Telerehabilitation Use With Spinal Cord Injury: Occupational Therapists' Perspective.

IMPORTANCE: Telerehabilitation provides people with spinal cord injury (SCI) an alternative mode of accessing specialized health care. Further research on occupational therapy practitioners' perspectives of telerehabilitation may provide additional evidence for clinical practice implementation. OBJECTIVE: To explore urban occupational therapists' perspectives on the benefits of and barriers to telerehabilitation use with SCI. DESIGN: A qualitative study design using a demographic questionnaire and a single, individual semistructured interview. Thematic analyses included member checking, constant comparative analysis, triangulation, and self-description and self-reflexivity. SETTING: Residential and community settings. PARTICIPANTS: Six occupational therapists with a range of experience in SCI rehabilitation were recruited using purposeful sampling. RESULTS: Six participants were interviewed, and four primary themes emerged: (1) communication, (2) personal factors, (3) benefits, and (4) barriers. CONCLUSIONS AND RELEVANCE: Telerehabilitation offers numerous potential benefits for SCI intervention. This study provides an understanding of practitioner concerns and potential barriers to use. The results indicate that a hybrid model incorporating both in-person and distance-based treatment is likely optimal. What This Article Adds: Our results provide information that addresses practitioner concerns and recommendations for the use of telerehabilitation with people with SCI. As practitioner concerns are identified and addressed, telerehabilitation may increase in the U.S. health care system, potentially facilitating an alternative treatment delivery method for underserved populations.

Instrument-Assisted Soft-Tissue Mobilization for the Management of Chronic Plantar Heel Pain: A Pilot Study.

BACKGROUND: The purpose of this study was to determine feasibility of further investigation of treatment with instrument-assisted soft-tissue mobilization (IASTM), using the Graston technique, compared with conservative care for treatment of chronic plantar heel pain (CPHP). METHODS: Eleven participants with plantar heel pain lasting 6 weeks to 1 year were randomly assigned to one of two groups, with each group receiving up to eight physical therapy visits. Both groups received the same stretching, exercise, and home program, but the experimental group also received IASTM using the Graston technique. Outcome measures of pain and function were recorded at baseline, after final treatment, and 90 days later. Feasibility of a larger study was determined considering recruitment and retention rates, compliance, successful application of the protocol and estimates of the treatment effect. RESULTS: Both groups demonstrated improvements in current pain (pain at time of survey), pain with the first step in the morning, and function after final treatment and at 90-day follow up. Medium-to-large effect sizes between groups were noted, and sample size estimates demonstrated a need for at least 42 participants to realize a group difference. A larger-scale study was determined to be feasible with modifications including a larger sample size and higher recruitment rate. CONCLUSIONS: This pilot study demonstrates that inclusion of IASTM using the Graston technique for CPHP lasting longer than 6 weeks is a feasible intervention warranting further study. Clinically important changes in the IASTM group and moderate-to-large between-group effect sizes suggest that further research is warranted to determine whether these trends are meaningful.

Physician Impressions of Physical Therapist Practice in the Emergency Department: Descriptive, Comparative Analysis Over Time.

BACKGROUND: Emergency department (ED) use in the United States is expected to rapidly increase. Nearly half of all ED visits are classified as semiurgent or nonurgent, and many fall into the musculoskeletal category. Despite growing international evidence that patients are appropriately and safely managed by ED physical therapists in a time-efficient manner, physical therapist practice in EDs is not widely understood or utilized in the United States. To date, no studies have reported the impressions of ED physicians about this practice. OBJECTIVES: The purposes of this study were: (1) to assess ED physicians' impressions of ED physical therapist practice 2 years after practice was initiated and (2) to determine whether physicians' impressions changed 7 years later. METHODS: All ED staff physicians and medical residents at a level I trauma hospital were invited to complete a survey in 2004 and 2011. RESULTS: In both years, a majority of physicians reported favorable impressions of ED physical therapist practice. Physical therapists were valued for educating patients about safety and injury prevention, providing appropriate gait training, assisting with disposition planning, and providing interventions as alternatives to pain medication. Many physicians supported standing physical therapist orders for certain musculoskeletal conditions. The most common concern was the additional time that patients spend in the ED for a physical therapist consult. LIMITATIONS: The results of this study may not reflect the impressions of physicians in all EDs that employ physical therapists. CONCLUSIONS: Emergency department physicians reported favorable impressions of ED physical therapist practice 2 years and 9 years following its implementation in this hospital. This study showed that ED physicians support standing physical therapist orders for certain musculoskeletal conditions, which suggests that direct triage to ED physical therapists for these conditions could be considered.

