Clinical orthopedic medicine course for physical therapy students. Aligning content with current practice

The purpose of our study was to obtain information that would help align instruction in a clinical orthopedic medicine course for physical therapy students with the current practice of physical therapists. We sent a questionnaire concerning treatment of orthopedic conditions to 3,000 physical therapists. Of the 1,804 (60%) respondents, 58.8% were in general practice, and 35% combined specialty areas with general practice. The respondents indicated that they treated two distinct groups (four categories each) of musculoskeletal disorders. Of the respondents, 87.6% spent less than five hours a week treating bone infections, tumors, and developmental and congenital disorders, whereas 63.4% worked more than five hours a week with fractures and dislocations, low back and neck pain, ligament and soft tissue injuries, and arthritis. We provide a model that uses survey results and course content analysis for planning critical orthopedic medicine instruction for physical therapy students.     

Legislative change to permit direct access to physical therapy services: a study of process and content issues

The purpose of this study was to examine process and content issues related to legislative change to permit direct access to physical therapy services. Data sources were survey questionnaires sent to the presidents of the 52 chapters of the American Physical Therapy Association (APTA), APTA publications, state statutes, and personal contacts. Results were based on the experiences of 35 chapters, 17 in direct-access states and 18 in non-direct-access states. The majority of direct-access states obtained their status in a single legislative campaign; the majority of non-direct-access jurisdictions attempting legislative change have been unsuccessful for 2 or more years. Over 80% of the chapters reported using legislative lobbyists. Opposing forces varied from state to state and included hospital and medical associations, physicians, chiropractors, and physical therapists. The following limitations on practice in a direct-access mode are found in the various practice acts: diagnosis requirements, eventual referral requirements, physical therapist qualifications, patient consent requirements, and practice setting restrictions.     

Identification of intervention categories for physical therapy, based on the international classification of functioning, disability and health: a Delphi exercise

BACKGROUND AND PURPOSE: Disability or limitations in human functioning are universal experiences that concern all people. Physical therapists aim to improve functioning and prevent disability. With the approval of the new International Classification of Functioning, Disability and Health (ICF), we can now rely on a globally recognized framework and classification to be used in different health care situations by all health care professionals in multidisciplinary teams. The objective of this study was to identify ICF categories that describe the most relevant and common patient problems managed by physical therapists in acute, rehabilitation, and community health care situations taking into account 3 major groups of health conditions: musculoskeletal, neurological, and internal. SUBJECTS: The subjects were physical therapists who were identified as possible participants by the heads of physical therapy departments who were members of the Swiss Association of Physical Therapy Department Heads or who were recruited from the membership of the Swiss Association of Physiotherapy. METHODS: A consensus-building, 3-round, electronic-mail survey with 9 groups of physical therapists was conducted using the Delphi technique. RESULTS: Two hundred sixty-three physical therapists participated in at least one round of the Delphi exercise. They had consensus levels of 80% or higher for categories in all ICF components (Body Functions, Body Structures, Activities and Participation, and Environmental Factors 1 and 2). DISCUSSION AND CONCLUSION: This study is a first step toward identifying a list of intervention categories relevant for physical therapy according to the ICF. The ICF, designed as a common language for multidisciplinary use, is also a very helpful framework for defining the core competence for the physical therapy profession.     

Competencies in biomechanics for the physical therapist. Suggestion for entry-level curricula

The purpose of this paper is to identify competencies needed in the area of biomechanics for physical therapists. The discussion is divided into the following three areas: prevention of movement dysfunction, patient evaluation, and patient treatment. Clinical examples for each area are included. Physical therapists must understand normal biomechanical development, pathomechanical development, biomechanics of normal movement, and pathomechanics of the musculoskeletal system. In addition, physical therapists should be experts in biomechanics of exercise and be able to analyze biomechanically various types of activities.     

