COVID-19 Lessons From The Field: Toward A Pediatric Physical Therapy Telehealth Framework.

Introduction: Telehealth is an established health service delivery method, yet little is known regarding pediatric physical therapy telehealth. We aimed to evaluate users' experiences and create a framework for effective delivery. Methods: A pediatric physical therapists' telehealth user survey was conducted. Results: Seventy-three respondents varied in years of experience and caseload. Most found telehealth easy to learn and use, and they believed the treatment they delivered was useful. Three main themes for successful treatments emerged and were organized into a framework for effective delivery: (1) caregivers' involvement; (2) therapist telehealth 'toolbox' (sub-divided into: treatment management tools, and therapist-caregivers' collaboration tools); and (3) telehealth client (child) characteristics. Conclusion: This study suggests a new framework for effective pediatric physical therapy telehealth delivery to support best practice, for use by administrators and therapists, and recommends directions for further research.

Burnout and intent-to-leave in physical therapists: a preliminary analysis of factors under organizational control.

METHODS: Twelve hundred PTs were sent a survey packet including the 20-item Ethics Environment Questionnaire (EEQ) and additional items inquiring about contemporary practice factors. Returned packets (n = 340) were analyzed utilizing correlational and regression analyses to determine relationships between ethical environment, burnout, intent-to-leave, productivity standards, billing and coding requirements and ability to provide pro-bono services. RESULTS: There was a strong correlation between PTs' view of organizational ethics and burnout (Tb = -0.55), and a moderate correlation between organizational ethics and intent-to-leave (Tb = -0.43). There was also a strong relationship between burnout/intent-to-leave and practice factors such as productivity standards, billing/coding policy, and organizational provision of pro-bono services (p ≤ 0.01). Finally, there was a moderate correlation between PTs' view of organizational ethics and practice factors such as productivity standards (Tb = 0.46) and billing and coding policy (Tb = -0.45). CONCLUSIONS: Contemporary practice factors such as productivity standards and billing/coding practices are related PT's perception of ethical workplace environment and both are related to PT burnout and intent-to-leave. Factors identified in this study related to burnout are all under organizational control.

Case Report: Stem cell therapy in amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease leading to loss of upper and lower motor neurons at both spinal and bulbar levels.   For patients with ALS rehabilitation is important to maintain functional independence, ensure safety and optimize quality of life but is not curative. Stem cell therapy (SCT) provides a new approach to treat previously incurable diseases although peer reviewed published evidence has shown no benefit in ALS for slowing disease progression or functional loss.   This case report presents a patient with ALS who underwent SCT but deteriorated rapidly after the procedure. Whether the deterioration was due to the natural progress of the disease or expedited by SCT remains unknown. The ethical considerations of how marketing influences healthcare and individuals' decisions in desperate situations along with reasons for taking desperate measures are discussed.  Patient education and open communication with ALS patients are imperative in gaining patient satisfaction and overcoming ill effects that marketing could have on unconventional methods of intervention. Raising awareness about the availability and access to multidisciplinary care, the timing of decisions with regards to symptom management and end of life care have proven to enhance the quality of life for such patients.

What Factors Predict Falls in Older Adults Living in Nursing Homes: A Pilot Study.

BACKGROUND: In community-dwelling older adults, slow gait speed is linked to falls; however, little is known about the use of gait speed to predict falls in nursing home residents. The prevalence of risk factors for falls in nursing home residents is multifactorial. OBJECTIVE: The purpose of this study was to examine the relationship between falls and multiple factors such as age, sex, gait speed, mobility device, fear of falling, cognitive function, medication, and environmental causes in a nursing home setting. MATERIAL AND METHODS: Participants were recruited from a nursing home. Independent variables such as age, sex, gait speed for 40 feet, use of a mobility device, fear of falls, cognitive function, medication, and environmental causes of falls were measured and recorded. The dependent variable was falls. Participants were followed-up for a period of six months for falls. Falls were documented from the computerized medical records at the facility. RESULTS: Five of the 16 participants had falls in the follow-up period. Exact logistic regression, bivariate analysis, showed no significant relationship between falls and the independent variables of age, sex, gait speed, mobility device, fear of falls, cognitive function, and medication. More than 30% of recorded falls had an environmental cause, which was significant at p = 0.0005. CONCLUSION: Environmental causes had a significant relationship with falls in nursing home participants. Environment hazard monitoring is therefore important to ensure the safety of nursing home residents.

Proprioception retraining for a patient with chronic wrist pain secondary to ligament injury with no structural instability.

STUDY DESIGN: Case report. INTRODUCTION: Previously published studies demonstrate the importance of the sensory innervation of the carpal ligaments and the implication for the sensorimotor control of the wrist. In addition, this case considers key rehabilitation concepts to include the dart-throwing motion and the stabilizing effect of the forearm muscles. PURPOSE OF THE STUDY: To describe the rehabilitation program for a patient with chronic wrist pain, diagnosed with a partial tear of the dorsal intercarpal ligament and a sprain of the scapholunate ligament of the right wrist. METHODS: The patient participated in a staged treatment plan over a 3-month period (20 sessions), which began with a focus on proprioceptive awareness and joint position sense retraining. The treatment progressed to strengthening of specific muscles to enhance stability of the wrist joint. The patient completed the Quick Disabilities of the Arm, Shoulder and Hand and the patient-rated wrist evaluation on initial evaluation, re-evaluation at ninth session, and discharge at 20th session. RESULTS: Raw scores in the Quick Disabilities of the Arm, Shoulder and Hand and the patient-rated wrist evaluation improved from 33 and 61.5 on initial evaluation to 18 and 17.5 on discharge, respectively. CONCLUSIONS: Sensorimotor techniques including proprioceptive retraining may improve pain, neuromuscular control, and functional outcomes in patients with chronic wrist pain due to ligament injury. The effectiveness of proprioceptive retraining needs to be evaluated in a well-designed randomized controlled trial recruiting this patient population. LEVEL OF EVIDENCE: 5.