Building the Science of Physical Therapy: Conundrums and a Wicked Problem.

Producing science that supports the physical therapist profession in all its endeavors is critical to ensure that the best evidence is used in practice and education. In this Perspective, numerous conundrums are discussed that can constrain efforts to be productive in research in the academic institutions that serve as the intellectual centers of the discipline. Taken together, these conundrums and the conditions that create them collectively contribute to the wicked problem of how to generate sufficient evidence to support the practice of physical therapy. In response, this Perspective recommends changes in the Standards and Elements of the Commission on Accreditation in Physical Therapy Education to support the importance of faculty research, reconfigure the rules for faculty composition, and introduce a new metric of productivity that reinforces the need of all programs to produce evidence for the profession, while still allowing flexibility and institutional prerogative to govern how this need is expressed.

Crises as the Crucible for Change in Physical Therapist Education.

This Perspective issues a challenge to physical therapists to reorient physical therapist education in ways that directly address the crises of COVID-19 and systemic racism. We advocate that professional education obligates us to embrace the role of trusteeship that demands working to meet society's needs by producing graduates who accept their social and moral responsibilities as agents and advocates who act to improve health and health care. To achieve this, we must adopt a curriculum philosophy of social reconstruction and think more deeply about the why and how of learning. Currently, health professions education places strong emphasis on habits of head (cognitive knowledge) and hand (clinical skills) and less focus on habits of heart (professional formation). We believe that habits of heart are the essential foundations of the humanistic practice needed to address health inequities, find the moral courage to change the status quo, and address imbalances of power, privilege, and access. A social reconstruction orientation in physical therapist education not only places habits of heart at the center of curricula, but it also requires intentional planning to create pathways into the profession for individuals from underrepresented groups. Adopting social reconstructionism begins with a faculty paradigm shift emphasizing the learning sciences, facilitating learning, metacognition, and development of a lifelong master adaptive learner. Achieving this vision depends not only on our ability to meet the physical therapy needs of persons with COVID-19 and its sequalae but also on our collective courage to address injustice and systemic racism. It is imperative that the physical therapy community find the moral courage to act quickly and boldly to transform DPT education in ways that enable graduates to address the social determinants of health and their systemic and structural causes that result in health disparities. To succeed in this transformation, we are inspired and strengthened by the example set by Geneva R. Johnson, who has never wavered in recognizing the power of physical therapy to meet the needs of society.

Exercise and cardiometabolic risk factors in graduate students: a longitudinal, observational study.

OBJECTIVE: To evaluate cardiometabolic risk of students longitudinally and compare them with age-matched national samples. PARTICIPANTS: Participants are 134 graduate students enrolled between August 2005 and May 2010. METHODS: Students were assessed at the beginning and end of their 3-year curriculum. Comparative samples included 966 National Health and Nutrition Examination Survey participants and 5,154 National College Health Assessment respondents. RESULTS: Most students had desirable weight, blood glucose, lipids, and fitness at both time points. However, 26.9% had elevated blood pressure, 29.9% performed aerobic exercise < 3 days/week, and 80.6% consumed < 5 fruits/vegetables daily. Relative to young adults nationwide, these students exhibited more favorable exercise patterns, dietary patterns, and cardiometabolic indices. Over time, increases in adiposity and decreases in exercise frequency correlated with adverse changes in lipid concentrations and fitness. CONCLUSIONS: Small changes in lifestyle behaviors and adiposity within a healthy cohort of young adults significantly influenced cardiometabolic indices during their graduate career.

Analysis of empathy in Doctor of Physical Therapy students: a multi-site study.

