Measuring Clinical Decision-Making and Clinical Skills in DPT Students Across a Curriculum: Validating A New Survey Tool.

BACKGROUND: Healthcare is a fast-paced, dynamic atmosphere. Clinical decision-making and clinical skills have been identified as necessary skills for autonomous practitioners in physical therapy. However, there are limited tools to measure these skills, which are cumbersome to implement and not validated. PURPOSE: To validate a survey tool across three cohorts of DPT students and one cohort of physical therapy interns. DESIGN: A cross-sectional, descriptive study. METHODS: A 25-item survey tool was used to measure clinical decision-making and clinical skills. The survey tool was sent and data collected online via REDCap (Research Electronic Data Capture). RESULTS: The survey response rates were between 19% and 47%. The Cronbach's alpha was ≥0.964 across domains and the total scale. Mann-Whitney U-tests demonstrated significant differences between all cohorts except between the second- and third-year students. The interns demonstrated less variance in their answers than students earlier in the curriculum. CONCLUSIONS: The survey demonstrated excellent internal consistency and construct and face validity. The psychometric properties of the tool and the possibility of a ceiling effect need to be studied further.

The effect of therapeutic exercise and mobilization on patients with shoulder dysfunction : a systematic review with meta-analysis.

STUDY DESIGN: Systematic review with meta-analysis. OBJECTIVE: To pool and summarize the published research evidence examining if the combination of therapeutic exercise and joint mobilization is more beneficial than therapeutic exercise alone in patients with shoulder dysfunction. BACKGROUND: Therapeutic exercise is an effective intervention for patients with shoulder dysfunction, which is often supplemented by joint mobilization techniques. Numerous studies have examined the effects of the combination of therapeutic exercise and joint mobilization on patients with shoulder dysfunction. METHODS: Six databases were searched for randomized controlled trials. All the randomized controlled trials published in English that have studied the effectiveness of therapeutic exercise and joint mobilization on adults with either clinically or radiographically confirmed shoulder dysfunction resulting in pain, restriction of range of motion (ROM), and/or limitation in function, were included in this review. Effect size was calculated in the form of standardized mean difference and 95% confidence interval (CI) for each variable, then combined to represent weighted standardized mean differences (WSMDs) and 95% CIs. RESULTS: Seven studies that met the inclusion criteria were identified, with a total of 290 participants. The WSMDs and CIs, which combined the results of all the studies for a particular variable, revealed equivocal results for all variables. The resulting WSMD (95% CI) for each of the variables was 0.2 (-0.68, 1.08) for pain, 0.15 (-0.67, 0.97) for abduction ROM, -0.04 (-0.65, 0.57) for flexion ROM, 0.01(-0.79, 0.81) for internal and external rotation ROM, and 0.09 (-0.46, 0.64) for function and disability. Even after elimination of sources of heterogeneity, the new WSMDs and CIs continued to overlap zero, giving equivocal results. CONCLUSION: The current evidence is inconclusive with respect to the beneficial effects of the combination of therapeutic exercise and joint mobilization versus therapeutic exercise alone for reducing pain, increasing ROM and function, and limiting disability in patients with shoulder dysfunction. LEVEL OF EVIDENCE: Therapy, level 1a-.