Dizziness in Orthopaedic Physical Therapy Practice: Classification and Pathophysiology

Abstract

Dizziness is a frequent complaint in patients presenting to orthopaedic physical therapists. Differential diagnosis of dizziness is complex but essential and requires knowledge of musculoskeletal, vestibular, cardiovascular, neurological, metabolic, and psychiatric conditions, thus transcending the musculoskeletal boundaries of orthopaedic physical therapy clinical practice. Physical therapy intervention is not indicated for many causes of dizziness. Some types of dizziness present contra-indications to certain orthopaedic physical therapy interventions. This article presents a diagnostic classification system and relevant pathophysiology that may facilitate orthopaedic physical therapy diagnosis, screening, and subsequent appropriate physical therapy management or medical referral.     

Myelodysplasia--the musculoskeletal problem: habilitation from infancy to adulthood

The physical therapy and orthopedic management of patients with myelodysplasia from infancy to adulthood are reviewed. The overall goal for the child with myelodysplasia is functional independence. Physical therapy and orthopedic intervention enable the individual to achieve this goal. Associated problems, however, such as Arnold-Chiari malformation, hydrocephalus, and tethered spinal cord, influence functional expectations. Physical therapy management begins in the neonatal period and continues through adolescence. Treatment is modified at the various stages of development. Knowledge of current orthotic and adaptive equipment is necessary to achieve optimal locomotor function. Orthopedic management decisions are based on musculoskeletal and neurologic assessments, to which the physical therapist provides a significant contribution. Controversies exist over the orthopedic management of dislocated hips, scoliosis, and kyphosis.     

Ankylosing spondylitis in a patient referred to physical therapy with low back pain

Low back pain (LBP) is one of the most common and costly medical conditions in the United States; various studies have reported up to 80% of the adult population will experience a significant episode of LBP sometime within their lifetime. Although many cases of LBP are related to the musculoskeletal system and appropriate for the care of the physical therapist (PT), some episodes of LBP have a systemic cause. Thus, it is the role of the PT to ensure each patient is appropriate for physical therapy intervention throughout the episode of care. When the patient's condition is not appropriate for physical therapy intervention, it is the PT's responsibility to refer the patient to other medical professions to ensure optimal patient care. The purpose of this case report is to describe a patient referred to PT who was diagnosed with ankylosing spondylitis. The patient presented initially to physical therapy with a diagnosis of LBP. However, after several visits her symptoms were inconsistent with mechanical LBP and thus required further medical consultation.     

Ankylosing spondylitis in a patient referred to physical therapy with low back pain

Low back pain (LBP) is one of the most common and costly medical conditions in the United States; various studies have reported up to 80% of the adult population will experience a significant episode of LBP sometime within their lifetime. Although many cases of LBP are related to the musculoskeletal system and appropriate for the care of the physical therapist (PT), some episodes of LBP have a systemic cause. Thus, it is the role of the PT to ensure each patient is appropriate for physical therapy intervention throughout the episode of care. When the patient's condition is not appropriate for physical therapy intervention, it is the PT's responsibility to refer the patient to other medical professions to ensure optimal patient care. The purpose of this case report is to describe a patient referred to PT who was diagnosed with ankylosing spondylitis. The patient presented initially to physical therapy with a diagnosis of LBP. However, after several visits her symptoms were inconsistent with mechanical LBP and thus required further medical consultation.     

Outpatient physical therapy cardiovascular assessment: Physical therapist perspective and experience

