysis focuses on relational data that explores 1) influences of direct and indirect ties, 2) structures and composition for enhancing or constraining information spread, and 3) impact of one’s position in the network. There is evidence network size is just as important as the depth and breadth of experiences each member-connection brings. Given that education and teaching are social in nature, opportunities for the use of SNA in PT education are abundant. It could shed light on the relationships between students, faculty and even entities on social media platforms. Early network analysis of a PT cohort could transform the PT educational experience through early identification to remediate students with ineffective networks for collaboration, information sharing and support. Another application includes measuring the flow of information and noting which students are brokering information that aids in maximizing the collaborations for team-based care. An effective network could also positively impact PT faculty and may reduce tension between the requirements of teaching, scholarly activity and service for progress toward goals of promotion and tenure. Network collaboration was shown by medicine faculty to provide vital knowledge and maximizing scholarly activity. Exploring aspects of PT faculty professional networks could lead to valuable information to balance the composition of network members’ expertise and leverage connections. CONCLUSIONS/RELEVANCE The value of SNA includes the ability to quantify relationships between people and explore how connections emerge as an asset or constraint. Adding measurement of relational factors to individual information could significantly increase the evidence to guide our understanding of actions for PT students and faculty success. Currently, SNA has not been reported in PT education literature but is a methodology that will produce substantial insights to transforming PT education. FUNDING SOURCE Funding provided by the College of Allied Health Professions, University of Nebraska Medical Center and Education Section of the American Physical Therapy Associatio

The Impact Of E-Learning On Physical Therapy Students’ Clinical Skill Development

Purpose: The purpose of this special interest report is to review the effectiveness of e-learning in comparison to traditional classroom learning by exploring different methods of implementation of e-learning into PT curriculum Description: Education delivery via e-Learning is becoming a common teaching mode that appeals to students because it can be completed asynchronously at a self-directed pace and reviewed anytime, anywhere and as often as necessary for understanding. Translating knowledge from eLearning materials to skill performance is important to consider for PT students due to the requirements of psychomotor performance and demonstration of appropriate affective professional behaviors. Literature review: A literature search was conducted through PubMed and Scopus utilizing the following key terms: e-learning, blended learning, physical therapy, practical examination and clinical skills. The search resulted in eight studies, in which four were chosen for critical review as they most closely aligned with the question of interest and compared the use of adjunctive e-learning methods to a control group who received only traditional, face to face lecture, lab, and access to textbooks. In each study, at least one outcome measure assessed clinical skill performance based on a practical examination. No study reported negative impacts of e-Learning. Summary of Use: In each study, students who utilized e-learning to enhance their understanding of the material performed slightly higher on the practical exam, but not all findings were statistically significant. However, e-Learning was well-received and physical therapy students reported having more confidence, less anxiety and better understanding of grading standards prior to the practical exam. Since most students entering physical therapy school are digital natives the utilization of e-learning may relate well to their learning styles. E-learning may be more sustainable over time than traditional teaching methods and affords the learner individualization, self-paced learning and instructional consistency. Importance to Members: This review supports the idea that e-learning could be successfully utilized in a DPT curriculum as the results show clinical skills performance outcomes with e-learning are at least as good as traditional classroom instruction. Because clinical skills require professional interactions and psychomotor demonstration, e-learning is likely best utilized as a complementary means of learning, but not as a stand-alone source of instruction. Educational institutions may be able to extrapolate this information to achieve long-term cost savings and resource management within their educational programs. Overall, students continue to value in-class time to discuss material at a higher level, work through clinical cases, and ask questions for clarification of course content and objectives

Enhancing Scholarly Productivity Among Physical Therapy Faculty through Professional Networks

Purpose Let\u27s build a talented workforce of physical therapy educators with diverse ideas who collaborate on projects and discover new knowledge! Faculty are the educational leaders in physical therapy. With growing demands on workload and time, it is essential to attract talent to academia and provide a supportive team to navigate the path toward a successful career. Scholarly productivity accreditation requirements are challenging, especially for new faculty with primary teaching responsibilities or those without an academic doctoral degree. Evidence suggests that network connections can improve faculty performance, innovation and retention. This study arose from concerns in recent years related to the large number of early career faculty joining physical therapy schools across the country. The purpose of this session is to show how effective professional networks for physical therapy faculty aid in success with scholarly activity. This session will apply key principles of the social capital theory to challenge future educational leaders to carefully examine their professional network connections and the role of these connections in their work-related outcomes. Social capital, marked by trust, reciprocity and cooperation can be acquired via professional network connections. One who has an effective network can leverage their social capital to access information and resources, retain support and cohesion, and attain introductions to new professional contacts from brokers within their network. In higher education, there is also evidence that knowing about the value of professional connections can aid in higher performance and varied collaborations - all important for faculty recruitment, development and retention. Methods and/or Description of Project During this session, we will explore the results of a one-year nationwide study of early career physical therapy faculty and the most effective professional network structure and composition. In addition, participants will have an opportunity to compare components of their own professional network against several existing models among physical therapy educators. There is no perfect network model however knowing about how network connections are built and maintained can help individuals leverage their network knowledge for purposeful advancement in their career path. During this session participants will identify individuals who are important sources of work-related information. We will review information about these network contacts such as gender, academic rank, location of work, and discuss connections among the individuals in the network. This information will be used to illustrate networks via network maps that visualize the connections. Participants will learn about certain elements of their network to better understand and characterize their professional network connections. In addition to the size of one\u27s network, we will discuss interconnectedness (density), homophily (similarity to the faculty member), and heterogeneity (diversity of network characteristics), and what these concepts mean for professional network development. Results/Outcomes Network composition results from over 50 early career PT faculty from 39 different institutions across the country will be shared. We assessed network size and density (connectedness) and six measures of homophily ( characteristics similar to the early career faculty member) and 18 measures of heterogeneity ( diversity). We used univariate analysis and multiple logistic regression to explore how the baseline network structure and composition predicted scholarly activity one year later. The results from this study demonstrated that a more open, less interconnected network was associated with greater quantity and higher-quality scholarly activity, even after controlling for the duration as a faculty member and achievement of an academic doctoral degree. Conclusions/Relevance to the conference theme Key take-aways related to faculty development from this session include: 1) some early career faculty are productively using their network connections, despite the Carnegie Classification of their institution, duration in their faculty job, and earning an academic doctoral degree; 2) the structure of a most effective professional network for scholarly activity is open with low connectedness among contacts; and 3) mentors can guide early career faculty to systematically and strategically modify their network to be more effective and support their scholarly agendas