Population-Based Practice in Occupational Therapy.

As occupational therapists develop their roles in promoting the health of populations, it is important to understand the nature of population-based practice. Seventeen occupational therapists engaged in population-based practice participated in semi-structured interviews that explored major aspects of their practice. Qualitative descriptive analysis was used to summarize results. The population-based practice of participants was primarily at the community level and focused on health teaching and coaching, and collaboration and consultation. Four topic areas within population-based practice were identified (with respective themes): characteristics (bigger impact, respond to specific needs of communities, and emphasize prevention), preparation (community engagement within occupational therapy education, education beyond occupational therapy, and networking and leadership experiences), challenges (difficulty obtaining funding, resistance, and time consuming), and benefits (doing more within the scope of practice, and positive client impact). These themes can inform the work of occupational therapists engaged in population-based practice.

Characteristics of Population-Based Practice in Physical Therapy.

OBJECTIVE: Physical therapy is placing new emphasis on how the profession might contribute to improving population health. However, little is known about the nature of population-based practice (PBP) of physical therapists. Therefore, the purpose of this study was to develop a view of PBP from the perspective of physical therapists engaged in it. METHODS: Twenty-one physical therapists participating in PBP were interviewed. Qualitative descriptive analysis was used to summarize results. RESULTS: Most of the reported PBP was at the community and individual level, and the most common types of PBP were health teaching and coaching, collaboration and consultation, and screening and outreach. Three topic areas were identified (with respective themes): characteristics of PBP (meeting group or community needs, promotion and prevention, access, and movement), preparation for PBP (core vs elective, experiential learning, social determinants of health, and health behavior change), and rewards and challenges of PBP (intrinsic rewards, funding and resources, professional recognition, and complexity of behavior change). CONCLUSION: PBP in physical therapy presents practitioners with rewards and challenges as they work to improve the health of populations. IMPACT: Physical therapists who are currently engaged in PBP are, in effect, defining the role of the profession in improving health at a population level. The information in this paper will help the profession move from a theoretical view of the role of physical therapists in improving population health to understanding what this role looks like in practice.

Population Health Content in Entry-Level Occupational Therapy Programs.

IMPORTANCE: If occupational therapy is to play an important role in improving population health, it is important to understand how academic programs are preparing new occupational therapists for this role. OBJECTIVE: To determine current and desired coverage of population health concepts in entry-level occupational therapy programs. DESIGN: Online survey administered to occupational therapy program directors. SETTING: Higher education institutions. PARTICIPANTS: Survey invitations were sent to all 182 entry-level occupational therapy program directors in Spring 2018. MEASURES: Questionnaire responses were used to calculate current and desired curriculum coverage of 23 population health domains. RESULTS: Of 182 program directors, 60 (33.0%) responded. Respondents agreed that 21 of 23 population health domains should be included in entry-level occupational therapy programs, and 11 of the domains had moderate or better coverage in their current programs. The largest gaps between current and desired coverage were found in global health issues, population health informatics, environmental health, and organization of health systems. CONCLUSIONS AND RELEVANCE: Occupational therapy faculty can use these results to further develop the population health content of their programs. WHAT THIS ARTICLE ADDS: Although the occupational therapy profession advocates for the role of occupational therapists in the improvement of population health, little information is available about how to prepare new occupational therapists for this role. This study addresses this gap by presenting occupational therapy program directors' assessments of current and desired levels of population health content within their programs.

Beyond the individual: population health and physical therapy.

Improving the health of populations is critical to meeting global health targets. The purpose of this article is to define population health and differentiate it from related concepts and introduce a framework that can be used to inform the population-based practice of physical therapists. The Population-Based Practice (PBP) Framework is modified from the Public Health Nursing Intervention Wheel and can be used to understand levels (i.e., systems, community, and individual) and types (i.e., screening and outreach, referral and follow-up, health teaching and coaching, consultation and collaboration, advocacy and policy development, and social marketing) of population-based practice. Several physical therapy examples illustrate selected cells within the model. The PBP Framework provides practitioners, educators, and scholars with a new way to envision population-based practice for physical therapists. Such a shift in both thinking and practice is needed if physical therapists are to use their unique skills to move beyond the individual, embracing population-based practice to improve health outcomes and reduce health disparities while controlling costs.

Exploring aftercare programs following outpatient musculoskeletal physical therapy: a case series report.