Background: Physical therapists are recognized healthcare providers who play an important role in cardiovascular disease prevention. Heart rate (HR) and blood pressure (BP) are important parameters in cardiovascular risk assessment; however, physical therapists do not usually integrate them into clinical practice. Therefore, this study aimed to examine the current practice and opinion of outpatient physical therapists toward HR and BP measurements in clinics. Methods: A 12-item survey questionnaire was distributed to outpatient physical therapists. Five senior staff from different specialties, including orthopedic, neurology, pediatric, cardiopulmonary, and sport specialties, participated in a focus group interview to gather their opinions. Results: In total, 285 (56%: male) physical therapists participated. Only 68 (24%) measured HR and BP; of these, 27 (41%) used manual sphygmomanometers. Nearly one-fifth reported that cardiovascular adverse events, such as syncope and chest pain, occurred during therapeutic exercise of their patients and were the highest among the sport and orthopedic physical therapists. Most physical therapists felt that measuring cardiovascular indices is not their job and does not add value to their treatment plan. Conclusion: Majority of the physical therapists were not measuring HR and BP during clinical assessment, although some reported cardiovascular adverse events occurring in their patients.     

Moving forward in occupational health physical therapy: the journey toward specialization in the United States

Abstract

Background: The Occupational Health Special Interest Group of the Orthopaedic Section of the American Physical Therapy Association has championed the role of physical therapy in the area of occupational health in the United States.

Objective: This article is a brief review of the role physical therapists play in occupational health, competencies for professional development in this practice area, and efforts to achieve physical therapy specialization in the United States through petition to the American Board of Physical Therapy Specialties.

Major Findings: Physical therapists have an important role to play in the health, wellness, and sustained function of the working population based on the numbers and types of injuries sustained in the workplace, and chronic problems common to working age adults. Physical therapists can help prevent injury and promote return to work through interventions including ergonomics, job modifications and transitional duty programs, functional testing, case management and communication, and care coordination with workers and other stakeholders. Practice analysis competencies are discussed as the foundation of professional development in the field of occupational health. This article also overviews petitioning materials for specialization.

Conclusion: Physical therapist specialization in occupational health may benefit workers and employers through injury reduction and improved or sustained abilities of the workforce following injury. Specialization will help to promote consistency within the field of physical therapy for external stakeholder recognition of skills, while also promoting knowledge transfer and diffusion of best practice. The specialization petition has not been approved; however the process is ongoing.     

Work-related musculoskeletal disorders in physical therapists: prevalence, severity, risks, and responses

BACKGROUND AND PURPOSE: Physical therapists are at risk for work-related musculoskeletal disorders (WMSDs). Little is known of how therapists respond or of what actions they take to prevent injury. The purpose of this study was to investigate the prevalence and severity of WMSDs in physical therapists, contributing risk factors, and their responses to injury. SUBJECTS: As part of a larger study, a systematic sample of 1 in 4 therapists on a state register (n=824) was surveyed. METHODS: An 8-page questionnaire was mailed to each subject. Questions investigated musculoskeletal symptoms, specialty areas, tasks and job-related risk factors, injury prevention strategies, and responses to injury. RESULTS: Lifetime prevalence of WMSDs was 91%, and 1 in 6 physical therapists moved within or left the profession as a result of WMSDs. Younger therapists reported a higher prevalence of WMSDs in most body areas. Use of mobilization and manipulation techniques was related to increased prevalence of thumb symptoms. Risk factors pertaining to workload were related to a higher prevalence of neck and upper-limb symptoms, and postural risk factors were related to a higher prevalence of spinal symptoms. CONCLUSION AND DISCUSSION: Strategies used to reduce work-related injury in industry may also apply to physical therapists. Increased risk of thumb symptoms associated with mobilization techniques suggests that further research is needed to establish recommendations for practice. The issues for therapists who move within or leave the profession are unknown, and further research is needed to better understand their needs and experiences.     

Imaging in conjunction with physical therapy in management of a patient with history of thoracic tumour

Abstract

Background:

Physical therapy care for musculoskeletal conditions includes an ongoing process that systematically considers and prioritises diagnostic hypotheses. These diagnostic hypotheses include those that are typical for common musculoskeletal conditions, and must also include more rare conditions that would require care outside the scope of practice of the physical therapist. When additional screening is required, physical therapists collaborate with other providers or directly order the appropriate tests to rule out suspected pathology.     