BACKGROUND: Empathy is a human emotion that is important in the effective provision of health care and amenable to change through explicit and implicit experiences in an individual's life. This study measured levels of empathy in students pursuing doctoral degrees in physical therapy and compared the influence of professional education at different institutions on these levels. METHODS: Our cross-sectional, two-cohort, multisite study used a modified version of the Jefferson Scale of Physician Empathy, Student Version, to investigate empathy levels at enrollment, mid-curriculum, and end-of-curriculum. Statistical tests of differences were performed between institutions, within institutions for each cohort across the three time points, and within institutions between cohorts. Data were analyzed using descriptive statistics, ANOVA, and the least squared difference test. Alpha was set at 0.05 for main test of difference and 0.04 for all post-hoc tests. RESULTS: For both cohorts, empathy levels differed significantly between institutions at program entry (Cohort 1, p=0.0150; Cohort 2, p=0.0273); within institutions the two cohorts were similar at the beginning of the first semester. In Cohort 1, no significant changes occurred within any institution; students at the two institutions with higher entering scores maintained their higher scores at the end of the last didactic semester. Students in Cohort 2 showed significant differences in empathy levels at the end of the last didactic semester within and between institutions (p=0.0251; p<0.0001). CONCLUSIONS: Empathy levels may differ at enrollment for PT students at different institutions even with similar recruitment approaches and no significant differences in student demographics between institutions. Despite uniform accreditation requirements for curriculum content, significant differences between institutions did exist in the last didactic semester in Cohort 2 but not Cohort 1. The direction and magnitude of such changes were not explained by institutional characteristics. This study challenges assumptions that measurements of empathy in students at one institution can be generalized to students at other institutions and that one cohort in the same institution can predict another cohort.

Exercise intervention for management of obesity.

Obesity touches the lives of most Americans regardless of age. In adults, accrual of co-morbidities, including frank disability, impacts health in ways that mandate aggressive public health action. In children, the rising prevalence of overweight and obesity raises serious prospective concerns for life as these children enter adulthood. Action is imperative to provide medical interventions and preventive strategies to reduce the threat this condition poses to future generations. Obesity primarily results from an energy regulation imbalance within the body; understanding its origin and effects requires considering both the intake (via eating) and output (via moving) of energy. This article focuses on how exercise and physical activity (i.e., energy output) can influence the primary condition of obesity and its health sequelae. Components, strategies, and expected outcomes of exercise and lifestyle activity are addressed. Successful long-term participation in daily movement requires matching exercise regimens and physical activity outlets to individual preferences and environmental conditions. Activity habits of Americans must change at home and in the workplace, schools and the community to positively influence health. Although the goals of Healthy People 2010 to reduce sedentary behavior have not been met, success of other public health interventions (e.g., immunizations, use of bicycle helmets) suggests that social change to alter activity habits can be achieved. Failure to reach our public health goals should serve as a catalyst for broad-based action to help children, adolescents, and adults attain and maintain behaviors that reduce the risk of obesity and its health insults.

Physical therapy in the emergency department: development of a novel practice venue.

BACKGROUND AND PURPOSE: The American Physical Therapy Association's Vision 2020 advocates that physical therapists be integral members of health care teams responsible for diagnosing and managing movement and functional disorders. This report details the design and early implementation of a physical therapist service in the emergency department (ED) of a large, urban hospital and presents recommendations for assessing the effectiveness of physical therapists in this setting. CASE DESCRIPTION: Emergency departments serve multiple purposes in the American health care system, including care of patients with non-life-threatening illnesses. Physical therapists have expertise in screening for problems that are not amenable to physical therapy and in addressing a wide range of acute and chronic musculoskeletal pain problems. This expertise invites inclusion into the culture of ED practice. This administrative case report describes planning and early implementation of a physical therapist practice in an ED, shares preliminary outcomes, and provides suggestions for expansion and effectiveness testing of practice in this novel venue. OUTCOMES: Referrals have increased and length of stay has decreased for patients receiving physical therapy. Preliminary surveys suggest high patient and practitioner satisfaction with physical therapy services. Outpatient physical therapy follow-up options were developed. Educating ED personnel to triage patients who show deficits in pain and functional mobility to physical therapy has challenged the usual culture of ED processes. DISCUSSION: Practice in the hospital ED enables physical therapists to fully use their knowledge, diagnostic skills, and ability to manage acute pain and musculoskeletal injury. Recommendations for future action are made to encourage more institutions across the country to incorporate physical therapy in EDs to enhance the process and outcome of nonemergent care.