A Preliminary Exploration of the Effects of a 6-week Interactive Video Dance Exercise Program in an Adult Population.

PURPOSE: The purpose of this study was to determine the effects of a 6-week interactive video dance game (IVDG) program on adult participants' cardiorespiratory status and body mass index (BMI). METHODS: Twenty-seven healthy adult participants attended IVDG sessions over a 6-week period. Participants completed pre- and post-testing consisting of a submaximal VO(2) treadmill test, assessment of resting heart rate (RHR) and blood pressure (BP), BMI, and general health questionnaires. Data were analyzed using descriptives, paired t-tests to assess pre-to post-testing differences, and one-way ANOVAs to analyze variables among select groups of participants. Questionnaire data was manually coded and assessed. RESULTS: Twenty participants attended at least 75% of available sessions and were used in data analysis. Mean BMI decreased significantly (from 26.96 kg/m(2) to 26.21 kg/m(2); 2.87%) and cardiorespiratory fitness measured by peak VO(2) increased significantly (from 20.63 ml/kg/min to 21.69 ml/kg/min; 5.14%). Most participants reported that the IVDG program was a good workout, and that they were encouraged to continue or start an exercise routine. Forty percent reported improvements in sleep, and nearly half stated they had or were considering purchasing a home version of a video dance game. CONCLUSIONS: Interactive video dance game is an effective and enjoyable exercise program for adults who wish to decrease their BMI and improve components of cardiorespiratory fitness.

The influence of a topic-specific, research-based presentation on physical therapists' beliefs and practices regarding evidence-based practice.

BACKGROUND/PURPOSE: Evidence-based practice (EBP) is an important objective as physical therapists strive for autonomous practice. The most commonly identified barrier to EBP is clinicians' lack of time. Purposes of this study were to determine (1) clinicians' opinions of EBP; (2) whether EBP presentations would influence clinicians' beliefs and practices; and (3) if additional barriers would be identified. METHODS: Twenty-four physical therapists, representing four clinical settings, participated. Each facility selected one presentation topic. Presenations were prepared, then given at each facility. Data were collected from three surveys. RESULTS: The majority of participants agreed that EBP is an essential component of practice. Most reported a willingness to change their practice to be more aligned with research. The top three barriers identified were lack of time, access to publications, and research in specific areas. Most reported gaining new information and integration of the material. CONCLUSIONS: EBP is considered essential by most clinicians, but lack of time is consistently identified as a primary barrier. Clinicians found it helpful to have EB information presented to them. Many would welcome additional presentations. Clinicians may increase their use of EBP if the barrier "lack of time" is lessened by locating, synthesizing, and presenting this information to them.

Differential diagnosis and treatment in a patient with posterior upper thoracic pain.

BACKGROUND AND PURPOSE: Determining the source of a patient's pain in the upper thoracic region can be difficult. Costovertebral (CV) and costotransverse (CT) joint hypomobility and active trigger points (TrPs) are possible sources of upper thoracic pain. This case report describes the clinical decision-making process for a patient with posterior upper thoracic pain. CASE DESCRIPTION: The patient had a 4-month history of pain; limited cervical, trunk, and shoulder active range of motion; limited and painful mobility of the right CV/CT joints of ribs 3 through 6; and periscapular TrPs. Interventions included CV/CT joint mobilizations, TrP release, and flexibility and postural exercises. OUTCOMES: The patient reported intermittent mild discomfort after 7 physical therapy sessions. Examination findings were normal, and he was able to resume all preinjury activities. DISCUSSION: This case suggests that CV/CT mobilizations and active TrP release may have been beneficial in reducing pain and restoring function in this patient.