ABSTRACT
Entrustable professional activities have emerged as a means for the evaluation of resident competency that is expressed in terms of the assessed need for supervision. Recently, 19 physical medicine and rehabilitation-specific entrustable professional activities were published (Am J Phys Med Rehabil. 2017;96:762-764). The electrodiagnostic entrustable professional activity and six new electrodiagnostic entrustable professional activities subcategories (observable practice activities) were piloted as an entrustable professional activities/observable practice activities set within five residency programs. Survey-based (quantitative) and open-ended (qualitative) feedback was collected from participants. Participating attendings found this method feasible and generally reported satisfaction with the entrustable professional activities/observable practice activities as a means of providing feedback to residents. Residents were less clear on the added value of this approach. Qualitative data supported the need for adjustments to the entrustment scale to allow for more gradations within supervisory levels, a standardized orientation of residents to the use of observable practice activities and an increased quantity of assessments for each observable practice activities category to allow for demonstration of resident progress toward independence. Use of the electrodiagnostic entrustable professional activity/observable practice activities set shows promise as a means for observational competency assessment in the outpatient setting. However, feedback acquired through this pilot study suggests changes that could be made to improve future implementation.
Subject(s)
Clinical Competence/statistics & numerical data , Competency-Based Education/methods , Educational Measurement/methods , Internship and Residency/methods , Physical and Rehabilitation Medicine/education , Adult , Feasibility Studies , Female , Humans , Male , Pilot Projects , United StatesABSTRACT
PURPOSE: To understand the relationship of walking speed to self-reported pain, fatigue, and physical function in adults with CP. METHODS: Design: Cross-sectional study. SETTING: Accredited clinical motion analysis laboratory in a regional children's hospital. PARTICIPANTS: 72 ambulatory patients ⩾ 18 years of age, diagnosed with CP, who previously had ⩾ 1 prior instrumented gait analysis at our facility. MAIN OUTCOME MEASURES: PROMIS-57 pain interference/intensity, physical function, and fatigue measures and walking speed. RESULTS: Physical function was significantly lower than able-bodied normal values by 1-2 standard deviations (40.3 ± 8.5). Pain interference (51.4 ± 9.0) and fatigue (50.2 ± 9.2) were not significantly different when compared to able-bodied normal values. Only physical function was statistically correlated with walking speed (p< 0.001), while pain interference (p= 0.39), pain intensity (p= 0.36), and fatigue (p= 0.75) were not. Pain interference, pain intensity, and fatigue were not statistically significant factors in the multiple regression of walking speed. Fatigue could significantly predict physical function, pain interference, and pain scores (p= 0.032, p< 0.001, p< 0.01, respectively), however, fatigue did not directly predict walking speed (p= 0.747). CONCLUSIONS: Self-reported physical function correlates with objectively measured walking speed in young adults with CP while patient-reported pain and fatigue did not, contrary to what would be predicted by the literature.
Subject(s)
Cerebral Palsy/physiopathology , Motor Skills , Walking/physiology , Adolescent , Adult , Cross-Sectional Studies , Fatigue/etiology , Fatigue/physiopathology , Female , Humans , Male , Middle Aged , Motor Skills/physiology , Self Report , Young AdultABSTRACT
UNLABELLED: This focused review highlights important issues in the care of persons who are aging with a disability. It is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on significant medical and rehabilitation issues pertinent to persons with cerebral palsy, spina bifida, postpoliomyelitis syndrome, and selected other neurologic and neuromuscular diseases. In addition to normal physiologic aging, people with these conditions often experience secondary complications and accelerated impairments because of aging itself. These complications are described, and monitoring strategies and treatment are recommended. OVERALL ARTICLE OBJECTIVE: To summarize issues in the care of persons aging with a disability.