A survey of therapeutic ultrasound use by physical therapists who are orthopaedic certified specialists

BACKGROUND AND PURPOSE: For many years, ultrasound (US) has been a widely used and well-accepted physical therapy modality for the management of musculoskeletal conditions. However, there is a lack of scientific evidence on its effectiveness. This study examined the opinions of physical therapists with advanced competency in orthopedics about the use and perceived clinical importance of US in managing commonly encountered orthopedic impairments. SUBJECTS: Four hundred fifty-seven physical therapists who were orthopaedic certified specialists from the Northeast/Mid-Atlantic regions of the United States were invited to participate. METHODS: A 77-item survey instrument was developed. After face and content validity were established, the survey instrument was mailed to all subjects. Two hundred seven usable survey questionnaires were returned (response rate=45.3%). RESULTS: According to the surveys, the respondents indicated that they were likely to use US to decrease soft tissue inflammation (eg, tendinitis, bursitis) (83.6% of the respondents), increase tissue extensibility (70.9%), enhance scar tissue remodeling (68.8%), increase soft tissue healing (52.5%), decrease pain (49.3%), and decrease soft tissue swelling (eg, edema, joint effusion) (35.1%). The respondents used US to deliver medication (phonophoresis) for soft tissue inflammation (54.1%), pain management (22.2%), and soft tissue swelling (19.8%). The study provides summary data of the most frequently chosen machine parameters for duty cycle, intensity, and frequency. DISCUSSION AND CONCLUSION: Ultrasound continues to be a popular adjunctive modality in orthopedic physical therapy. These findings may help researchers prioritize needs for future research on the clinical effectiveness of US.     

Establishing recommendations for physical medicine and rehabilitation: the SOFMER methodology.

OBJECTIVE: The development of a rigorous methodology based on published results of clinical trials, evaluation of daily practice in France and multidisciplinary expert opinion to elaborate recommendations for rehabilitation interventions. METHODS AND RESULTS: The following describes the methodology of SOFMER (Société Fran?aise de Médecine Physique et de Réadaptation [French Society of Physical Medicine and Rehabilitation]) for developing recommendations for rehabilitation interventions. The test case was developing recommendations for rehabilitation in hip or knee osteoarthritis (OA) and hip or knee arthroplasty. Physicians in rehabilitation, orthopedic surgery and rheumatology identified, synthesized, and analyzed data from the literature by use of the usual French system of grading trials (the French Agency for Accreditation and Evaluation in Healthcare [ANAES] scale). The data were published results of comparative controlled studies such as randomized controlled trials, controlled clinical trials, cohort studies, case control studies, reviews of clinical trials, and case series, as well as uncontrolled cohort studies. The resulting recommendations were presented to the three annual French national congresses of rehabilitation, rheumatology, and orthopedic surgery for comment and for adapting to French professional practice. Finally, a panel of multidisciplinary experts (physicians in physical medicine and rehabilitation, rheumatologists, orthopedic surgeons, general practitioners, physical therapists, social workers, podologists, occupational therapists, nurses, and patients) validated the recommendations. CONCLUSION: The SOFMER methodology could be an interesting tool for use in developing recommendations elaborated by all the concerned medical and surgical specialists in the wide domain of rehabilitation.     

Cause, prevalence, and response to occupational musculoskeletal injuries reported by physical therapists and physical therapist assistants.