Aftercare programs allow patients to continue to exercise with supervision following discharge from physical therapy. Although not yet widespread in clinical practice, aftercare programs represent a growing trend following outpatient physical therapy settings in the United States. The purpose of this study was to explore and describe the characteristics, implementation, and impact of contemporary aftercare programs in a selected sample of outpatient physical therapy settings. A purposeful sample of three aftercare program and four clients were interviewed to provide the descriptive data for this study. Each client was also later interviewed at 3-4 months and again at 6 months. A general health outcomes measurement tool (SF-36) and musculoskeletal regional outcomes tools also were used to measure health status and function. Directors of the three programs cited similar rationales for starting their aftercare programs. However, specific features and goals of the three aftercare programs varied, as did utilization and participation. Clients were generally pleased with their aftercare involvement, and they demonstrated clinically important improvements on outcome measures of function and health-related quality of life in addition to subjective reports of satisfaction. Aftercare programs are an emerging clinical trend following physical therapy, and this study provides an initial description of the development, implementation, and effectiveness of such programs. Future study should investigate a greater variety of aftercare settings and larger samples of participants and should also further examine how well aftercare programs promote health and wellness.

Documentation of red flags by physical therapists for patients with low back pain.

The comprehensiveness of physical therapists' adherence to the guidelines for red flag documentation for patients with low back pain has not previously been described. Therefore, the purpose of this study was to describe that comprehensiveness. Red flags are warning signs that suggest that physician referral may be warranted. Clinic charts for 160 patients with low back pain seen at 6 outpatient physical therapy clinics were retrospectively reviewed, noting the presence or absence of 11 red flag items. Seven of the 11 red flag items were documented over 98% of the time. Most charts (96.3%) had at least 64% of the red flag items documented. Documentation of red flags was comprehensive in some areas but lacking in others. Red flags that were regularly documented included age over 50, bladder dysfunction, history of cancer, immune suppression, night pain, history of trauma, saddle anesthesia, and lower extremity neurological deficit. The red flags not regularly documented included weight loss, recent infection, and fever/chills. Factors influencing item documentation comprehensiveness are discussed, and suggestions are provided to enhance the completeness of recording patient examination data. The study results provide a red flag documentation benchmark for clinicians working with patients with low back pain and they lay the groundwork for future research.

Physical and functional measures related to low back pain in individuals with lower-limb amputation: an exploratory pilot study.

For this study, we compared the physical impairments and functional deficits of individuals with lower-limb amputation (LLA) for those with and without low back pain (LBP). Nineteen participants with LLA were placed into two groups based on visual analog scores of LBP. We assessed functional limitations, iliopsoas length, hamstring length, abdominal strength, back extensor strength, and back extensor endurance. Data analysis included correlations and t-tests. We found significant correlations between pain score and functional limitations, iliopsoas length, and back extensor endurance. We also detected significant differences in functional limitations, iliopsoas length, back extensor strength, and back extensor endurance between those with and without LBP. We saw significant differences in back extensor strength and back extensor endurance between those with transtibial and transfemoral amputations. Differences exist in physical measures of individuals with LLA with and without LBP. Clinicians should consider these impairments in individuals with amputation who experience LBP. Because of the participants' characteristics, these findings may be applicable to veterans with LLA.

Ambulatory activity in men with diabetes: relationship between self-reported and real-world performance-based measures.

The measurement of physical activity, especially walking activity, is important for many outcome studies. In many investigations, the Physical Activity scale of the short-form-36 (SF-36) health assessment questionnaire is used in lieu of an actual physical measurement of walking. This study determined the relationship between the SF-36 questionnaire and the Step Activity Monitor (SAM), a real-world performance-based tool that counts the actual number of steps taken during daily activities. We studied the physical activity of 57 men with diabetes using step count monitoring and the SF-36 questionnaire. The subjects averaged 3,293 steps/day, but had a very wide range (111-11,654) and a large standard deviation (SD = 2,037). The correlations between total daily steps and the SF-36 Physical Component Summary score, and the Physical Function, Bodily Pain, and Vitality scales of the SF-36 were only fair (Pearson's r = 0.376, 0.488, 0.332, 0.380, respectively). The corresponding coefficients of determination range from only 7.7% to 23.8%. Physical activity is a complex concept not completely represented by either the SF-36 or the step counts. The correlation between actual walking activity and the SF-36 is not as strong as many researchers believe. Caution should be exercised with the use of the SF-36 to specifically measure walking activity.