Worksite Opportunities for Wellness (WOW): effects on cardiovascular disease risk factors after 1 year.

OBJECTIVE: To evaluate the effectiveness of a worksite health promotion program on improving cardiovascular disease risk factors. METHODS: In St Louis, Missouri from 2005 to 2006, 151 employees (134 F, 17 M, 81% overweight/obese) participated in a cohort-randomized trial comparing assessments + intervention (worksite A) with assessments only (worksite B) for 1 year. All participants received personal health reports containing their assessment results. The intervention was designed to promote physical activity and favorable dietary patterns using pedometers, healthy snack cart, WeightWatchers(R) meetings, group exercise classes, seminars, team competitions, and participation rewards. Outcomes included BMI, body composition, blood pressure, fitness, lipids, and Framingham 10-year coronary heart disease risk. RESULTS: 123 participants, aged 45+/-9 yr, with BMI 32.9+/-8.8 kg/m(2) completed 1 year. Improvements (P< or =0.05) were observed at both worksites for fitness, blood pressure, and total-, HDL-, and LDL-cholesterol. Additional improvements occurred at worksite A in BMI, fat mass, Framingham risk score, and prevalence of the metabolic syndrome; only the changes in BMI and fat mass were different between worksites. CONCLUSION: A multi-faceted worksite intervention promoted favorable changes in cardiovascular disease risk factors, but many of the improvements were achieved with worksite health assessments and personalized health reports in the absence of an intervention.

Changes in weight and health behaviors from freshman through senior year of college.

OBJECTIVE: To assess weight changes, exercise and diet behaviors among college students from the beginning of freshman year until the end of senior year. DESIGN: Longitudinal observational study. SETTING: Private university in St. Louis, Missouri. PARTICIPANTS: College students (138 females, 66 males). MAIN OUTCOME MEASURES: Weight and height were measured, body mass index (BMI) was calculated, and exercise and dietary behaviors were assessed by questionnaire. ANALYSIS: Changes in weight, BMI, exercise, and dietary patterns from the beginning of freshman year to the end of senior year. RESULTS: Females gained 1.7 +/- 4.5 kg (3.75 +/- 9.92 lb) [mean +/- SD] from freshman to senior year, and males gained 4.2 +/- 6.4 kg (9.26 +/- 14.11 lb) (both P < .001). Weight changes were highly variable between students, however, ranging from -13.2 kg to +20.9 kg (-29.10 to +46.08 lb). CONCLUSIONS AND IMPLICATIONS: Weight gain was common but variable among college students. Importantly, exercise and dietary patterns did not meet the recommended guidelines for many college students, which may have long-term health implications.

Weight changes, exercise, and dietary patterns during freshman and sophomore years of college.

Weight gain and behavioral patterns during college may contribute to overweight and obesity in adulthood. The aims of this study were to assess weight, exercise, and dietary patterns of 764 college students (53% women, 47% men) during freshman and sophomore years. Students had their weight and height measured and completed questionnaires about their recent exercise and dietary patterns. At the beginning of freshman year, 29% of students reported not exercising, 70% ate fewer than 5 fruits and vegetables daily, and more than 50% ate fried or high-fat fast foods at least 3 times during the previous week. By the end of their sophomore year, 70% of the 290 students who were reassessed had gained weight (4.1+/-3.6 kg, p < .001), but there was no apparent association with exercise or dietary patterns. Future research is needed to assess the contributions of fat, muscle, and bone mass to observed weight gain and to determine the health implications of these findings.