BACKGROUND AND PURPOSE: Physical therapists (PTs) and physical therapist assistants (PTAs) are susceptible to occupational musculoskeletal injuries. The purpose of this study was to examine the reported causes and prevalence of occupational musculoskeletal injuries to PTs and PTAs during a 2-year period. SUBJECTS: A questionnaire was mailed to 500 PTs and 500 PTAs randomly selected from the American Physical Therapy Association 1996 active membership list. Six hundred sixty-seven questionnaires were returned, giving a response rate of 67%. METHOD: Based on a literature review and a pilot study, an occupational injury questionnaire was constructed and mailed. Self-reports of injuries were obtained. RESULTS: Thirty-two percent of the PTs and 35% of the PTAs reported sustaining a musculoskeletal injury. The highest prevalence of injury was to the low back (62% of injured PTs and 56% of injured PTAs). The PTs reported the upper back and the wrist and hand as having the second highest prevalence (23%). The PTAs reported the upper back as having the second highest prevalence (28%). The PTs and PTAs reported making changes in their work habits of improved body mechanics, increased use of other personnel, and frequent change of work position. The majority of PTs and PTAs reported they did not limit patient contact time or area of practice after sustaining an injury. CONCLUSION AND DISCUSSION: Although PTs and PTAs are recognized to be knowledgeable in prevention and treatment of musculoskeletal injuries, they are susceptible to sustaining occupational musculoskeletal injuries because of performing labor-intensive tasks.     

Mandatory continuing education in physical therapy: survey of physical therapists in states with and states without a mandate

BACKGROUND AND PURPOSE: Although formal continuing education (CE) in physical therapy is one part of professional development, its value for renewing licensure is not shared by all states. The purpose of this study was to explore the differences in how physical therapists pursue formal continuing education on the basis of state mandate, sex, years of experience, practice specialty, American Physical Therapy Association membership, motivation, and perception of the benefits of CE. SUBJECTS AND METHODS: A survey questionnaire was sent to 3,000 physical therapists in 7 states--1,500 to physical therapists in states with mandatory CE and 1,500 to physical therapists in states without a requirement. A total of 1,145 usable survey questionnaires were returned, for a response rate of 38.2%. RESULTS: Physical therapists in states with mandatory CE averaged 33.8 hours of CE per year, whereas physical therapists in states without a mandate averaged 28.3 hours per year; 5.9% of therapists in states without a mandate reported taking no CE at all, and 10.8% reported taking 2 or fewer hours of CE within the preceding 5 years. No statistically significant relationships were observed between the amount of CE taken and years of experience, sex, or practice specialty. Therapists who reported membership in the American Physical Therapy Association participated in 7.2 more hours of CE per year than therapists who did not report membership. Significant motivational variables that respondents noted for taking CE were state mandate, increased clinical competence, and certification. Therapists overwhelmingly (96.2%) believed that CE had a beneficial effect on their clinical practice. DISCUSSION AND CONCLUSION: Results from this study suggest that mandatory CE does have a significant association with the number of formal CE hours taken by physical therapists.     

Accuracy and reliability of 'specialized' physical therapists in auscultating tape-recorded lung sounds

This study investigated the accuracy and inter-rater reliability of 'specialized' physical therapists in the auscultation of tape-recorded lung sounds. In addition, a correlation was investigated between accuracy of interpretation and the number of years of specialization in the field of cardiorespiratory physical therapy. This research follows an earlier study which investigated the accuracy and inter-rater reliability of auscultating tape-recorded lung sounds in a 'non-specialized' cohort of physical therapists. The subjects were 26 'specialized' cardiorespiratory physical therapists working in acute urban teaching hospitals. These individuals were required to have been practising currently and exclusively for at least one year in the area of cardiorespiratory physical therapy. Participants listened with a stethoscope to five different sounds and identified them from a standardized list of terms. One of three tapes with the same lung sounds in different order was randomly selected for each physical therapist. The percentage of correct answers for all subjects was calculated. An accurate response in the detection of lung sounds was arbitrarily defined as a percentage of correct answers of 70% or greater. The difference between the pooled correct response rate of 50% and the arbitrarily set value of 70% was statistically significant (z = 2.23, p < 0.05), indicating that the 'specialized' physical therapists were not accurate in identifying lung sounds. There was no relationship evident between the accuracy and the number of years of cardiorespiratory 'specialization' (r = 0.08). Analysis of inter-rater reliability revealed 'fair agreement' (kappa = 0.26) among subjects. These results were similar to those found in the previous study.(ABSTRACT TRUNCATED AT 250 WORDS)